Macular morphology in patients with optic nerve head drusen and optic disc edema.

PURPOSE: In this study we investigated macular morphology, including individual retinal layers, in patients with optic nerve head drusen (ONHD) and optic disc edema (ODE) compared with healthy participants, using high-resolution spectral domain optical coherence tomography (OCT). DESIGN: Prospective, cross-sectional, observational study. PARTICIPANTS: A total of 67 patients with ONHD, 36 patients with ODE, and 57 healthy participants. METHODS: High-resolution spectral domain OCT (Copernicus [OPTOPOL Technology S.A., Zawiercie, Poland] 3-µm resolution, 7 × 7 × 2-mm volumetric scans) was used to image macula morphology. Average retinal nerve fiber layer (RNFL) thickness was measured using a semiautomated method with manual correction of the internal limiting membrane, RNFL, and retinal pigment epithelium (RPE). Retinal and RNFL thicknesses were measured and analyzed in 3 circular zones (Early Treatment Diabetic Retinopathy Study protocol). Individual retinal layers at the macula were quantified by analyzing tomograms using ImageJ (http://rsbweb.nih.gov/ij/; Accessed June 1, 2013). MAIN OUTCOME MEASURES: Average retinal and individual retinal layer thickness in patients with ODE or ONHD, and healthy controls. RESULTS: Patients with ONHD had thicker retinae in the inner annulus compared with patients with ODE and controls (significant in the temporal segment compared with those with ODE [P = 0.013] and in the superior segment compared with controls [P = 0.05]). Patients with ONHD had a significantly thinner inner plexiform layer (IPL) (P = 0.02), nerve fiber layer (P = 0.05), and RPE (P = 0.0001), and thicker ganglion cell layer (P = 0.003) and outer plexiform layer (OPL) (P < 0.001) compared with controls. Patients with ODE demonstrated the thickest retina and RNFL in the outer annulus (significant in the inferior segment compared with controls, P = 0.02 for both) with significant thickening in the IPL (P = 0.004), OPL (P < 0.003), and outer segment layer (P ≤ 0.02), and severe ganglion cell loss (P = 0.004) and RPE (P = 0.0001) thinning compared with healthy volunteers. CONCLUSIONS: Our study shows that optic nerve diseases are associated with selective changes in different retinal layers in patients with ODE and ONHD. These findings may be of diagnostic value and could be taken into consideration in assessing patients and studying the pathogenesis of these conditions.

Gender- and Ethnicity-Related Differences in Optic Nerve Head Topography in Healthy Indian and Caucasian Participants.

We investigated the effect of ethnicity and gender on optic nerve head morphology in healthy subjects using spectral-domain optical coherence tomography (SD-OCT). Thirty-five Indian (i.e. Indian subcontinent) females, 34 Caucasian females, 32 Indian males, and 32 Caucasian males were examined using SD-OCT (Copernicus, Optopol Technology). Disc and rim areas were larger in Caucasian males compared with females but smaller in Indians males compared with females. Indian participants had significantly larger cup areas and volumes without significant differences in retinal nerve fibre layer (RNFL) thicknesses between groups. Gender and ethnicity differences should be considered in assessment of patients.

Short-term progression of optic disc and macular changes in optic nerve head drusen.

PURPOSE: To quantify in patients with optic nerve head drusen (ONHD)changes after 1-year observation in: (i) optic disc and (ii) macular optical coherence tomography (OCT) parameters and (iii) the effect of age at enrolment in the study. DESIGN: Prospective, cross-sectional observational study using Spectral Domain-OCT (Copernicus; OPTOPOL Technology S.A., Zawiercie, Poland) imaging was carried out in 35 patients with ONHD (age-42.8 ± 19.9 years; males = 15; females = 20) at baseline and after 12 months follow-up. RESULTS: Patients with ONHD had significant thinning of the surface nerve fibre layer in the central (p = 0.03), superior (p = 0.05) and inferior (p = 0.04) areas; mean ppRNFL thinning (p = 0.0 4) and ppRNFL thinning in the nasal segment (p = 0.028). Retinal thinning in the central (p = 0.001), inner (p = 0.01) and outer (p = 0.002) temporal, outer superior (p = 0.03) and inferior (p = 0.02) areas; borderline ganglion cell layer thinning (p = 0.051) and outer nuclear layer (p = 0.03) thinning in the central retina and outer segment layer thinning nasally (p = 0.01) between the first and the second visit in macula. Correlation of the difference in optic disc and macular parameters with the age at enrolment did not reveal any significance. CONCLUSIONS: Statistically detectable thinning of the optic nerve and macula structures occurred already after 12 months. The proximity of optic nerve changes to the vascular arcades can possibly be explained by involvement of retinal vessels in the pathophysiology of ONHD.

Detection and characterisation of optic nerve and retinal changes in primary congenital glaucoma using hand-held optical coherence tomography.

