Comparative evaluation of macular thickness and peripapillary RNFL thickness to analyse and monitor glaucoma patient (original) (raw)
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IP Innovative Publication Pvt. Ltd., 2018
Aims: To quantify and compare the retinal nerve fiber thickness in normal, ocular hypertensive and glaucomatous eyes using Optical coherence tomography (OCT). Materials and Methods: Patients were divided in to three groups of 30 each for normal, ocular hypertensive and primary open angle glaucoma. Inclusion criteria were of patients between 30-70 years of age, visual acuity of 6/36 or better, Refractive error not exceeding 5D and no prior surgery. Complete eye evaluation and was done followed by OCT Scan using the protocol “Fast RNFL thickness”. RNFL thickness was assessed in 4 quadrants and statistical analysis was done using student t test and analysis of variance (ANOVA). Results: RNFL was significantly thinner in OHT eyes than in normal eyes specifically in the inferior and nasal quadrants. 12.6% decrease in RNFL thickness was seen in OHT eyes as compared to normal eyes and about 22.29% decrease in RNFL thickness in POAG eyes as compared to OHT. Conclusions: Incorporation of OCT in glaucoma practice can helped us in evaluation of optic disc, quantifying of RNFL, identifying the structural changes in RNFL and the progression of disease. The magnitude of focal RNFL thinning in OCT was related to the magnitude of decreased global indices sensitivity in glaucomatous patient. Keywords: Low coherence optical tomography, Optic disc, Retinal nerve fiber layer, Visual field
Journal of Evidence Based Medicine and Healthcare, 2015
To study the RNFL thickness measured by stratus optical coherence tomography (OCT) patients with primary open angle glaucoma (POAG) and normal subjects, analyse the quadrant which is most efficient parameter for detecting glaucomatous damage and its correlation with visual fields. MATERIAL AND METHODS: This is a cross-sectional study of 50 glaucomatous eyes and 50 normal subjects. RNFL thickness was measured in different quadrants using stratus optical coherence tomography. RESULTS: The RNFL thickness measured by OCT in 50 glaucomatous and 50 normal eyes showed that the Inferior RNFL thickness in POAG is 77.54±31.11 compared to normal subjects where Inferior RNFL thickness is 124.96±16.74 (P<0.001). The Superior RNFL thickness in POAG is 78.32±34.81 compared to normal subjects where Superior RNFL thickness is 113.86±15.07 (P<0.001). The Nasal RNFL thickness in POAG is 53.52±13.88 compared to normal subjects where Nasal RNFL thickness is 78.103±17.87 (P<0.001). The Temporal RNFL thickness in POAG is 49.72±18.01 compared to normal subjects where Temporal RNFL thickness is 60.17±12.15 (P<0.001). The Average RNFL thickness in POAG is 63.94±18.01 compared to normal subjects where Average RNFL thickness is 97.97±9.59 (P<0.001). Both mean deviation (MD) and pattern standard deviation (PSD) showed a significant correlation with all the RNFL thickness parameters in eyes with glaucoma (pearson correlation coefficient >0.4). CONCLUSION: RNFL thickness measured on OCT may serve as useful adjunct in accurately detecting glaucoma. Average and inferior RNFL thicknesses are among the most efficient parameters for detecting glaucoma correlating with the visual field changes.
