Optic Disc Margin Anatomy in Patients with Glaucoma and Normal Controls with Spectral Domain Optical Coherence Tomography

doi:10.1016/j.ophtha.2011.09.054

Ophthalmology

Volume 119, Issue 4, April 2012, Pages 738-747

https://doi.org/10.1016/j.ophtha.2011.09.054 Get rights and content

Objective

To characterize optic nerve head (ONH) anatomy related to the clinical optic disc margin with spectral domain-optical coherence tomography (SD-OCT).

Design

Cross-sectional study.

Participants

Patients with open-angle glaucoma with focal, diffuse, and sclerotic optic disc damage, and age-matched normal controls.

Methods

High-resolution radial SD-OCT B-scans centered on the ONH were analyzed at each clock hour. For each scan, the border tissue of Elschnig was classified for obliqueness (internally oblique, externally oblique, or nonoblique) and the presence of Bruch's membrane overhanging the border tissue. Optic disc stereophotographs were co-localized to SD-OCT data with customized software. The frequency with which the disc margin identified in stereophotographs coincided with (1) Bruch's membrane opening (BMO), defined as the innermost edge of Bruch's membrane; (2) Bruch's membrane/border tissue, defined as any aspect of either outside BMO or border tissue; or (3) border tissue, defined as any aspect of border tissue alone, in the B-scans was computed at each clock hour.

Main Outcome Measures

The SD-OCT structures coinciding with the disc margin in stereophotographs.

Results

There were 30 patients (10 with each type of disc damage) and 10 controls, with a median (range) age of 68.1 (42–86) years and 63.5 (42–77) years, respectively. Although 28 patients (93%) had 2 or more border tissue configurations, the most predominant one was internally oblique, primarily superiorly and nasally, frequently with Bruch's membrane overhang. Externally oblique border tissue was less frequent, observed mostly inferiorly and temporally. In controls, there was predominantly internally oblique configuration around the disc. Although the configurations were not statistically different between patients and controls, they were among the 3 glaucoma groups. At most locations, the SD-OCT structure most frequently identified as the disc margin was some aspect of Bruch's membrane and border tissue external to BMO. Bruch's membrane overhang was regionally present in the majority of patients with glaucoma and controls; however, in most cases it was not visible as the disc margin.

Conclusions

The clinically perceived disc margin is most likely not the innermost edge of Bruch's membrane detected by SD-OCT. These findings have important implications for the automated detection of the disc margin and estimates of the neuroretinal rim.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Participants

Thirty patients with open-angle glaucoma with early to moderate visual field loss and 10 healthy age-matched normal control subjects were recruited from 2 prospective longitudinal observational studies being conducted at the Eye Care Centre, Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada. To include a range of optic disc appearances in glaucoma, patients with focal, diffuse, or sclerotic optic disc damage were recruited. These forms of optic disc damage have been described in

Results

The subjects comprised 20 men (50%) and 20 women (50%) of European ancestry. Table 1 summarizes the age, gender, and visual field mean deviation statistics. There were no group differences in age or gender distribution; however, the mean deviation was significantly worse in patients than in controls.

Overall, the most frequent border tissue configuration was internally oblique in patients with glaucoma (Fig 5, available at http://aaojournal.org). It was the most frequent configuration superior

Discussion

Characterizing the anatomic variations of structures that define the optic disc margin may more accurately describe the clinical construct we currently recognize as the disc margin. To the best of our knowledge, this is the first published study to use SD-OCT ONH data co-localized to clinical photographs to identify structures that underlie optic disc margin appearance in patients with glaucoma and normal controls. The patients were selected to represent the broad appearances of the optic disc

