reis and chauhan influence of clinically invisible but optical coherence tomography detected optic...

8/2/2019 Reis and Chauhan Influence of Clinically Invisible but Optical Coherence Tomography Detected Optic Disc Margin Anatomy on Neuroretinal Rim Evaluation IOVS 2012

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Influence of Clinically Invisible, but 1

Detected, Optic Disc Margin Anatomy2

3

Alexandre S C. Reis, MD1,24

Neil OLeary, Ph.D15

H li Y Ph D36

IOVS Papers in Press. Published on March


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R01EY011610 (CFB) from the National Eye 23

Health, Bethesda, Maryland; The Legacy G24

Portland, Oregon; the Sears Trust for Biome25

Missouri; the Alcon Research Institute (CFB26

and unrestricted research support from He27

d lb


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ABSTRA41

42

Purpose: We previously demonstrated tha43

extensions of Bruchs membrane (BM) insid44

(DM) that are clinically and photographical45

h fi di DM d BM i (BM46


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rim parameters. DM-HRW and BMO-HRW63

(median =0.84) than DM-HRW and BMO-64

and BMO-MRW (median =0.60) ranks. Se65

BMO-MRW were infrequently the same as 66

67


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Examination of the optic nerve head72

neuroretinal rim from the clinically identifi73

edge. Identification of the DM is necessary74

photographic or based on imaging techniqu75

tomography. In clinical or photographic ex76

b l f h


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extensions of BM that are not photographic94

Taken together, these findings undermine t95

identified DM is a consistent outer border f96

Because retinal ganglion cell axons cannot p97

cases with extensions of BM internal to the 98

h h d b


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measurement is made perpendicular to the 116

account the variable trajectory of axons ove117

current strategies for measuring peripapilla118

We present comparative analyses of horizo119

corresponding to clinical, photographic or s120

h b d h d d


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122

SUBJECTS AND123

124

The subjects, detailed inclusion and 125

methods employed in the present study hav126

i bli ti 7 h th li t127


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NY).11, 12 The registration and co-localizatio163

clip (Supplemental material: Clip 1).164

165

Segmentation of ONH Structures166

The clinically identified DM was def167

fl i i h i l i168


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The 24 radial B-scans yielded 48 sect185

marking the DM and BMO. A spline was f186

closed curve within which the clinical optic187

The BMO points were similarly fitted to de188

With the 3-D coordinates of the DM points,189

h f l bl h d


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Comparisons between DM area and 206

differences between all pairs of rim parame207

BMO-MRW) were analyzed. To determine208

between the rim parameters, two analyses w209

widths (from widest to narrowest) indepen210

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RESUL228

229

The median (range) age of the 30 gla230

68.1 (42 to 86) and 63.5 (42 to 77) years resp231

visual field mean deviation were -2.9 (-13.0 232

Th diff b t th233


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notable regional variations. The mean posi250

the BMO for most of the ONH, however, th251

temporal quadrant in both patients and con252

Regional variations were observed in253

and BMO-HRW (Fig. 4). In glaucoma patie254

d h h h h h


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when DM and BMO coincide, a horizontal r272

HRW) is larger than one made perpendicul273

(BMO-MRW). In these cases, BMO-MRW i274

assessments are substantially different. In 275

was significant discordance between the cli276

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DISCUSS292

293Imaging with SD-OCT has enabled c294

the ONH and their variations which to date295

Principal among these structures is BM and296

ti l i i t bl d i297


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need to derive rim measurements perpendi314

however, quantitative analyses supporting 315

not made. To the best of our knowledge, th316

characterize the properties of the BMO-MR317

the conventional DM-HRW derived from th318

h h l l d d


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comparisons, hence, depending on which o336

location of the narrowest rim is frequently 337

Automated identification of the ILM338

described and are being used in commercia339

segmentation of these structures was perfor340

f d h h l


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around the ONH represents a logical refere358

parameters. However, current BMO based359

area as proposed with SD-OCT4, 13, 14 do not360

Future advances with SD-OCT could includ361

quantification of the BMO-MRW and poten362

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In summary, findings from our prev380

that the rationale for the clinically defined o381

neuroretinal rim is questionable. The clinic382

horizontal rim measurements regionally un383

amount of remaining rim tissue. We have d384

h h k


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REFEREN392

3931. Burk RO, Vihanninjoki K, Bartke T, e394

reference plane for the Heidelberg retina to395

and experimental ophthalmology 2000;238:375-396

2 P li A S hidi NG H TA G397


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7. Reis ASC, Sharpe GP, Yang H, Nicol412

Optic disc margin anatomy in glaucoma pa413

spectral domain optical coherence tomogra414

8. Nicolela MT, Drance SM. Various gl415

clinical correlations. Ophthalmology 1996;103416

l l


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14. Lee K, Niemeijer M, Garvin MK, Kw432

Segmentation of the optic disc in 3-D OCT s433Trans Med Imaging 2010;29:159-168.434

15. Wojtkowski M, Srinivasan V, Fujimo435

imaging with high-speed ultrahigh-resoluti436


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21. Povazay B, Hofer B, Hermann B, et a454

three-dimensional optical coherence tomog455Biomed Opt 2007;12:041204.456

22. Strouthidis NG, Fortune B, Yang H, 457

change detected by spectral domain optical458

h d d ll


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28. Yip LW, Mikelberg FS. A comparison476

earlier heidelberg retina tomograph data an477glaucoma patients.J Glaucoma 2008;17:513-5478

29. Oddone F, Centofanti M, Rossetti L, 479

Retinal Tomograph 3 diagnostic accuracy a480


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35. O'Leary N, Crabb DP, Mansberger S498

series of stereoscopic photographs and Hei499Arch Ophthalmol 2010;128:560-568.500

36. Chauhan BC, Hutchison DM, Artes P501

glaucoma: comparison of confocal scanning502


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FIGURE LEG507

508Figure 1. Schematic representations of the 509

Salient anatomical features of the optic disc510

tissue (BT) configuration (left) where BT ex511


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patient. A. Disc photograph with localized529

no neuroretinal rim remaining in the infero530margin (DM) positions obtained from exam531

(green) and projected Bruchs membrane op532

from SD-OCT scans. Insets show magnified533


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converted to right-eye format and data poin551

obtained from the 24 radial B-scans. SN = su552nasal, IT = infero-temporal, T = temporal an553

554

Figure 5. Comparison of conventional hori555


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DM-horizontal rim width (DM-HRW) being573

or BMO-minimum rim width (BMO-MRW)574DM and BMO in the left ONH of a glaucom575

in the temporal sector, DM-HRW is erroneo576

however, because the trajectory of the nerve577


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width (BMO-MRW). C. BMO-HRW and B595

indicates the median of the distribution.596597

Figure 8. Distribution of angular distance b598

nerve head sector positions. A. Disc margi599


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