A comparative study of spectral-domain optical coherence tomography findings in papilledema and pseudopapilledema

The purpose of this study was to model the influence of cataract on Spectral Domain Optical Coherence Tomography (SDOCT) image quality and Retinal Nerve Fibre Layer (RNFL) thickness measurements. SDOCT images, made with two different devices (3DOCT-1000, Topcon and Cirrus HD-OCT), before and after cataract surgery were compared and judged against measurements from normal subjects using artificial filters simulating the effects of cataract. Optical density of the images was calculated based on a mathematical model described previously. In total, forty-eight eyes were included for pre- and postoperative cataract extraction measurements. OCT image quality significantly (p < 0.001) improved postoperative and postoperative RNFL thickness was significantly (p < 0.001) thicker in both groups of patients. The measurements using artificial filters showed a rather precise linear relation between change in filter induced optical density and change in RNFL thickness (R = 0.941, p < 0.001 for 3DOCT-1000 and R = 0.785, p < 0.001 for Cirrus HD-OCT). For the patient groups, the relation was less marked, 3DOCT-1000 Rs = 0.697, p < 0.03 and Cirrus HD-OCT Rs = 0.444, p < 0.03. The predictive potential based on the found linear relationship between OCT-effective optical density of cataract and the cataract-induced underestimation was however limited, and mean difference ± SD between predicted and measured RNFL thickness were 1.68 ± 7.55 (3DOCT-1000) and 3.71 ± 2.97 (Cirrus HD-OCT) micron. A linear relationship exists between OCT-effective optical density of cataract and underestimation of RNFL thickness measured with OCT. This finding holds promise to correct for cataract-induced changes in RNFL measurements, but will differ for each type of OCT device.

Purpose: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured by spectral and time domain optical coherence tomography (OCT).Patients and Methods: One hundred and eighty-eight subjects (normal tension glaucoma, n = 80; primary open angle glaucoma, n = 49; healthy controls, n = 59) were included in this study. Peripapillary RNFL thickness was measured by an Optic Disc Cube 200 × 200 scan of the spectral domain Cirrus HD OCT and by a Fast RNFL scan of the time domain Stratus OCT. They were compared using linear regression (R2), Bland-Altman plots, weighted Kappa (Kw) coefficients, and areas under the receiver operating characteristic curve (AROC).Results: Except for the inferior quadrant, RNFL thickness measurements by Cirrus HD OCT were thinner than Stratus OCT (all p < 0.001); for the inferior quadrant, this tendency was vice versa (p = 0.043). Average RNFL thicknesses of the two OCTs showed a good correlation (R2, 0.852) but not excellent agreement (mean of difference, 4.0 μm; +1.96 SD, 10.7 μm; -1.96 SD, -18.6 μm). Regarding the probability codes, only the average RNFL thickness had almost perfect agreement (Kw, 0.983). In addition, Cirrus HD OCT had the largest AROC for the superior quadrant (0.795), but Stratus OCT had the largest AROC for average RNFL thickness (0.764) (p = 0.281).Conclusions: Except for the inferior quadrant, the average and quadrants RNFL thickness measured by the Cirrus HD OCT were thinner than the Stratus OCT. Regarding discriminating power for glaucoma detection, the Cirrus HD OCT was better than the Stratus OCT for the superior and inferior quadrant RNFL thicknesses but not for the average RNFL thickness.

