Optic Nerve Head Drusen Prevalence and Associated Factors in Clinically Normal Subjects Measured Using Optical Coherence Tomography.

OBJECTIVE: To investigate the prevalence of optic nerve head drusen (ONHD) in clinically normal subjects using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate associated factors. DESIGN: Prospective, cross-sectional, observational study. PARTICIPANTS: Total of 130 clinically normal subjects. METHODS: Serial horizontal and vertical EDI OCT B-scans (interval between scans, ∼30 µm) of the optic nerve head (ONH) were obtained in both eyes of clinically normal subjects. Signs of ONHD were defined as horizontal hyperreflective bands perpendicular to the OCT beam with or without a signal-poor core. The minimum length of isolated hyperreflective bands was determined based on analysis of 34 eyes with clinically definite ONHD. Age, gender, ONH diameter, and axial length were obtained from participants. MAIN OUTCOME MEASURES: Prevalence of ONHD in clinically normal subjects and its association with age, gender, ONH diameter, and axial length. RESULTS: Based on the measurements of 94 isolated hyperreflective bands in the 34 eyes with clinically definite ONHD, the minimum length of isolated hyperreflective ONHD bands in clinically normal subjects was set as 45 µm (mean minus 2 standard deviations). Among 260 clinically normal eyes (130 subjects; 68 women; mean age, 40±17 years), EDI OCT was positive for horizontal hyperreflective ONHD bands in 28 eyes (10.8%) of 19 subjects (14.6%). Of these 28 eyes, 25 eyes (9.6% of total 260 eyes) of 16 subjects (12.3% of total 130 subjects) showed isolated hyperreflective bands with no signal-poor core, and 3 eyes (1.2% of total 260 eyes) of 3 subjects (2.3% of total 130 subjects) showed a signal-poor core surrounded by hyperreflective bands. No significant differences were found in mean age (44 vs. 39 years; P = 0.121) or gender distribution (56% vs. 52% female; P = 0.766) between clinically normal subjects with hyperreflective ONHD bands and those without. Logistic regression analysis showed that a decrease in ONH diameter by 100 µm and axial length by 1 mm increased the odds of ONHD presence by 1.5-fold (odds ratio [OR] = 1.56 [confidence interval (CI), 1.22-2.00]; P < 0.001) and 2-fold (OR = 2.00 [CI, 1.15-3.49]; P = 0.015), respectively. CONCLUSIONS: Subclinical ONHD may be more prevalent than previously believed. Significant associations of subclinical ONHD with smaller ONH and shorter axial length were found.

Glaucoma Diagnostic Capability of Circumpapillary Retinal Nerve Fiber Layer Thickness in Circle Scans With Different Diameters.

PURPOSE: To compare varying circumpapillary optical coherence tomographic (OCT) scan diameters for glaucoma diagnosis. MATERIALS AND METHODS: Prospective, cross-sectional, observational study. Circumpapillary retinal nerve fiber layer thickness (RNFLT) was measured using spectral-domain OCT in 1 randomly selected eye. Scans with diameters of 3.5, 4.1, and 4.7 mm were obtained, each with 7 parameters: mean global (G) RNFLT and mean RNFLT for the temporal-inferior (TI), nasal-inferior (NI), temporal-superior (TS), nasal-superior (NS), nasal (N), and temporal (T) sectors. Areas under the receiver operating characteristic curve (AUCs) were calculated. RESULTS: Mean age was 55±18 years in 68 healthy eyes and 59±15 years in 95 glaucomatous eyes (P=0.12). Visual field mean deviation was -7.55±6.61 dB in glaucomatous eyes. In all 3 circle scans, mean TI RNFLT had the greatest AUC (0.974 to 0.983), followed by mean G RNFLT (0.949 to 0.956). The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean TI RNFLTs in the 4.7- (0.978; P=0.128) and 3.5-mm (0.974; P=0.049) scans. The AUC of mean TI RNFLT in the 4.1-mm scan (0.983) was greater than the AUCs of mean G RNFLTs in the 3.5- (0.954; P=0.011), 4.1- (0.956; P=0.016), and 4.7-mm (0.949; P=0.011) scans. In 2 eyes with large parapapillary atrophy, RNFL segmentation error was noted only in the 3.5-mm scan in the area of parapapillary atrophy. CONCLUSIONS: Further investigations to find the spectral-domain OCT circle scan diameter with the best diagnostic capability and the least artifacts are warranted, especially focusing on larger-than-conventional circle scans.