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Cross-sectional study.
After OCT radial B-scan, ONH imaging, Bruch's membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented in each B-scan and projected to BMO reference plane. The direction and magnitude of BMO/ASCO offset and BMO/SFO offset as well as the location and magnitude of ENC, EOCBT and ESF regions, perineural canal (pNC) retinal nerve fiber layer thickness (RNFLT) and pNC choroidal thickness (CT) were calculated within 30° sectors relative to the Foveal-BMO (FoBMO) axis. Hi-ESF eyes were defined to be those with an ESF region ≥100 µms in at least 1 sector.
Hi-Myo eyes more frequently demonstrated Hi-ESF regions (87/122) than Non-Hi-myo-Healthy eyes (73/362) and contained significantly larger ENC, EOCBT, and ESF regions (P < .001) which were greatest in magnitude and prevalence within the inferior-temporal FoBMO sectors where Hi-Myo pNC-RNFLT and pNCCT were thinnest. BMO/ASCO offset and the BMO/SFO offset were both significantly increased (P < .001) in the Hi-Myo eyes, with the latter demonstrating a greater increase.
ENC region tissue remodeling that includes the scleral flange is enhanced in Hi-Myo compared to Non-Hi-Myo-Healthy eyes. Longitudinal studies are necessary to determine whether the presence of an ENC region influences ONH susceptibility to aging and/or glaucoma.
Optical Coherence Tomographic Optic Nerve Head Morphology in Myopia III: The Exposed Neural Canal Region in Healthy Eyes—Implications for High Myopia
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To determine the prevalence and magnitude of optical coherence tomography (OCT) exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT), and exposed scleral flange (ESF) regions in 362 non–highly myopic (spherical equivalent –6.00 to 5.75 diopters) eyes of 362 healthy subjects.
Cross-sectional study.
After OCT optic nerve head (ONH) imaging, Bruch membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented. BMO, ASCO, and SFO points were projected to the BMO reference plane. The direction and magnitude of BMO/ASCO offset as well as the magnitude of ENC, EOCBT, and ESF was calculated within 30° sectors relative to the foveal-BMO axis. Hi-ESF eyes demonstrated an ESF ≥100 µm in at least 1 sector. Sectoral peri–neural canal choroidal thickness (pNC-CT) was measured and correlations between the magnitude of sectoral ESF and proportional pNC-CT were assessed.
Seventy-three Hi-ESF (20.2%) and 289 non–Hi-ESF eyes (79.8%) were identified. BMO/ASCO offset as well as ENC, EOCBT, and ESF prevalence and magnitude were greatest inferior temporally where the pNC-CT was thinnest. Among Hi-ESF eyes, the magnitude of each ENC region correlated with the BMO/ASCO offset magnitude, and the sectors with the longest ESF correlated with the sectors with proportionally thinnest pNC-CT.
ONH BMO/ASCO offset, either as a cause or result of ONH neural canal remodeling, corresponds with the sectoral location of maximum ESF and minimum pNC-CT in non–highly myopic eyes. Longitudinal studies to characterize the development and clinical implications of ENC Hi-ESF regions in non–highly myopic and highly myopic eyes are indicated.
OCT Optic Nerve Head Morphology in Myopia II: Peri-Neural Canal Scleral Bowing and Choroidal Thickness in High Myopia—An American Ophthalmological Society Thesis
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Within ONH radial B-scans, Bruch membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and pNC scleral surface were segmented. BMO and ASCO planes and centroids were determined. pNC-SB was characterized within 30° foveal-BMO (FoBMO) sectors by 2 parameters: pNC-SB-scleral slope (pNC-SB-SS), measured within 3 pNC segments (0-300, 300-700, and 700-1000 μm from the ASCO centroid); and pNC-SB-ASCO depth relative to a pNC scleral reference plane (pNC-SB-ASCOD). pNC-CT was calculated as the minimum distance between the scleral surface and BM at 3 pNC locations (300, 700, and 1100 μm from the ASCO).
pNC-SB increased and pNC-CT decreased with axial length (P < .0133; P < .0001) and age (P < .0211; P < .0004) among all study eyes. pNC-SB was increased (P < .001) and pNC-CT was decreased (P < .0279) in the highly myopic compared to control eyes, and these differences were greatest in the inferior quadrant sectors (P < .0002). Sectoral pNC-SB was not related to sectoral pNC-CT in control eyes, but was inversely related to sectoral pNC-CT (P < .0001) in the highly myopic eyes.
Our data suggest that pNC-SB is increased and pNC-CT is decreased in highly myopic eyes and that these phenomena are greatest in the inferior sectors. They support the hypothesis that sectors of maximum pNC-SB may predict sectors of greatest susceptibility to aging and glaucoma in future longitudinal studies of highly myopic eyes. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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2023, Photodiagnosis and Photodynamic Therapy
To compare the optic disc capillary vascular status between crowded and normal optic discs using optical coherence tomography angiography (OCT-A).
A total of 101 eyes were included in this cross-sectional, comparative study. Fifty-one eyes with crowded optic discs (Group 1) were compared with 50 eyes with normal discs (Group 2). Peripapillary and optic disc head capillary vascular density measurements were obtained quantitatively with OCT-A.
Mean ages were 46.2 ± 6.2 years in Group1 and 45.9 ± 6.0 years in Group2 (p=0.796).Vertical disc diameters were 1.52±0.2 mm in Group 1 and 1.61±0.16 mm in Group 2 (p=0.022) whereas horizontal disc diameters were 1.53±0.17 mm in Group 1 and 1.61±0.13 mm in Group 2(p˂0.014). OCT-A findings were as follows: radial peripapillary capillary, vascular density whole image measurements (%); 49.6 ± 2.3 in Group 1 and 49.1 ± 2.3 in Group 2 (p=0.292), peripapillary capillary density; 53.3 ± 2.8 in Group 1 and 52.6 ± 2.6 in Group 2 (p=0.176), inside disc measurements 52.4 (48.7–54.7) in Group 1 and 46.5 (42.6–49.6) in Group 2 (p˂0.001). RNFL was 118.2 ± 12.2 µm in Group 1 and 110.8 ± 11.4 µm in Group 2(p=0.002).
The vascular density of the disc circumference in individuals with healthy crowded optic discs is not different from those with normal discs. However, inside disc measurements differ between crowded and normal size discs. This finding suggests that when the disc size is reduced, the amount of vessels in it does not decrease in a way that correlates with the size. Therefore, the vascular structures are suitable for compression in the narrow optic nerve head.
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Optical coherence tomography scans of optic nerve heads were graded for PHOMS, disc tilt, prelaminar hyperreflective lines, and scleral canal diameter and investigated for associated prenatal and ocular parameters. Children with optic disc drusen or optic disc edema were excluded.
PHOMS were found in 8.9% of children. The location of PHOMS was predominantly in the superonasal section of the optic disc. Myopia and optic nerve head tilt were more common in children with PHOMS than in children without PHOMS (P < .001 and P < .001, respectively). Prelaminar hyperreflective lines were found in 17.9% of children with PHOMS compared to 7.3% of children without PHOMS (P < .001). Prelaminar hyperreflective lines with and without PHOMS were associated with a shorter axial length of the eye (P < .001). There were no prenatal factors associated with PHOMS. Prelaminar hyperreflective lines were associated with higher birth weight and continued maternal smoking during pregnancy (P = .01 and P = .02, respectively).
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: Manuscript no. 2011-480.

