Elsevier

Ophthalmology

Volume 120, Issue 4, April 2013, Pages 745-752
Ophthalmology

Original article
Diagnostic Capability of Lamina Cribrosa Thickness by Enhanced Depth Imaging and Factors Affecting Thickness in Patients with Glaucoma

https://doi.org/10.1016/j.ophtha.2012.09.051Get rights and content

Objective

To determine the diagnostic ability of laminar thickness obtained using enhanced depth imaging (EDI) of the Heidelberg Spectralis optical coherence tomography (OCT) system (Heidelberg Engineering, Heidelberg, Germany) and the factors related to laminar thickness in patients with glaucoma.

Design

Evaluation of a diagnostic test.

Participants

A total of 144 patients with glaucoma (68 with primary open-angle glaucoma [POAG], 76 with normal-tension glaucoma [NTG]), and 65 healthy controls.

Methods

All patients underwent retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) scanning with the Spectralis OCT system. Mean laminar thickness was defined at the center of the mid-superior, central, and mid-inferior horizontal B-scans of the ONH, and the mean of 3 laminar thickness measurements was used for the diagnostic test. Receiver operating characteristic (ROC) curves were obtained for average and quadrant RNFL thickness and mean laminar thickness. Areas under the ROC curve (AUCs), 95% confidence intervals (CIs), and sensitivities at a fixed specificity (90%) were calculated. Factors related to mean laminar thickness were analyzed by univariate and multivariate regression analyses in patients with glaucoma.

Main Outcome Measures

Comparison of diagnostic ability using AUCs.

Results

Mean laminar thickness had the largest AUCs among all patients with glaucoma (AUC, 0.980; 95% CI, 0.966–0.993) and patients with NTG (AUC, 0.989; 95% CI, 0.980–0.994). The AUC of the mean laminar thickness of patients with NTG was significantly different from the AUC of the inferior RNFL thickness (AUC, 0.947; 95% CI, 0.929–0.965; P = 0.047), which had the largest AUC among the RNFL thickness parameters. The AUCs for discrimination between early glaucomatous eyes and normal eyes showed significant differences between the NTG group (AUC, 0.981; 95% CI, 0.968–0.992) and all patients with glaucoma (AUC, 0.941; 95% CI, 0.931–0.952; P = 0.007). The factor significantly associated with laminar thickness in both univariate and multivariate regression was NTG diagnosis (P = 0.001).

Conclusions

The diagnostic ability of laminar thickness was comparable to that of peripapillary RNFL thickness in patients with glaucoma overall and better than peripapillary RNFL thickness in patients with early NTG.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

The study used a cross-sectional, case-control design and enrolled 165 Korean adults with glaucoma and 75 normal controls (healthy volunteers). Participants were recruited from Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, between June 2010 and February 2012. In cases with both eyes eligible for the study, 1 eye was randomly chosen for inclusion.

The study was performed with the informed consent of the participants and followed all guidelines for experimental

Results

Spectralis peripapillary RNFL thickness and EDI OCT images of the ONH were observed in 165 patients with glaucoma and 75 normal controls. Among the patients with glaucoma, 21 (12.7%) had unclear lamina structures or posterior borders and thus were excluded. Ten normal controls (13.3%) were excluded for the same reason. The remaining 144 patients (68 with POAG and 76 with NTG) and 65 normal controls were considered for analysis.

Discussion

By providing objective, quantitative, and reproducible measurements of RNFL thickness, OCT provides supplemental information that may help to differentiate glaucomatous eyes from normal eyes.18, 19 With the advent of SD-OCT, unprecedented high-resolution, high-speed RNFL imaging has been possible.20, 21 The Spectralis OCT system is one of many commercially available SD-OCT instruments. With its faster scan speeds and eye-tracking system, the Spectralis OCT system may reduce the variability of

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    Manuscript no. 2012-543.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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