Abstract
Purpose :
To compare the patten of macular ganglion cell layer (GCL) damage seen with optical coherence tomography (OCT) in eyes with non-glaucomatous optic neuropathy to a model of damage due to glaucoma.[1]
Methods :
Forty-two eyes from 26 patients diagnosed with non-glaucomatous optic neuropathy and with macular GCL damage on the GCL thickness map from Spectralis (Heidelberg Engineering) OCT reports (Fig. 1A) were selected from a larger group referred by a neuro-ophthalmolgist. The pattern of the GCL damage was compared to a model [1] of glaucoma progression of the thick donut shaped region of the GCL around the fovea seen in healthy eyes (Fig. 1A, left). According to the model, glaucomatous damage to this donut starts in the temporal sectors and progresses towards the nasal sectors, and thus results in characteristic patterns. The patterns of macular GCL in the 42 eyes were categorized as: “Consistent” with the model; “Uniform” damage, so the model does not apply; and “Inconsistent” with the model. The referring neuro-ophthalmologist classified the etiology of the disease of each eye based upon all available information.
Results :
The damage in 21 (50%) of the eyes was consistent with the model, while the model did not apply in 16 (38%) eyes involving the entire macula GCL sector. The remaining 5 (12%) showed patterns of GCL damage inconsistent with the model of glaucoma. Table 1 shows the analysis based on disease etiology. All 5 inconsistent eyes, including the 4 eyes with ischemic optic neuropathy (ION) and one eye with optic neuritis, had more severe damage in the nasal sectors of the macula than the more temporal sectors. Fig. 1 contains the GCL map of one of the 4 ION eyes (C) and the one optic neuritis eye (D). This pattern is relatively rare in eyes with glaucoma.[1]
Conclusions :
Non-glaucomatous optic neuropathy presents diverse morphological patterns of macular GCL defects. Glaucoma specialists confronted with eyes with relatively more nasal GCL damage should rule out other causes such as ION or optic neuritis. On the other hand, ION patients can also present with a pattern consistent with the model. Thus, agreement with the model does not distinguish ION from glaucoma.
[1] Hood DC, et al. Invest Ophthalmol Vis Sci 2023
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.