Journal of Current Glaucoma Practice, 2020
Aim and objective: To appraise the validity of measuring macular ganglion cell layer (mGCL) thickness as an indicator of early glaucoma, as compared to measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness. Materials and methods: This was a single-center, single-observer, cross-sectional, retrospective study. Records included Filipino adult patients seen from January 2017 onward. Patients underwent testing of both automated visual field (VF) testing with either Humphrey Visual Field Analyzer (24-2 SITA program) or Octopus 311 (G1 program), and standard Spectral-Domain Optical Coherence Tomography (Cirrus HD-OCT 5000). Modified Hodapp-Anderson-Parrish criteria were used to classify subjects as either healthy, suspect, or early glaucomatous eyes. Thickness changes were directly observed through optical coherence tomography. Area under receiver operating curve (AUC) analysis was used to determine ability of mGCL and pRNFL to discriminate between healthy and early glaucomatous states. Results: A total of 96 eyes were included. Progressive thinning for all parameters was noted for both pRNFL and mGCL from healthy to suspect to early glaucomatous eyes. The highest AUC of 0.744 was seen in average pRNFL of healthy vs early glaucomatous eyes. However, AUC values for both pRNFL and mGCL were all above 0.500. Conclusion: Measurements of mGCL thickness in Filipino patients exhibit comparable performance to pRNFL measurements in detecting early anatomic glaucomatous change. It is a tool that can be utilized for early glaucoma detection in addition to current standard diagnostic tests. Clinical significance: This study, the first to be performed on Filipino patients, validates using mGCL thickness as a good parameter in discriminating between normal and early glaucoma patients for this particular population and Ethnic group.
Macular and Retinal Nerve Fiber Layer Thickness: Which Is More Helpful in the Diagnosis of Glaucoma?
Investigative Opthalmology & Visual Science, 2011
PURPOSE. To explore factors affecting the glaucoma diagnostic capability of macular thickness and circumpapillary retinal nerve fiber layer (cRNFL) thickness as determined by spectral domain-optical coherence tomography. METHODS. Area under the curve (AUC) of the receiver operating characteristics (ROC) discriminating healthy from glaucomatous eyes was determined using 10 macular thickness and 16 cRNFL thickness parameters. Glaucomatous eyes were categorized into two groups using four criteria according to whether cRNFL thickness or macular thickness measurement was better for glaucoma detection (cRNFL better group [RBG], macula better group [MBG], respectively). The clinical characteristics were compared between RBG and MBG. ROC regression analysis was conducted to identify variables affecting diagnostic capability using either macular thickness or cRNFL thickness measurements. RESULTS. Four hundred twenty-four glaucomatous patients and 297 healthy subjects were analyzed. Of all cRNFL parameters, average thickness showed the largest AUC (0.958). Of macular parameters, the inferior outer sector showed the largest AUC (0.880). More eyes were placed into the RBG than the MBG, making use of all four criteria (90 vs. 24, 143 vs. 46, 76 vs. 18, and 103 vs. 36, respectively). RBG patients had a smaller optic disc area than did MBG patients in 3 of the 4 criteria. Signal strength affected the diagnostic performance of cRNFL thickness measurement (P ϭ 0.043), whereas that of macular thickness was not affected by any covariate analyzed. CONCLUSIONS. Overall, cRNFL thickness measurements were generally superior to those of macular thickness when used to diagnose glaucoma. Macular thickness parameters were of greater value in eyes with larger optic discs. (Invest Ophthal
Significance of macular thickness in glaucoma
2015
The revolution in diagnostic and investigative ophthalmology that was provoked with the invention of imaging diagnostic methods had brought to the light new evidence that have defined and resolved some dilemmas in a number of ocular diseases concerning retina and optic nerve. Nowadays it is accepted as scientific fact that imaging technologies (Optical Coherence Tomography, Confocal Scanning Laser Ophthalmoscopy, and Scanning Laser Polarimetry) are providing quantitative information confirming that structural damage in glaucoma most often precede functional changes, identified through the condition of visual field. Assessment of the peripapillary retinal nerve fiber layer thickness (RNFL) and parameters of optic nerve head (ONH) conducted through the imaging methods has proved its importance in the recognition and detection of early glaucoma. Different studies have previously reported controversial results comparing diagnostic accuracy between RNFL and macular thickness in glaucoma. The invention of Spectral domain Optical Coherence Tomography (SD-OCT) and the ability of evaluation of macular thickness and macular ganglion cell complex (mGCC) has improved the potential of early glaucoma diagnosis and monitoring of glaucoma progression. It is common knowledge that retinal ganglion cell loss (RGCs) is basic pathophysiological phenomenon in glaucoma. Retinal nerve fiber layer (RNFL) and retinal ganglion cells (RGCs) together comprise about 35-40% of the macular thickness. Early detection and recognition of structural damage is considered to be crucial for diagnosis and management of glaucoma. But, on the other hand, glaucomatologists should always take into account the objective limitations of imaging methods that should not be used as substitution for the clinical evaluation and assessment of visual field in patients with glaucoma. Proper diagnosing of glaucoma should be made only with complementary and comprehensive evaluation and interpretation of all available methods, in order to make the right diagnosis and start immediate treatment if necessary.