Objective: To discuss the correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the visual field mean defect in different periods of pseudoexfoliation glaucoma (PXG). Methods: This was a clinical case control study. In the study, samples were selected consecutively from patients who were hospitalized in the Glaucoma Department of the First Hospital of Shijiazhuang from January 2013 to January 2018. The PXG group included 97 eyes of 97 patients who were divided into an early PXG group (28 eyes), a medium PXG group (27 eyes), and a late PXG group (42 eyes). The normal control group consisted of 32 eyes of 32 people who were matched for age, gender and refractive error. All subjects underwent spectral domain optical coherence tomography (SD-OCT) scans to measure peripapillary RNFL thickness in every quadrant. The SD-OCT and the visual field measurements among the different groups were compared using analysis of variance, and the correlation between the average RNFL thickness and visual field defects were analyzed with a Pearson correlation. Results: The average RNFL thickness in the normal control group, and the early, medium and late PXG groups was 104±11 μm, 92±14 μm, 82±12 μm, and 54±18 μm, respectively. The difference between the 4 groups in nasal, nasal superior, temporal superior, temporal, temporal inferior, nasal inferior quadrants and the average RNFL thickness were all statistically significant (F=24.38, 36.40, 47.84, 8.70, 95.46, 54.75, 82.28, all P<0.001). The differences between the normal control group and the early PXG group in the temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences between the normal control group and the medium PXG group in the nasal, nasal superior, temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences in RNFL thickness between the normal control group and the late PXG group in every quadrant were statistically significant (P<0.001). The average RNFL thickness was positively correlated with visual field mean differences in the medium PXG group and the late PXG group (r=0.404, P=0.037; r=0.582, P<0.001). Conclusions: The average peripapillary RNFL thickness is positively correlated with visual field mean differences in the medium and late PXG eyes. The changes of peripapillary RNFL thickness can be monitered by SD-OCT, which can be used as an important reference index for the status and follow-up of PXG. Key words: optical coherence tomography; pseudoexfoliation glaucoma; peripapillary retinal nerve fiber layer thickness; visual field mean defect; correlation

This study aimed to investigate normal values and interocular differences in retinal nerve fibre layer (RNFL) thickness, using optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT), in 5-16-year-old children born at full-term with normal birthweights. Fifty-six children with normal visual acuity and refraction were examined with Stratus OCT and HRT. Three examinations were performed in each eye. One eye in each child was randomized for analyses of normal values. Findings in 54 eyes were evaluated. Mean values of RNFL thickness were calculated. Coefficients of variance and intraclass correlations were calculated. The correlation between right and left eyes and the limits of difference were determined for both methods. Mean RNFL thickness was 98.4 μm (standard deviation [SD] 7.88 μm) assessed with OCT and 213.0 μm (SD 54.0 μm) assessed with HRT. No correlations between age or gender and RNFL thickness were found. The coefficients of variance were 2.9% and 5.6% for OCT and HRT, respectively, and intraclass correlations were 0.85 and 0.88, respectively. The limits of difference between the two eyes ranged from -9 μm to 9 μm with OCT and from -109 μm to 87 μm with HRT. Both OCT and HRT can be used in children aged 5-16 years, but OCT provides less variability in determinations of RNFL thickness, both in repeated examinations of the same eye and in comparisons between the two eyes. The present study provides values for normal RNFL thickness in healthy children which can be used to make comparisons with values in children with optic nerve diseases.

Peripapillary retinal nerve fiber layer (RNFL) thickness measurements may be influenced by the range and severity of lesions that are observed distinctively in each retinal disease. We investigated the effects of various macular (central serous chorioretinopathy, macular hole, epiretinal membrane, wet age-related macular degeneration) and retinal vascular (branch retinal vein occlusion, central retinal vein occlusion, diabetic macular edema) diseases on peripapillary RNFL thickness measurements using spectral-domain optical coherence tomography. Six hundred thirty-one eyes from 464 patients with various retinal diseases and 167 controls of similar age were included in this retrospective study. Using spectral-domain optical coherence tomography, we measured the thickness of the macula and the RNFL in both various retinal disease eyes and normal control eyes. Four sectorial and average RNFL thicknesses were compared between each disease and age-matched control eyes. The macular thicknesses were also compared. In the macular disease group, superior (P = .033) and temporal (P = .024) quadrant RNFL thicknesses of central serous chorioretinopathy and temporal (P < .001) quadrant RNFL thicknesses of epiretinal membrane were greater than the age-matched control eyes. No RNFL measurements in macular hole or wet age-related macular degeneration differed significantly from the controls. In the retinal vascular disease group, all sectorial and average RNFL thicknesses of diabetic macular edema and central retinal vein occlusion were greater than those of the controls (all P < .05). In branch retinal vein occlusion, superior (P = .012) and temporal (P < .001) quadrant RNFL thicknesses were greater than those of the controls. Peripapillary RNFL thickness measurements may be influenced by the range and severity of lesions that are observed distinctively in each retinal disease. It also appeared that macular disease had a local effect on RNFL thickness, whereas retinal vascular disease had a diffuse effect on RNFL thickness.

