Effect of Refractive Status and Axial Length on Peripapillary Retinal Nerve Fibre Layer Thickness: An Analysis Using 3D OCT

Associations between Optic Nerve Head-Related Anatomical Parameters and Refractive Error over the Full Range of Glaucoma Severity

Purpose

To evaluate the associations between optic disc (OD)-related anatomical parameters (interartery angle [IAA] between superior and inferior temporal retinal arteries, OD tilt [TL], rotation [ROT], and torsion [TO], OD surface curvature [CUR], and central retinal vessel trunk entry point location [CRVTL] on OD) and the spherical equivalent of refractive error (SE), and to assess the impact of glaucoma severity on these relationships.

Methods

Cirrus optical coherence tomography (OCT) fundus images and 24-2 visual fields of 438 patients were included. Ellipses were fitted to OD borders. IAA was calculated between marked retinal artery locations on a circle around OD. Blood vessel entry point on OD was marked to locate CRVTL. TL was measured as the angle between the lines fitted to OD clinical boundary and the Bruch's membrane edges on the horizontal B-scans. Ellipse rotation relative to the vertical axis defined ROT. Angle between the long axis of OD and the interartery line defined TO. CUR was determined by the inner limiting membrane on the horizontal B-scans. Linear regression models evaluated by Bayes Factors (BF) were used to determine the covariance structure between the parameters and SE as well as possible impacts of mean deviation (MD).

Results

Our results showed that CRVTL had the strongest relationship with SE, followed by ROT, TL, and IAA (BFs: 3.59 × 10⁷, 2645, 1126, and 248, respectively). MD did not significantly modulate the relationship between ONH parameters and SE.

Conclusion

Our results suggest that SE should be considered when interpreting the OD and its circumpapillary region for diagnostic purposes.

Translational Relevance

The reported relationships between OD-related parameters and ametropia may help to decrease false-positive clinical diagnoses of optic neuropathies.

Glaucoma Increases Retinal Surface Contour Variability as Measured by Optical Coherence Tomography

Purpose

We investigated the feasibility of glaucoma detection by measuring retinal surface contour variability (RSCV) using optical coherence tomography (OCT).

Methods

The peripapillary region in one eye of each participant was scanned over an 8 × 8 mm area with a swept source OCT prototype. The retinal surface contour was sampled at approximately 1.5- to 3.5-mm radius circles centered on the optic nerve head. The RSCV is defined as the average log value within a middle spatial frequency band of the Fourier transform to the elevation profile of the inner retinal surface. The spatial frequency band was optimized to distinguish glaucoma from normal. Nerve fiber layer thickness (NFLT) was sampled around a 1.7-mm radius circle. Glaucoma severity was assessed by automated static perimetry.

Results

We enrolled 17 glaucomatous eyes and 17 healthy eyes. A great majority of the glaucoma group were in the early stage (visual field mean deviation average −2.48 ± 3.73 dB). Significant differences were found for RSCV between glaucoma and control eyes (P < 0.003) at all radii. The area under the receiver operating characteristic curve (AROC = 0.90) of RSCV was best at the 3.5-mm radius. This was not significantly better than NFLT (AROC = 0.84). With the 99% specificity, the glaucoma detection sensitivity was 53% for RSCV and 29% for NFLT (P = 0.13).

Conclusions

Retinal surface contour variability was significantly increased in glaucoma patients. The diagnostic accuracy of RSCV was equal to NFLT in early glaucoma. Since the RSCV detects small-scale focal damage and the average NFLT measures global damage, they provide different diagnostic information that may be synergistic.

Correlation of Retinal Nerve Fiber Layer Thickness and Axial Length on Fourier Domain Optical Coherence Tomography

INTRODUCTION

The assessment of the peripapillary Retinal Nerve Fiber Layer (RNFL) thickness has been an important tool for evaluating and diagnosing glaucoma and its progression. Literature suggests that myopic eyes are at an increased risk for developing glaucoma. This study gives an insight into the relationship of RNFL thickness to the axial length in normal population.

AIM

To correlate the RNFL thickness and the axial length in normal individuals with Fourier domain Optical Coherence Tomography (OCT).

MATERIALS AND METHODS

In the current study, 298 eyes of 149 normal individuals (10 years or older) with or without refractive error were recruited. The RNFL thickness was measured using Optovue (RTVue) three-dimensional Fourier domain OCT.

RESULTS

We observed an inverse relationship between average RNFL thickness and increasing axial length(p=0.003). Maximum RNFL thickness was seen in the Infero-Temporal (IT) quadrant and minimum in the Supero-Nasal (SN) quadrant. RNFL thickness did not show any tendency to decline with age using the Pearsons correlation (r=0.07). Females had an increased RNFL thickness in the Supero-Temporal (ST) and Infero-Nasal (IN) quadrant (p-value 0.046 and 0.02) in comparison to males. There was a statistically significant thinning in Ganglion Cell Complex (GCC) with increasing axial length (p-value 0.000).

CONCLUSION

The current study suggests that the average RNFL thickness does not decrease with age. The RNFL and GCC thickness shows an inverse correlation with axial length of the eyeball hence observations have to be carefully interpreted in myopic eyes. Clinicians need to keep the anatomical variations in RNFL for better patient management.