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Purpose: We wished to determine whether a relationship exists between Heidelberg retina tomograph (HRT) parameters and the visual field indices. Methods: One eye was randomly chosen from 59 normal patients [normal visual field and normal optic nerve head (ONH) and intraocular pressure (IOP) <21 mm Hg], 64 ocular hypertensive patients (normal visual field and normal OHN and IOP >22 mm Hg), 124 high-tension glaucoma patients (abnormal visual field and/or abnormal optic nerve and IOP >22 mm Hg) and 47 lowtension glaucoma patients (abnormal visual field and or optic disc and IOP <21 mm Hg). All the patients were examined with Humphrey Perimeter, program 30–2, and HRT. Findings were assessed by analysis of variance, Pearson's correlation coefficient, and multiple linear regression. Results: Among all subjects, we noted a statistically significant correlation (Pearson's r, p < 0.001) between cup area, cup/disc area ratio, rim area, rim volume, cup shape measure, and retinal nerve fiber layer cross-section area with mean deviation and corrected pattern SD. Multiple linear regression analysis demonstrated that rim area was the most important predictor of mean deviation and corrected pattern SD. Conclusions: The presence of significant correlations between some HRT parameters, such as rim area and cup shape measure and visual field indices, suggests that these HRT parameters could be good indicators of the degree of glaucomatous ONH damage.
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Purpose: Idiopathic intracranial hypertension (IIH) leads to optic nerve head swelling and optic atrophy if left untreated. We wanted to assess an easy to perform volumetric algorithm to detect and quantify papilledema in comparison to retinal nerve fiber layer (RNFL) analysis using optical coherence tomography (OCT). Methods: Participants with and without IIH underwent visual acuity testing at different contrast levels and static perimetry. Spectralis-OCT measurements comprised standard imaging of the peripapillary RNFL and macular ganglion cell layer (GCL). The optic nerve head volume (ONHV) was determined using the standard segmentation software and the 3.45 mm early treatment diabetic retinopathy study (ETDRS) grid, necessitating manual correction within Bruch membrane opening. Three neuro-ophthalmologists graded fundus images according to the Frisén scale. A mixed linear model (MLM) was used to determine differences between study groups. Sensitivity and specificity was evaluated using the area under the receiver-operating characteristic (ROC). Results: Twenty-one patients with IIH had an increased ONHV of 6.46 ± 2.36 mm3 as compared to 25 controls with 3.20 ± 0.25 mm3 (P < 0.001). The ONHV cutoff distinguishing IIH from controls was 3.97 mm3 (i.e. no patient with IIH had an ONHV below and no healthy individual above this value). The area under the curve (AUC) for ONHV was 0.99 and for the RNFL at 3.5 mm 0.90. The Frisén scale grading correlated higher with the ONHV (r = 0.90) than with the RNFL thickness (r = 0.68). ONHV measurements were highly reproducible in both groups (coefficient of variation <0.01%). Conclusions: OCT-based volumetry of the optic nerve head discriminates very accurately between individuals with and without IIH. It may serve as a useful adjunct to the rating with the subjective and ordinal Frisén scale. Translational Relevance: A simple OCT protocol run on the proprietary software of a commercial OCT device can reliably discriminate between normal optic nerve heads or pseudo-papilledema and true papilledema while being highly reproducible. Our normative data and OCT preset may be used in further clinical studies.
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The distinction between true papilledema and pseudopapilledema rests on characteristics of the optic disc when examined ophthalmoscopically. Buried disc drusen frequently simulate papilledema and often result in misdirected diagnostic maneuvers in search of a cause for presumed intracranial hypertension. When an elevated optic disc exhibits an irregular, "lumpy, bumpy" border, a diagnosis of buried drusen of the optic nerve is usually made. We report a case with papilledema secondary to increased intracranial pressure in which the margins of the swollen optic disc presented this lumpy, bumpy border characteristic of buried drusen. The lumpy character of the disc border disappeared with resolution of the papilledema, and ultrasonography demonstrated the absence of any buried drusen. Other characteristics of papilledema, including extension of the disc swelling into the peripapillary nerve fiber layer, telangiectasia of the superficial vessels of the optic disc, and obscuration of the retinal vessels as they crossed the margins of the optic disc, provided strong evidence of true papilledema and remain the most reliable findings allowing a distinction between true papilledema and pseudopapilledema.
