Correlation between cup-to-disc ratio and cup/retrobulbar optic nerve diameter proportion assessed by high-resolution ultrasound in glaucomatous eyes

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Abstract

PURPOSE: To investigate the correlation between the measurements of the cup/retrobulbar optic nerve diameter (C/OND) proportion obtained by high-resolution 20-MHz B-mode ultrasound (US) and those of the cup/disc ratio (C/D) obtained by fundus biomicroscopy (BIO) and optical coherence tomography (OCT). METHODS: Thirty eyes of 15 glaucomatous patients with any C/D proportion were studied. All patients underwent examination of the vertical C/D by BIO with a 78D lens and time-domain OCT analysis, as well as the vertical C/OND proportion using 20-MHz US measurements. All data were analyzed by correlation and agreement tests. RESULTS: The Spearman test showed a strong correlation between C/D results obtained by BIO and the measurements of C/OND (US) (r=0.788, p<0.0001), and with C/D obtained by OCT (r=0.8529, p<0.0001). However, comparison of C/D results obtained with OCT to those obtained by with C/OND (US) showed only a moderate correlation (r=0.6727, p<0.0001). Bland-Altman analysis did not show good agreement between C/D (BIO) and C/OND (US). CONCLUSIONS: The results demonstrate that B-mode ultrasound examination with a 20 MHz probe can be a good additional method for the evaluation of the C/D ratio in glaucomatous patients, and may be considered as an alternative gross tool in glaucomatous patients with optic media opacities.

Translated abstract

OBJETIVOS: Verificar a correlação entre os achados da relação escavação/diâmetro do nervo óptico retrobulbar (E/DNO) obtidos pelo exame de ultrassom (US) modo B de alta resolução com sonda de 20 MHz e a relação escavação/disco (E/D) obtidos pela biomicroscopia de fundo de olho (BIO) e pela tomografia de coerência óptica (OCT). MÉTODOS: Foram analisados 30 olhos de 15 pacientes com diagnóstico de glaucoma com qualquer proporção da relação E/D. Todos os pacientes foram submetidos ao exame de BIO, com lente 78D, e de OCT, com tecnologia de domínio temporal, para a análise da relação E/D vertical e exame de US modo B, com sonda de 20 MHz, para determinação da proporção E/DNO vertical. Todos os resultados foram analisados por métodos de correlação e concordância. RESULTADOS: Observou-se forte correlação entre as medidas E/D obtidas pela BIO, e as medidas E/DNO (US) (r=0,788; p<0,0001), e com as medidas E/D obtidas pelo OCT (r=0,8529; p<0,0001). Porém, a análise entre as medidas E/DNO (US) e E/D (OCT) mostrou apenas níveis moderados de correlação (r=0,6727, p<0,0001). O teste de Bland-Altman não mostrou bons níveis de concordância entre E/D (BIO) e E/DNO (US). CONCLUSÕES: Os resultados demonstraram que o exame de US modo B com sonda de 20 MHz pode ser um bom método adicional para avaliar a relação E/D de pacientes com glaucoma, a ser considerado como uma ferramenta alternativa na avaliação de pacientes glaucomatosos com opacidades dos meios ópticos.

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Optic nerve head and retinal nerve fiber layer analysis: a report by the American Academy of Ophthalmology.

Shan Lin, Kuldev Singh, Henry D. Jampel … (2007)

To evaluate the current published literature on the use of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) measurement devices in diagnosing open-angle glaucoma and detecting progression. A search of peer-reviewed literature was conducted on February 15, 2006 in PubMed and the Cochrane Library for the period January 2003 to February 2006. The search was limited to studies of adults in English-language journals and yielded 442 citations. The panel reviewed the abstracts of these articles and selected 159 articles of possible clinical relevance for review. Of these 159 full-text articles, 82 were determined to be relevant for the first author and methodologist to review and rate according to the quality of evidence. There were no studies classified as having the highest level of evidence (level I). The ONH and RNFL imaging instruments reviewed in this assessment were determined to be highly effective in distinguishing eyes with glaucomatous visual field (VF) loss from normal eyes without VF loss, based on level II evidence. In addition, some studies demonstrated that parameters from ONH or RNFL imaging predicted the development of VF defects among glaucoma suspects. Studies on detecting glaucoma progression showed that although there was often agreement on progression between the structural and functional (VF) tests, a significant proportion of glaucoma patients progressed by either the structural or the functional test alone. The ONH and RNFL imaging devices provide quantitative information for the clinician. Based on studies that have compared the various available technologies directly, there is no single imaging device that outperforms the others in distinguishing patients with glaucoma from controls. Ongoing advances in imaging and related software, as well as the impracticalities associated with obtaining and assessing optic nerve stereophotographs, have made imaging increasingly important in many practice settings. The information obtained from imaging devices is useful in clinical practice when analyzed in conjunction with other relevant parameters that define glaucoma diagnosis and progression.

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Effects of changes in intraocular pressure on human ocular haemodynamics.