The aim of this study was to assess parameters of retinal morphology by using high-definition optical coherence tomography (OCT) in patients with Wolfram syndrome (WFS) and their relation to optic tract atrophy in magnetic resonance imaging (MRI). High-definition OCT and MRI parameters were evaluated in 12 patients with WFS (three males, nine females; median age at examination 12y 8mo, range 10y 2mo-15y 11mo) and referred to 30 individuals with type 1 diabetes (T1D) (12 males, 18 females; median age at examination 20y 5mo, range 16y 8mo-21y 4mo) and 33 typically developing comparison participants (10 males, 23 females; median age at examination 20y 7mo, range 13y-22y 4mo). Total thickness and quadrant thickness of the retinal nerve fibre layer (RNFL), macular full-thickness parameters and macular ganglion cell layer/inner plexiform layer, intraorbital and intracranial thickness of the optical nerve, as well as the optic chiasm and visual tracts were significantly reduced in patients with WFS compared with those having T1D and the typically developing comparison participants. Optic chiasm thickness correlated negatively in patients with WFS with both age (r=-0.79; p=0.002) and duration of diabetes (r=-0.62; p=0.032). Thickness of the intraorbital parts of the optic nerves in patients with WFS correlated positively with thickness of the superior RNFL (r=0.73; p=0.006). High-definition OCT in combination with MRI could become an important tool for evaluating the effectiveness of therapeutic trials in patients with WFS. Provides evidence of significant reduction of retinal parameters and optic nerves in patients with Wolfram syndrome (WFS). Shows correlations between magnetic resonance imaging parameters and retinal morphology parameters in patients with WFS.

To develop an automated method for the quantification of volumetric optic disc swelling in papilledema subjects using spectral-domain optical coherence tomography (SD-OCT) and to determine the extent that such volumetric measurements correlate with Frisén scale grades (from fundus photographs) and two-dimensional (2-D) peripapillary retinal nerve fiber layer (RNFL) and total retinal (TR) thickness measurements from SD-OCT. A custom image-analysis algorithm was developed to obtain peripapillary circular RNFL thickness, TR thickness, and TR volume measurements from SD-OCT volumes of subjects with papilledema. In addition, peripapillary RNFL thickness measures from the commercially available Zeiss SD-OCT machine were obtained. Expert Frisén scale grades were independently obtained from corresponding fundus photographs. In 71 SD-OCT scans, the mean (± standard deviation) resulting TR volumes for Frisén scale 0 to scale 4 were 11.36 ± 0.56, 12.53 ± 1.21, 14.42 ± 2.11, 17.48 ± 2.63, and 21.81 ± 3.16 mm(3), respectively. The Spearman's rank correlation coefficient was 0.737. Using 55 eyes with valid Zeiss RNFL measurements, Pearson's correlation coefficient (r) between the TR volume and the custom algorithm's TR thickness, the custom algorithm's RNFL thickness, and Zeiss' RNFL thickness was 0.980, 0.929, and 0.946, respectively. Between Zeiss' RNFL and the custom algorithm's RNFL, and the study's TR thickness, r was 0.901 and 0.961, respectively. Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches.

Background/aimsTo assess the changes of ganglion cell–inner plexiform layer (GCIPL) thickness, retinal nerve fibre layer (RNFL) thickness, and central subfield thickness (CST) after panretinal photocoagulation (PRP) in diabetic retinopathy for...

To analyze the long-term changes of peripapillary retinal nerve fiber layer (RNFL) thickness before and after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy. In this retrospective observational case series, we reviewed the records of 46 patients (68 eyes) with severe diabetic retinopathy, who were treated with PRP and could be followed for more than 6 months. Peripapillary RNFL thickness and foveal thickness were measured at baseline, 3-month intervals until 1 year post-PRP, and 6- to 12-month intervals after 1 year post-PRP using optical coherence tomography. Long-term changes of peripapillary RNFL thickness and foveal thickness as well as the correlation between the two parameters were analyzed. The average RNFL thickness (360° measurement) decreased significantly from 108.4 μm to 103.5 μm at 2 years post-PRP. The average RNFL thickness increased slightly during the initial 3 months post-PRP and thereafter gradually decreased, showing statistically significant reductions at 2 years post-PRP (false discovery rate adjusted P = 0.0051). The superior and inferior quadrant RNFL thicknesses were significantly decreased at 2 years post-PRP (false discovery rate adjusted P = 0.0119 and 0.0051, respectively). The decrease in the nasal quadrant RNFL thickness showed borderline significance at 2 years post-PRP (false discovery rate adjusted P = 0.0854). However, there was no significant decrease in RNFL thickness for the temporal quadrant at any follow-up time. In addition, there was no significant difference in the foveal thickness. But, the pattern of temporal changes in foveal thickness showed a similar pattern with that of temporal RNFL thickness. This study shows that average RNFL thickness after PRP undergoes early thickening and subsequent progressive thinning throughout the 2 years post-PRP. This temporal change varies according to the peripapillary RNFL quadrant. Our results also indicate that temporal RNFL and foveal thickness have a similar pattern of long-term change after PRP.

