Retinal Nerve Fiber Layer Damage Assessment in Glaucomatous Eyes Using Retinal Retardance Measured by Polarization-Sensitive Optical Coherence Tomography
Reshma Radhakrishnan ParakkelDamon Wing Kee WongChi LiJ. S. CheongMonisha E. NongpiurRachel S. ChongTin AungLeopold SchmettererXinyu LiuJacqueline Chua
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Purpose: To assess the diagnostic performance and structure–function association of retinal retardance (RR), a customized metric measured by a prototype polarization-sensitive optical coherence tomography (PS-OCT), across various stages of glaucoma. Methods: This cross-sectional pilot study analyzed 170 eyes from 49 healthy individuals and 68 patients with glaucoma. The patients underwent PS-OCT imaging and conventional spectral-domain optical coherence tomography (SD-OCT), as well as visual field (VF) tests. Parameters including RR and retinal nerve fiber layer thickness (RNFLT) were extracted from identical circumpapillary regions of the fundus. Glaucomatous eyes were categorized into early, moderate, or severe stages based on VF mean deviation (MD). The diagnostic performance of RR and RNFLT in discriminating glaucoma from controls was assessed using receiver operating characteristic (ROC) curves. Correlations among VF-MD, RR, and RNFLT were evaluated and compared within different groups of disease severity. Results: The diagnostic performance of both RR and RNFLT was comparable for glaucoma detection (RR AUC = 0.98, RNFLT AUC = 0.97; P = 0.553). RR showed better structure–function association with VF-MD than RNFLT (RR VF-MD = 0.68, RNFLT VF-MD = 0.58; z = 1.99; P = 0.047) in glaucoma cases, especially in severe glaucoma, where the correlation between VF-MD and RR (r = 0.73) was significantly stronger than with RNFLT (r = 0.43, z = 1.96, P = 0.050). In eyes with early and moderate glaucoma, the structure–function association was similar when using RNFLT and RR. Conclusions: RR and RNFLT have similar performance in glaucoma diagnosis. However, in patients with glaucoma especially severe glaucoma, RR showed a stronger correlation with VF test results. Further research is needed to validate RR as an indicator for severe glaucoma evaluation and to explore the benefits of using PS-OCT in clinical practice. Translational Relevance: We demonstrated that PS-OCT has the potential to evaluate the status of RNFL structural damage in eyes with severe glaucoma, which is currently challenging in clinics.Although Heidelberg retinal tomography (HRT)-generated topographic images have been studied extensively for the detection of retinal nerve fiber layer (RNFL) defects, little is known about the role of HRT-generated surface reflectivity images in the detection of RNFL defects in either patients with glaucoma or glaucoma suspects.To evaluate the effectiveness of HRT version II (HRT II) optic nerve reflectivity images in uncovering RNFL defects in an outpatient population evaluated for glaucoma.In 102 consecutive eyes from 60 patients evaluated for glaucoma in an academic-based practice, HRT II optic nerve images were prospectively imaged and compared with clinical optic nerve exam techniques to see if HRT II was able to detect RNFL defects overlooked in clinical practice.Nine eyes (8.8%) were found to have RNFL defects recognized by screening with HRT II. Of these nine eyes, eight (88.9%) were recognized to demonstrate RNFL defects by conventional examination techniques. One additional eye had an RNFL defect seen on physical exam that was not detected by HRT.In academic practice, HRT II may be helpful in complementing conventional exam techniques in the recognition and documentation of acquired RNFL loss.