Peripapillary retinal thickness maps in the evaluation of glaucoma patients: a novel concept
ISRN ophthalmology, 2011
Purpose. To show how peripapillary spectral domain optical coherence tomography (SDOCT) retinal thickness (RT) maps can complement retinal nerve fiber layer (RNFL) thickness maps in the evaluation of glaucoma patients. Methods. After a complete eye exam with standard fundus photography and visual field testing, normal and glaucomatous eyes were imaged with an experimental SDOCT system. From SDOCT images, RNFL thickness and RT maps were constructed and then correlated with disc photography and visual field testing. Results. Two normal eyes of 2 patients and 5 eyes of 4 glaucoma patients were imaged. Although both RNFL and RT maps correlated well with visual field defects, glaucomatous arcuate defects were sometimes more easily identified in the RT maps. Conclusions. To our knowledge, this is the first paper to show that peripapillary SDOCT RT maps may provide important supplemental information to RNFL thickness maps in the evaluation of glaucoma patients.
Japanese Journal of Ophthalmology, 2013
Purpose To evaluate the capability of optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, and visual field (VF) measurements in glaucoma progression detection. Methods The study examined 62 eyes of 37 glaucoma patients observed over a 3-year period. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least 3 years. VF testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer (HFA) on the same day as the RNFL imaging. Both serial RNFL thicknesses and VF progression were assessed by the guided progression analysis (GPA) software program. RNFL thickness progression was evaluated by event analysis. Total deviation (TD) in the superior or inferior hemifield was also examined. Results A total of 295 OCT scans and 295 VFs were analyzed. Five eyes exhibited progression by OCT only and 8 eyes exhibited progression by VF GPA only. When the analysis was based on the combined measurement findings, progression was noted in 6 eyes. The average of the progressive hemifield TD at baseline for combined RNFL and VF progression was-3.21 ± 1.38 dB, while it was-2.17 ± 1.14 dB for RNFL progression and-9.12 ± 3.75 dB for VF progression. The average of the progressive hemifield TD indicated a significant advancement of VF progression as compared to RNFL progression (P = 0.002). Conclusions When a mild VF defect is present, OCT RNFL thickness measurements are important in helping discern glaucoma progression.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2013
Background The aim of this study was to evaluate the macular thickness (MT), ganglion cell complex (GCC), and circum-papillary retinal nerve fiber layer (RNFL) thickness in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) with spectral domain optical coherence tomography (SD-OCT). Methods A total of 169 subjects were enrolled: 52 normal subjects, 61 with POAG, and 56 with NTG. Spectraldomain optical coherence tomography (SD-OCT) was used to analyze MT, GCC, and RNFL thickness. To compare the discrimination capabilities between the MT, GCC, and RNFL thickness measurements, we analyzed the areas under the receiver operating characteristic (ROC) curves (AUCs). The relationships between GCC and RNFL measurement and also the relationships of the groups, with age, gender, GCC, and RNFL thickness were assessed. Results Normal subjects showed the thickest superior and inferior GCC, followed by in order NTG and POAG (p<0.05). While there was a statistically difference in MT value of the normal subjects and the glaucoma patients (p < 0.05), MT value did not differ between POAG and NTG (p < 0.05). RNFL thickness parameters were significantly greater in normal subjects, followed in order by the NTG, and POAG (p<0.05). Between the normal and entire glaucoma groups, all GCC and RNFL parameters showed the similar discrimination power. RNFL thickness parameters correlated significantly with all GCC thickness (p<0.05). Superior RNFL thickness was the only independent variable between the POAG and NTG patients (odds ratio (OR) 0.942, p00.004, 95 %CI 0.905-0.981). Conclusions SD-OCT evaluation results suggest higher GCC and RNFL parameters for NTG than POAG. Keywords Primary open-angle glaucoma. Normal tension glaucoma. Ganglion cell complex. Retinal nerve fiber layer thickness. Spectral optical coherence tomography The manuscript was presented at 45th National Congress of Turkish Ophthalmology Society, 5-9 October 2011, as oral presentation. The ID number for ClinicalTrials.gov is NCT01612416.
