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      Ability of spectral domain optical coherence tomography peripapillary retinal nerve fiber layer thickness measurements to identify early glaucoma

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          Abstract

          Purpose:

          To evaluate the ability of spectral domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness (RNFLT) parameters to distinguish normal eyes from those with early glaucoma in Asian Indian eyes.

          Design:

          Observational cross-sectional study.

          Materials and Methods:

          One hundred and seventy eight eyes (83 glaucoma patients and 95 age matched healthy subjects) of subjects more than 40 years of age were included in the study. All subjects underwent RNFLT measurement with spectral OCT/ scanning laser ophthalmoscope (SLO) after dilatation. Sensitivity, specificity and area under the receiving operating characteristic curve (AROC) were calculated for various OCT peripapillary RNFL parameters.

          Results:

          The mean RNFLT in healthy subjects and patients with early glaucoma were 105.7 ± 5.1 μm and 90.7 ± 7.5 μm, respectively. The largest AROC was found for 12 o’clock- hour (0.98), average (0.96) and superior quadrant RNFLT (0.9). When target specificity was set at ≥ 90% and ≥ 80%, the parameters with highest sensitivity were 12 o’clock -hour (91.6%), average RNFLT (85.3%) and 12 o’ clock- hour (96.8 %), average RNFLT (94.7%) respectively.

          Conclusion:

          Our study showed good ability of spectral OCT/ SLO to differentiate normal eyes from patients with early glaucoma and hence it may serve as an useful adjunct for early diagnosis of glaucoma.

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          Most cited references16

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          Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography.

          Quantitative assessment of nerve fiber layer (NFL) thickness in normal and glaucomatous eyes, and correlation with conventional measurements of the optic nerve structure and function. We studied 59 eyes of 33 subjects by conventional ophthalmologic physical examination, Humphrey 24-2 visual fields, stereoscopic optic nerve head photography, and optical coherence tomography. Nerve fiber layer thickness as measured by optical coherence tomography demonstrated a high degree of correlation with functional status of the optic nerve, as measured by visual field examination (P = .0001). Neither cupping of the optic nerve nor neuroretinal rim area were as strongly associated with visual field loss as was NFL thickness (P = .17 and P = .21, respectively). Cupping correlated with NFL thickness only when the cup was small (cup-to-diameter ratio, 0.1 to 0.3) or large (cup-to-diameter ratio, 0.8 to 1.0) (P = .006); there was no correlation between cupping and NFL thickness otherwise. Nerve fiber layer, especially in the inferior quadrant, was significantly thinner in glaucomatous eyes than in normal eyes (P = .04). Finally, we found a decrease in NFL thickness with aging, even when controlling for factors associated with the diagnosis of glaucoma (P = .03). Nerve fiber layer thickness can be measured using optical coherence tomography. These measurements provide good structural and functional correlation with known parameters.
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            Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss.

            Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88% of readable photographs at the time field loss first occurred; 60% (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11% (3/27) of normal eyes and 26% (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage.
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              Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography.

              To evaluate the relationship between visual field and retinal nerve fiber layer (RNFL) thickness measured by optical coherent tomography (OCT) and to assess the diagnostic ability of OCT to distinguish between early glaucomatous or glaucoma-suspect eyes from normal eyes. Retrospective, non-randomized, cross-sectional study. A total of 160 eyes of 120 normal Japanese adults, 23 eyes of 16 patients with ocular hypertension, 38 eyes of 35 glaucoma-suspect patients, and 237 glaucomatous eyes of 140 glaucoma patients were enrolled in the study. The glaucoma group included 89 early glaucomatous eyes. Thickness of the RNFL around the optic disk was determined with three 3.4-mm diameter circle OCT scans. Average and segmental RNFL thickness values were compared among all groups. The correlation between mean deviation and RNFL thickness in glaucomatous eyes was also analyzed. Receiver operating characteristic (ROC) curve area was calculated to discriminate normal eyes from early glaucomatous or glaucoma-suspect eyes. A significant relationship existed between the mean deviation and RNFL thickness in all parameters excluding the 3-o'clock area. The average RNFL thickness had the strongest correlation in all parameters (r = -0.729, P <.001). Retinal nerve fiber layer thickness at the 7-o'clock inferotemporal segment had the widest areas under the ROC curves in all parameters for early glaucomatous eyes (0.873). Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage. Furthermore, OCT measurements of RNFL thickness may provide clinically relevant information in monitoring glaucomatous changes.
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                Author and article information

                Journal
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications (India )
                0301-4738
                1998-3689
                Nov-Dec 2011
                : 59
                : 6
                : 455-459
                Affiliations
                [1]Department of Glaucoma, Pushpagiri Eye Institute, 241, Uma Plaza, 10-2-342, Road No 9, West Marredpally, Secunderabad-500 026, Andhra Pradesh, India
                [1 ]Department of Biostatistics, National Institute of Nutrition, Hyderabad, Andhra Pradesh, India
                Author notes
                Correspondence to: Dr. Tarannum Mansoori, Department of Glaucoma, Pushpagiri Eye Institute, 241, Uma Plaza, 10-2-342, Road No 9, West Marredpally, Secunderabad-500 026, Andhra Pradesh, India. E-mail: tarannummansoori@ 123456yahoo.com
                Article
                IJO-59-455
                10.4103/0301-4738.86312
                3214415
                22011489
                b941b500-93a6-49e6-b15f-863b8f2f4ba2
                Copyright: © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 June 2010
                : 21 June 2011
                Categories
                Original Article

                Ophthalmology & Optometry
                early glaucoma,spectral optical coherence tomography / scanning laser ophthalmoscope,retinal nerve fiber layer thickness

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