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Purpose To investigate the reproducibility of peripapillary retinal nerve fiber layer (RNFL) and macular thickness measurements in healthy Taiwanese subjects using optical coherence tomography (Stratus OCT). Methods Fifty-two eyes of 52 healthy Taiwanese subjects (32 females and 20 males) were enrolled in the cross-sectional study. A randomly chosen single eye from each healthy subject underwent thickness measurements using OCT, before and after pupillary dilation, by 3 trained and experienced operators. Average measurements of peripapillary RNFL and macular thickness were calculated. Comparisons of thickness measurements before and after pupillary dilation, and among the 3 operators were performed. Results The RNFL thickness measurements were higher in the inferior peripapillary area by RNFL scan (average: 107.4±17.8 μm) and the macular thickness measurements showed a ring-shaped hump in the 3 mm perifoveal area by macular scan (average: 252.8±8.9 μm). Comparing the peripapillary RNFL and macular thickness before and after pupillary dilation, there was no significant difference (P>0.05) in average, superior, inferior, temporal, or nasal peripapillary areas, in total macular volume and foveal thickness, nor in 1, 3, and 6-mm perifoveal areas, whether before or after pupillary dilation and irrespective of which operator performed the measurements. Conclusions The inferior RNFL area and the 3-mm perifoveal area showed higher thickness measurements in the peripapillary region and macular region, respectively. The thickness measurements performed using OCT showed no significant differences before and after pupillary dilation, and showed good reproducibility.
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Evaluation of the peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements in children with thalassemia minor.In this cross-sectional and comparative study, 30 thalassemia minor patients and 36 controls were included. Heidelberg spectral domain optical coherence tomography was used for peripapillary retinal nerve fiber layer thickness, subfoveal choroidal thickness, and retinal vessel caliber measurements.There was no statistically significant difference in retinal nerve fiber layer thickness and subfoveal choroidal thickness between the two groups (p > 0.05). There was no correlation between retinal nerve fiber layer thickness and hemoglobin values. Both the arterioral and venular calibers were higher in thalassemia minor group (p < 0.05).There is increased retinal arterioral and venular calibers in children with thalassemia minor compared with controls.
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Objective: To assess the role of quantification of retinal nerve fiber layer for early detection of anterior visualpathway lesions.
Study Design: Case-control study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan to Jul 2019.
Methodology: A total of 100 cases of anterior visual pathway lesions of varying clinical presentations wereincluded in the study. There were 100 matched controls who were selected from the community without anyophthalmological abnormality using non-probability consecutive sampling technique. Retinal nerve fiber layer(RNFL) thickness was measured with the help of optical coherence tomography in both the cases and controls.Mean retinal nerve fiber layer values were compared in both the groups. Student’s t-test was applied to look forany significant difference between the two groups.
Results: Mean age of the patients was 39.14 ± 3.925 years while mean age of the controls was 39.23 ± 2.415 years. Mean retinal nerve fiber layer thickness in the case group was 72.21 ± 9.615 µm while on the control group was 101.34 ± 9.615 µm. A statistically significant difference was observed between cases and controls in terms of mean retinal nerve fiber layer thickness (p<0.001). Subjects with retinal nerve fiber layer thickness <85 µm were more likely to exhibit anterior visual pathway lesions (OR= 15.915 [6.278-40.346]; 95% CI, p<0.001).
Conclusion: Decreased retinal nerve fiber layer thickness can serve as a predictor for anterior visual pathwaylesions. Optical coherence tomography should be incorporated for routine screening of high-risk cases in order.........
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Evaluation of the retinal nerve fibre layer (RNFL) is key to diagnosing and monitoring changes in glaucoma. Optical coherence tomography (OCT) is a non-invasive, objective, quantitative method that provides realtime in vivo images of the retina. The new spectral-domain OCTs have increased resolution and acquisition speed compared with earlier time-domain OCTs, enabling the generation of highly detailed 3D images. Axial resolution has also been improved from 10 to 3–5μm. Thus, spectral-domain OCT is a promising new clinical tool for evaluating the RNFL in glaucoma and other retinal diseases. Recent studies report that spectral-domain OCT provides peri-papillary RNFL measurements with excellent repeatability and reproducibility. The reduced variability compared with time-domain OCT may improve detection of disease progression in glaucoma patients. In cross-sectional studies, most authors suggest that the two OCT systems have similar diagnostic potential to discriminate between healthy and glaucoma patients. Nevertheless, the Cirrus HD-OCT (spectral-domain) tends to yield a slightly higher sensitivity at fixed specificities than the Stratus OCT (time-domain) for glaucoma diagnosis. In healthy subjects and patients with glaucoma, RNFL thickness measurements acquired with the two OCT systems correlated well, but their values cannot be used interchangeably.
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