PURPOSE. We determined the glaucoma screening performance of regional optical coherence tomography (OCT) layer thickness measurements in the peripapillary and macular region, in a population-based setting. METHODS. Subjects (n ¼ 1224) in the Rotterdam Study underwent visual field testing (Humphrey Field Analyzer) and OCT of the macula and optic nerve head (Topcon 3-D OCT-1000). We determined the mean thicknesses of the retinal nerve fiber layer (RNFL), retinal ganglion cell layer (RGCL), and inner plexiform layer for regions-of-interest; thus, defining a series of OCT parameters, using the Iowa Reference Algorithms. Reference standard was the presence of glaucomatous visual field loss (GVFL); controls were subjects without GVFL, an intraocular pressure (IOP) of 21 mm Hg or less, and no positive family history for glaucoma. We calculated the area under the receiver operating characteristics curve (AUCs) and the sensitivity at 97.5% specificity for each parameter. RESULTS. After excluding 23 subjects with an IOP > 21 mm Hg and 73 subjects with a positive family history for glaucoma, there were 1087 controls and 41 glaucoma cases. Mean RGCL thickness in the inferior half of the macular region showed the highest AUC (0.85; 95% confidence interval [CI] 0.77-0.92) and sensitivity (53.7%; 95% CI, 38.7-68.0%). The mean thickness of the peripapillary RNFL had an AUC of 0.77 (95% CI, 0.69-0.85) and a sensitivity of 24.4% (95% CI, 13.7-39.5%). CONCLUSIONS. Macular RGCL loss is at least as common as peripapillary RNFL abnormalities in population-based glaucoma cases. Screening for glaucoma using OCT-derived regional thickness identifies approximately half of those cases of glaucoma as diagnosed by perimetry.
Different Clinical Parameters to Diagnose Glaucoma Disease: A Review
International Journal of Computer Applications, 2015
Glaucoma is a severe human eye disease that causes permanent loss of vision. The main cause of glaucoma eye disease is the continuous loss of retinal nerve fiber layers due to the increase in the intra ocular pressure inside the eyes. The function of these retinal nerve fibers is the transformation of recognized object information in the form of signals to the brain, where these signals are recognized as object. Damages to these nerve fibers generate blind spots and these blind spots leads to permanent blindness. Therefore, Retinal Nerve Fiber Layer Thickness is the main parameter to diagnose glaucoma. Other parameters also leading to glaucoma are Intraocular Pressure, Vertical Cup to Disc Ratio, Neuro Retinal Rim Thickness, Central Cornea Thickness, Inferior Superior Nasal and Temporal Sector Ratio etc. Therefore, the identification of these parameters plays the major role in glaucoma assessment, since it allows timely treatment to prevent the vision loss caused by glaucoma. To estimate these parameters, clinical instruments such as Tonometry, Ophthalmoscopy, Heidelberg Retinal Tomography, Perimetry, Pachymetry, Optical Coherence Tomography, GDx etc are adopted. This paper presents the various parameters, as mentioned above, used to analyze and diagnose the Glaucoma disease and associated advantages, disadvantages and the different instruments used to analyze each clinical parameter.