O Findl, William Vass, K Strenn … (1997)

Myogenic autoregulation is the ability of a vascular bed to maintain blood flow despite changes in perfusion pressure. Ocular perfusion pressure is defined as the difference between ocular arterial pressure and ocular venous pressure, the latter dependent on intraocular pressure (IOP). The aim of the present study was to investigate the effect of moderate increases in IOP on ocular haemodynamics. Changes in IOP (+ 10 mmHg, +20 mmHg) were induced by a suction cup in 10 healthy subjects. Ocular fundus pulsations in the macula and the optic disc were measured by laser interferometry; blood flow velocities in the central retinal artery (CRA) and in the ophthalmic artery (OA) were measured by Doppler sonography. Changes in IOP caused a significant reduction in fundus pulsations, which was more pronounced in the macula (at +10 mmHg: -9 +/- 2%, p < 0.01; at +20 mmHg: -19 +/- 3%, p < 0.001) than in the optic disc (at +10 mmHg: -5 +/- 2% (ns); at +20 mmHg: -9 +/- 3%, p < 0.01). Mean flow velocity in the CRA was reduced by -5 +/- 3% at +10 mmHg (ns) and by -14 +/- 5% at +20 mmHg (p < 0.005), resistive index was increased by +4 +/- 1% at +10 mmHg (p < 0.05) and by +6 +/- 2% at +20 mmHg (p < 0.01). In contrast, a rise in IOP did not affect blood flow parameters in the OA. Our results from fundus pulsation measurements indicate that choroidal blood flow decreases when IOP is increased. The Doppler sonographic findings in the CRA indicate reduced blood flow velocity in this artery during raised IOP.

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Retrobulbar optic nerve diameter measured by high-speed magnetic resonance imaging as a biomarker for axonal loss in glaucomatous optic atrophy.

T A Bley, Michael Bach, Lillian Buhler … (2009)

To assess a novel magnetic resonance imaging (MRI) protocol for quantifying the optic nerve diameter (OND) as a measure of axonal loss in the optic nerve. Included in the study was one eye each from 47 subjects, of whom 9 had no eye disease, 16 had preperimetric glaucoma, 11 had a glaucomatous mean visual field defect of 10 dB. Each subject underwent automated perimetry, scanning laser polarimetry, optic coherence tomography, scanning laser tomography, and ultrafast high-resolution MRI at 3 T. OND was determined 5, 10, and 15 mm behind the eye with a half Fourier-acquired single-shot turbo spin-echo (HASTE)-sequence requiring 1.5 seconds of data acquisition time per slice and providing a spatial resolution of 0.11 mm. A multiple linear regression model was applied to determine correlations (r) among the different techniques. The correlation (r) was <0.37 for OND measurements taken 5 mm behind the eye. At 10 mm behind the eye, r increased to 0.57 and was statistically significant in four out six instances. In the orbital apex 15 mm behind the eye, r reached a maximum of 0.80 and was statistically significant in all instances. OND correlated best with the retinal nerve fiber layer thickness measured by optic coherence tomography. Retina- or optic nerve head-related surrogate markers for axonal content correlated closely with the OND, although only when it was measured in the orbital apex. High-resolution MRI using an ultrafast HASTE-sequence at 3 T proved useful for OND quantification and may be a valuable asset in future neuroprotection trials.

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Author and article information

Contributors

Wilian Silva Queiroz: Role: ND

Daniel da Rocha Lucena: Role: ND

Juliana de Lucena Martins Ferreira: Role: ND

Maria de Lourdes Veronese Rodrigues: Role: ND

Jayter Silva Paula: Role: ND

Journal

Journal ID (publisher-id): abo

Title: Arquivos Brasileiros de Oftalmologia

Abbreviated Title: Arq. Bras. Oftalmol.

Publisher: Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )

ISSN (Print): 0004-2749

ISSN (Electronic): 1678-2925

Publication date (Print and electronic): October 2013

Volume: 76

Issue: 5

Pages: 274-277

Affiliations

[02] Fortaleza CE orgnameEscola Cearense de Oftalmologia orgdiv1Center for Ophthalmology Brazil

[01] Ribeirão Preto SP orgnameUniversidade de São Paulo orgdiv1School of Medicine of Ribeirão Preto Brazil

Article

Publisher ID: S0004-27492013000500004

DOI: 10.1590/S0004-27492013000500004

SO-VID: 4c33c524-53ec-4e51-9461-a67955a6a229

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This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date received : 11 January 2013

Date accepted : 12 June 2013

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Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 4

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SciELO Brazil

Keywords: Tomografia de coerência óptica,Ultrassonografia,Fundo de olho,Nervo óptico,Glaucoma,Tomography, optical coherence,Ultrasound,Fundus oculi,Optic nerve

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Keywords: Tomografia de coerência óptica, Ultrassonografia, Fundo de olho, Nervo óptico, Glaucoma, Tomography, optical coherence, Ultrasound, Fundus oculi, Optic nerve

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Most cited references 21

Optic nerve head and retinal nerve fiber layer analysis: a report by the American Academy of Ophthalmology.

Effects of changes in intraocular pressure on human ocular haemodynamics.

Retrobulbar optic nerve diameter measured by high-speed magnetic resonance imaging as a biomarker for axonal loss in glaucomatous optic atrophy.

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