To investigate whether persistent visual field defects among patients exposed once to the antiepileptic drug vigabatrin (VGB) were associated with peripapillary retinal nerve fibre layer thickness (RNFLT) attenuation. Nine individuals with partial epilepsy and VGB-attributed visual field loss (group 1; 18 eyes) and seven age- and gender-matched individuals with epilepsy and no previous VGB exposure (group 2; 14 eyes) were included in the study. Full-field 120 point screening perimetry out to 60 degrees from central fixation using the Humphrey Field Analyzer was performed. RNFLT was quantified by optical coherence tomography (OCT) using Fast RNFLT protocol, Stratus OCT (3.0) after pupillary dilation. The results from the right eye are presented in this article. Among the patients with VGB-attributed visual field loss, five patients had only peripheral field defect (group 1a) and the remaining four had advanced field defects both in the periphery and within 30° from central fixation (group 1b). None of the patients in the control group had manifest visual field loss. The mean RNFLT among the patients with VGB-attributed visual field loss was significantly attenuated compared to the controls [mean total RNFLT: group 1: 75.6 ± 12.7 μm, group 2: 103.5 ± 9.7 μm, mean difference 27.9 μm, (CI 15.9-39.9; p < 0.001)]. RNFLT values classified as borderline according to normative database (Stratus OCT) occurred more frequently among individuals with VGB-attributed visual field loss than in controls (frequency in group 1: 6/9; group 2: 0/7, p = 0.011). The nasal, superior and inferior quadrants of RNFLT in individuals with VGB-attributed visual field loss were significantly attenuated, while no difference was detected in temporal quadrants compared to controls. Both individuals with peripheral and those with advanced visual field losses in the VGB group had attenuated mean total RNFLT compared to controls (p = 0.006, p = 0.002, respectively). Occurrence of borderline classification of total RNFLT ≤5th percentile was more frequent among individuals with advanced visual field loss than among controls (p = 0.048). Persistent visual field loss attributed to VGB is associated with reduced peripapillary RNFLT and was detected both among patients with advanced and among patients with only peripheral visual field defects. Measurements of RNFLT with OCT might be considered as a diagnostic supplement in the follow-up of patients exposed to vigabatrin.

Purpose: To assess the reproducibility and repeatability of peripapillary retinal nerve fibre layer (RNFL) thickness measurements using a spectral-domain optical coherence tomography (SD-OCT) device in healthy subjects. Methods: In this observational study, 68 young Caucasian healthy volunteers (68 eyes) were subjected to Cirrus™ high-definition (HD) OCT (Zeiss) peripapillary RNFL thickness measurements by two experienced examiners in two different sessions. Average, 4-quadrant and 12-clock-hour sector RNFL thicknesses were analysed. For each option, intra-observer, intrasession repeatability and interobserver, intersession reproducibility were tested. To assess the repeatability of measurements, the Bland and Altman plots were used and the coefficient of repeatability was calculated. Interobserver and intersession reproducibilities were analysed by means of concordance correlation coefficients (CCCs). Results: The sample age ranged from 21 to 39 years (mean 29.09, standard deviation ±5.21). The average RNFL thickness ranged from 90.97 to 91.46 and from 91.34 to 91.78 µm, for the first and the second operator, respectively. The highest repeatability and reproducibility were obtained for average RNFL thickness with coefficients of repeatability of 5.30 and 6.05 µm for the first and the second operator, interoperator CCCs of 0.95 and 0.96 for the first and the second session, and intersession CCCs of 0.96 and 0.97 for the first and the second operator, respectively. Conclusions: Cirrus OCT peripapillary average RNFL thickness measurement in young healthy subjects showed high interoperator and intersession reproducibility. Intrasession repeatability as tested by coefficient of repeatability was next to the device resolution, with very similar results between the two operators. When analysing quadrant and clock hour sector RNFL thickness measurements, both repeatability and reproducibility tend to decrease.