OBJECTIVE: To investigate (1) the feasibility of scanning the optic nerve (ON) and central retina with hand-held optical coherence tomography (HH-OCT) without sedation or anaesthesia in primary congenital glaucoma (PCG), (2) the characteristics of ON changes in comparison with adult primary open-angle glaucoma (POAG) in comparison with matched controls, (3) the sensitivity and specificity of ON parameters for diagnosis, and (4) changes of foveal morphology. METHODS AND ANALYSIS: HH-OCT (Envisu 2300; Leica Microsystems) was used to investigate ON and foveal morphology of 20 children with PCG (mean age 4.64±2.79) and 10 adult patients with POAG (mean age 66.8±6.94), and compared with age-matched, gender-matched and ethnicity-matched healthy controls without sedation or anaesthesia. RESULTS: HH-OCT yielded useful data in 20 out of 24 young children with PCG. Patients with PCG had significantly deeper cup changes than patients with POAG (vs respective age-matched controls, p=0.014). ON changes in PCG are characterised by significant increase in cup depth (165%), increased cup diameter (159%) and reduction in rim area (36.4%) as compared with controls with high sensitivity (81.5, 74.1% and 88.9%, respectively) and specificity (85.0, 80.0% and 75.0%, respectively). Patients with PCG have a significantly smaller width of the macula pit (p<0.001) with non-detectable external limiting membrane. CONCLUSION: HH-OCT has the potential to be a useful tool in glaucoma management for young children. We have demonstrated the use of HH-OCT in confirming a diagnosis of glaucoma within the studied cohort and found changes in disc morphology which characterise differently in PCG from POAG.

Assessment of the anterior segment of patients with primary congenital glaucoma using handheld optical coherence tomography.

PURPOSE: To investigate the potential of handheld optical coherence tomography (HH-OCT) in assessing the anterior segment of the eye in patients with primary congenital glaucoma. DESIGN: A prospective, case-controlled observational study. PARTICIPANTS: Twenty-two patients with primary congenital glaucoma (PCG, 9 females and 13 males; mean age 4.36 ± 3.4 years) and age-, gender- and ethnicity-matched healthy participants. METHODS: Anterior OCT was performed in all participants using a high-resolution HH SD-OCT device (Envisu 2300, Leica Microsystems, Germany) without anaesthesia or sedation. RESULTS: Anterior HH-OCT in PCG visualised Haab's striae in 14.3%, uneven internal cornea in 9.5% and epithelial thickening in 11.9% of patients with central corneal thickening (CCT, p < 0.001). CCT was significantly correlated with the intraocular pressure (IOP, p < 0.001). The flat iris with a thin collarette zone was found in 59.5%, anterior iris insertion in 11.90% of eyes affected by PCG. Two independent examiners showed sensitivity and specificity of 87% and 77%, respectively, by instating iris thinning and flattening of the anterior profile. CONCLUSIONS: Anterior HH-OCT has significant potential to improve diagnosis and management of PCG. Clinically relevant information can be obtained non-invasively and without sedation. High specificity makes anterior HH-OCT an important adjunct for management of PCG. Excellent visualisation of the iris insertion on OCT indicates potential for AS OCT to assist with surgical planning, including decision on the type of surgery and location of the incision.

Normal macular structure measured with optical coherence tomography across ethnicity.

OBJECTIVE: The difference in prevalence of various retinal pathologies in people of different ethnicity is well established. Optical coherence tomography (OCT) is a widely used technique that allows quantitative analysis of macular structure. In this study, we investigated macular layer morphology in healthy subjects using high-resolution spectral domain (SD) OCT across ethnicities comparing Asian (ie, Indian subcontinent) and Caucasian individuals. METHODS: 133 healthy volunteers (67-Asian, 66-Caucasian) were examined using SD-OCT. Average retinal and nerve fibre layer thickness were measured in a semiautomated way. Analysis of the measurements of each retinal layer at the macula was quantified using tomograms obtained by SD-OCT. RESULTS: In this study, we find significant difference in macular structure in Asian and Caucasian participants. Caucasian subjects have thicker inner segment (p=0.015 in the central region), outer segment (p=0.04 in the temporal region) and outer nuclear (p=0.021 and p=0.03 for the central and temporal regions, respectively) layers, while Asians demonstrate thicker retinal pigment epithelial layer (p=0.004 for the temporal region). CONCLUSIONS: Differences in macular morphology due to ethnicity should be considered in determining control values for diagnostic purposes, and can be used to guide future studies in risk and prognosis for macular pathologies.

Morphology of retinal vessels in patients with optic nerve head drusen and optic disc edema.

PURPOSE: We quantitatively investigated the peripapillary vascular morphology in patients with optic nerve head drusen (ONHD) and optic disc edema (ODE). METHODS: Computer-based fundus analysis was used to investigate peripapillary vascular morphology, including length, branching, and diameter of arteries and veins calibrated by optical coherence tomography. RESULTS: Patients with ONHD showed significantly larger diameters of arteries without branching (P = 0.05), and arteries after primary/before secondary branching (P = 0.04) and secondary venous branching started closer to the optic disc (P = 0.03) compared to healthy controls. The ODE patients had significantly reduced number of small peripapillary veins and larger number of veins without branching compared to ONHD and controls (P = 0.02). Anomalous branching with arterial and venous trifurcation presented in the ODE and ONHD groups, with significant higher prevalence in ODE patients for venous trifurcations compared to ONHD and controls (P = 0.02). CONCLUSIONS: The diameter of vessels in ONHD patients were significantly larger in arteries without branching (P = 0.05), after primary branching (P = 0.04), and venous branching closer to the disc area (P = 0.03) compared to controls. The ODE patients demonstrated widening of the small peripapillary veins measured by a significantly larger number of veins without branching (P = 0.001 and P = 0.02, compared to controls and ONHD, respectively) and less small veins (P = 0.001 and P = 0.04, compared to controls and ONHD, respectively).