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Drusen
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Drusen
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Eyes with glaucoma are characterized by optic neuropathy with visual field defects in the areas corresponding to the optic disk damage. The exact cause for the glaucomatous optic neuropathy has not been determined. Myopia has been shown to be a risk factor for glaucoma. The purpose of this study was to determine whether a significant correlation existed between the microcirculation of the optic disk and the visual field defects and the retinal nerve fiber layer thickness (RNFLT) in glaucoma patients with myopic optic disks.Sixty eyes of 60 patients with myopic disks were studied; 36 eyes with glaucoma (men:women = 19:17) and 24 eyes with no ocular diseases (men:women = 14:10). The mean deviation (MD) determined by the Humphrey field analyzer, and the peripapillary RNFLT determined by the Stratus-OCT were compared between the two groups. The ocular circulation was determined by laser speckle flowgraphy (LSFG), and the mean blur rate (MBR) was compared between the two groups. The correlations between the RNFLT and MBR of the corresponding areas of the optic disk and between MD and MBR of the optic disk in the glaucoma group were determined by simple regression analyses.The average MBR for the entire optic disk was significantly lower in the glaucoma group than that in the control group. The differences of the MBR for the tissue in the superior, inferior, and temporal quadrants of the optic disk between the two groups were significant. The MBR for the entire optic disk was significantly correlated with the MD (r = 0.58, P = 0.0002) and the average RNFLT (r = 0.53, P = 0.0008). The tissue MBR of the optic disk was significantly correlated with the RNFLT in the superior, inferior, and temporal quadrants.Our study suggests that there is a causal relationship between the thinner RNFLT that led to the MD and reduction in the microcirculation in the optic nerve head.
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The aim of this retrospective study was to evaluate if, in ocular normotensive patients, at the time of diagnosis of optic nerve head drusen (ONHD), perimetric mean deviation (PMD) on visual field (VF) examination and retinal nerve fibre layer (RNFL) thickness on optical coherence tomography correlated with intraocular pressure (IOP). There was a significant association between IOP and PMD (Spearman's rho = −0.863, p < .01) and between IOP and RNFL thickness (Spearman's rho = −0.630, p < .01). A higher IOP was associated with a greater functional loss in the VF and a reduction in the RNFL thickness. These results suggest that a clinical trial of IOP reduction should be considered in patients with ONHD to decrease the progression of optic nerve damage over time.
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OBJECTIVE: I compared measures of retinal and optic nerve head (ONH) anatomy to standard perimetry in patients with papilledema associated with intracranial hypertension.
BACKGROUND: Optical coherence tomography (OCT) provides quantitative ocular imaging in conditions causing optic neuropathy. Correlation of OCT-identified structural change to visual function has been well established in multiple sclerosis patients.
DESIGN/METHODS: I studied 26 patients with papilledema (22 with idiopathic intracranial hypertension) and no alternative ocular pathology. Fourteen patients were tested twice, at least 3 months apart. Using spectral-domain OCT, I quantified retinal nerve fiber layer (RNFL) thickness, total macular volume and ONH volume in each eye and compared values with standard automated static perimetry. Optic disc elevation was confirmed with 3-dimensional image reconstruction.
RESULTS: For most eyes, there was no relationship between the degree of RNFL or ONH swelling and perimetric mean deviation. In this group, even eyes with severe swelling showed normal or only mildly reduced mean deviation and RNFL thickness correlated significantly with ONH volume. In a smaller group of eyes with ONH volumes at the lower end of the supranormal range, RNFL thickness and macular volume were paradoxically subnormal and perimetry showed moderate to severe impairment. In 4 eyes of this latter group, serial testing showed stable or improved visual fields despite declining RNFL thickness within the subnormal range.
CONCLUSIONS: Quantitative measures of tissue swelling do not correlate with visual field loss in most patients with papilledema. In a minority of eyes, RNFL and macular thickness may be subnormal despite optic disk swelling, implying a combination of swollen and thin or missing axons. These eyes may show significant visual field loss, but further RNFL thinning does not always portend perimetric deterioration.
Study Supported by: Not applicable. Disclosure: Dr. Morrow has received research support from Novartis.
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