: Financial Disclosure(s): The author(s) have made the following disclosure(s): B.C. Chauhan, Heidelberg Engineering (financial support). C.F. Burgoyne, Heidelberg Engineering (financial support).

: Financial Support: Grants MOP11357 (B.C.C.) and MOP200309 (M.T.N.) from the Canadian Institutes of Health Research, Ottawa, Ontario; Capes Foundation, Ministry of Education of Brazil, Brasilia, Brazil (A.S.C.R.); United States Public Health Service Grants R01EY011610 (C.F.B.) from the National Eye Institute, National Institutes of Health, Bethesda, MD; The Legacy Good Samaritan Foundation (C.F.B.), Portland, OR; the Sears Trust for Biomedical Research (C.F.B.), Mexico, MO; the Alcon Research Institute (C.F.B.), Fort Worth, TX; and equipment and unrestricted research support from Heidelberg Engineering (B.C.C., C.F.B.), Heidelberg, Germany.

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Original articleOptic Disc Margin Anatomy in Patients with Glaucoma and Normal Controls with Spectral Domain Optical Coherence Tomography

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Participants

Results

Discussion

Am J Ophthalmol

Ophthalmology

Prog Retin Eye Res

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Effect of intraocular pressure on rapid axoplasmic transport in monkey optic nerve

Invest Ophthalmol

The dynamics and location of axonal transport blockade by acute intraocular pressure elevation in primate optic nerve

Invest Ophthalmol

Optic nerve damage in human glaucomaII. The site of injury and susceptibility to damage

Arch Ophthalmol

Comparison of optic disc margin identified by color disc photography and high-speed ultrahigh-resolution optical coherence tomography

Arch Ophthalmol

Original article
Optic Disc Margin Anatomy in Patients with Glaucoma and Normal Controls with Spectral Domain Optical Coherence Tomography