Abstract
To investigate whether the position of the central retinal vascular trunk (CRVT), as a surrogate of lamina cribrosa (LC) offset, was associated with the presence of glaucoma in normal-tension glaucoma (NTG) patients. The position of the CRVT was measured as the deviation from the center of the Bruch's membrane opening (BMO), as delineated by spectral-domain optical coherence tomography imaging. The offset index was calculated as the distance of the CRVT from the BMO center relative to that of the BMO margin. The angular deviation of CRVT was measured with the horizontal nasal midline as 0° and the superior location as a positive value. The offset index and angular deviation were compared between glaucoma and fellow control eyes within individuals. NTG eyes had higher baseline intraocular pressure (P = 0.001), a larger β-zone parapapillary atrophy area (P = 0.013), and a larger offset index (P<0.001). In a generalized linear mixed-effects model, larger offset index was the only risk factor of NTG diagnosis (OR = 31.625, P<0.001). A generalized estimating equation regression model revealed that the offset index was larger in the NTG eyes than in the control eyes for all ranges of axial length, while it was the smallest for the axial length of 23.4 mm (all P<0.001). The offset index was larger in the unilateral NTG eyes, which fact is suggestive of the potential role of LC/BMO offset as a loco-regional susceptibility factor.
Highlights
Glaucoma is characterized by progressive axonal loss of retinal ganglion cells [1,2,3]
The offset index was larger in the unilateral normal-tension glaucoma (NTG) eyes, which fact is suggestive of the potential role of lamina cribrosa (LC)/Bruch’s membrane opening (BMO) offset as a loco-regional susceptibility factor
In many cases, glaucomatous damage starts with a localized retinal nerve fiber layer (RNFL) defect, whereas intraocular pressure (IOP) affects the optic nerve head (ONH) universally
Summary
Glaucoma is characterized by progressive axonal loss of retinal ganglion cells [1,2,3]. In many cases, glaucomatous damage starts with a localized retinal nerve fiber layer (RNFL) defect, whereas IOP affects the optic nerve head (ONH) universally This suggests a loco-regional susceptibility factor that makes some parts of the ONH more vulnerable to damage. The direction of LC offset from the BMO center showed a strong spatial correlation with the initial hemispheric location of glaucomatous damage in both myopic normal-tension glaucoma (NTG) [8] and myopic high-tension glaucoma [9]. This indicated that LC/BMO offset might reflect the loco-regional susceptibility of the ONH
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