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Nicole De Cuir, Maria Anna Mavrommatis, Juan Reynaud, C Gustavo De Moraes, Daiyan Xin, Rashmi Rajshekhar, Jeffrey M Liebmann, Robert Ritch, Brad Fortune, Donald Charles Hood; Paravascular defects and epiretinal membranes are seen on en-face slab OCT images in eyes with early glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):862.
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© ARVO (1962-2015); The Authors (2016-present)
Mechanical disruptions of the retinal nerve fiber layer (dRNFL) are easy to see with en-face slab analysis of optical coherence tomography (OCT) scans.[1,2] Here we examine the prevalence of dRNFL, specifically paravascular defects (PD) [1,3] and macular epiretinal membranes (ERM), in eyes categorized as mild glaucoma or glaucoma suspect.
126 eyes of 126 patients (57.15 +/- 13.6 yrs) had abnormal or suspicious looking discs based upon stereo photographs, a mean deviation (MD) of better than -6dB on the 24-2 VF, and a spherical refractive error between +/-6D. Eyes were classified by 2 glaucoma specialists using 24-2 and 10-2VFs, disc stereo photographs, a custom inner retina report consisting of retinal nerve fiber and retinal ganglion cell layer thickness and probability plots superimposed with information, and information from the patient's chart as requested. Of the 126 eyes, 71 eyes were classified as glaucomatous, 51 as suspects, and 4 as undecided, which were excluded. 68 eyes from 49 healthy individuals served as controls (55.6 +/- 9.6 yrs). All eyes had wide-field, swept-source OCT cube scans (9x 12 mm, 256 b-scans, 512 a-scans; DRI-OCT, Topcon, Inc). Using special purpose software (ATL 3D-Suite), en-face slabs were generated, as previously described. Two graders, masked as to eye classification, identified ERMs with separation from the internal limiting membrane and PDs on the en-face slab images using horizontal b-scans and derived vertical b-scans (Fig. 1).
The prevalence of dRNFL in glaucomatous eyes (G) was significantly greater than than in suspects (S) and controls (C) [p =0.007]. 15 of 71 (21.1%) G, 1of 51 (2.0%) S, and 2 of 68 (2.9%) C eyes exhibited dRNFL. There were 11 eyes with PDs, 9 were G and 2 eyes were C. All PDs were adjacent to blood vessels. ERMs were identified in 8 eyes, 7 G eyes and 1 S eye and were associated with older age [p =0.10]. Although PDs are associated with ERMs,[1,3] only 3 of the 11 G eyes with PDs had ERMs.
Eyes with early glaucoma have a higher prevalence of dRNFL than suspects or controls and exhibit PDs even in the absence of ERM or high myopia.1. Hood, et al. IOVS. 2015; 2. Fortune et al. IOVS. 2014. 3. Muraoka et al. JAMA Ophth. 2015; 4. Hood & Raza BJO. 2014.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Fig. 1 En-face slab images with b-scan insets. A. PD B. ERM
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