ABSTRACTPurpose: To investigate the repeatability of macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements made using swept-source optical coherence tomography (SS-OCT) and automated segmentation. Measurements were made in non-diabetic controls and in patients with diabetic retinopathy (DR) with or without diabetic macular edema (DME).Materials and Methods: A total of 131 eyes of 131 participants were included. Fifty-one eyes with DR had no DME (DME[–]), 45 eyes with DR had DME (DME[+]), and 35 eyes were healthy. Measurements of RNFL and full retinal thickness were simultaneously obtained with SS-OCT in the peripapillary area and in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields using the wide three-dimensional mode. All measurements were made twice on the same day by a single examiner to test intra-observer repeatability. Intraclass correlation coefficients (ICCs) and coefficients of repeatability were examined to evaluate repeatability.Results: Average macular and temporal peripapillary RNFL thickness values were greater in the DME[+] group (36.4 ± 13.2 and 83.8 ± 19.4 µm, respectively) than in the control (27.4 ± 3.5 and 73.5 ± 11.4 µm, respectively) and DME[–] (27.9 ± 3.4 µm and 70.3 ± 11.3 µm, respectively) groups (both P < 0.001). The ICCs of average macular (control: 0.982, DME[–]: 0.913, and DME[+]: 0.970) and peripapillary (control: 0.972, DME[–]: 0.973, and DME[+]: 0.958) RNFL thickness measurements indicated good repeatability in all three study groups.Conclusions: Although the ICCs of average RNFL thickness measurements were relatively lower in eyes with DR than in healthy controls, the intra-observer repeatability of SS-OCT RNFL and full retinal thickness measurements is sufficiently reliable for them to be clinically useful.

To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high-pass resolution perimetry (HRP). Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans-sphenoidal and one trans-cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino-cortical neural channels in HRP. RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression.

AimTo evaluate the influence of axial length on retinal nerve fibre layer (RNFL) thickness in myopic, hyperopic and emmetropic eyes by spectral domain optical coherence tomography (OCT).MethodsSubjects were divided into...

Objective: To establish a database of the peripapillary retinal nerve fiber layer (RNFL) thickness in myopic and emmetropic children; to analyze the thickness and distribution of the peripapillary RNFL topographical map in children and adolescents with different degrees of myopia; and to measure regional differences in the thickness of the peripapillary RNFL and the factors that influence it in myopic and emmetropic children. Methods: This was a population-based, cross-sectional study. The average thickness of the peripapillary RNFL in children 6-18 years old was measured by spectral domain-optical coherence tomography. Ophthalmic parameters and systemic parameters, including height, weight, body mass index, head circumference, chest circumference, waist circumference, and blood pressure were measured. The children were divided into different refractive groups based on spherical equivalent (SE). The thickness of the peripapillary RNFL in different quadrants under different refractive conditions and relevant influencing factors were analyzed. The correlation between the average RNFL thickness and all parameters was analyzed by a simple linear regression and multiple stepwise regression. Differences between the groups were analyzed by one-way analysis of variance. Results: The average thickness of the peripapillary RNFL in 1 056 myopic and emmetropic children was 104±10 µm. It was 107±9 µm for emmetropes, and 105±9 µm for mild myopes, 101±10 µm for moderate myopes, and 95±8 µm for high myopes. The RNFL in emmetropes was thicker than in mild myopes (P=0.007) and moderate and high myopes (P<0.001 each). The RNFL thickness was positively correlated with SE (r=0.25, P<0.001) and lens thickness (r=0.10, P=0.033). It was negatively correlated with axial length (r=-0.18, P<0.001), but not correlated with age, sex, or other parameters. In all subjects, the inferior temporal quadrant was thickest, 162±23 µm, and the nasal quadrant thinnest, 61±10 µm. The topographical distribution for each group was different. The infratemporal sector was the thickest, and the nasal sector was the thinnest. The thickness of the temporal peripapillary RNFL increased with an increase in the degree of myopia. In mild myopes it was 87±14 µm, and in high myopes it was 98±21 µm. The thickness in other quadrants changed in the opposite direction, especially the infranasal sector. Conclusions: The average thickness of the peripapillary RNFL was positively correlated with SE and lens thickness, and negatively correlated with axial length. The topographical distribution was different in each myopia group. The thickness of the temporal quadrant gradually increased with increased degree of myopia, while that of the other quadrants decreased. Key words: myopia; retinal nerve fiber layer; optical coherence tomography