Abstract
ObjectivesTo compare the optic nerve head (ONH) structure between compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON), and to determine whether selected ONH quantitative parameters effectively discriminate between GON and CON, especially CON cases presenting with a glaucoma-like disc.MethodsWe prospectively assessed 34 patients with CON, 34 age-matched patients with moderate or severe GON, and 34 age-matched healthy control subjects. The quantitative parameters of ONH structure were compared using the Heidelberg Retina Tomograph 2 (HRT2) and Spectralis optical coherence tomography with an enhanced depth imaging method.ResultsThe mean and maximum cup depths of CON were significantly smaller than those with GON (P<0.001 and P<0.001, respectively). The distance between Bruch's membrane opening and anterior surface of the lamina cribrosa (BMO-anterior LC) of CON was also significantly smaller than that of glaucoma but was similar to that of the healthy group (P<0.001 and P = 0.47, respectively). Based on Moorfields regression analysis of the glaucoma classification of HRT2, 15 eyes with CON were classified with a glaucoma-like disc. The cup/disc area ratio did not differ between cases of CON with a glaucoma-like disc and cases of GON (P = 0.16), but the BMO-anterior LC and mean and maximum cup depths of CON cases with a glaucoma-like disc were smaller than those in GON (P = 0.005, P = 0.003, and P = 0.001, respectively).ConclusionsMeasurements of the cup depths and the LC depth had good ability to differentiate between CON with a glaucoma-like disc and glaucoma. There was no laminar remodeling detected by laminar surface position in the patients with CON compared to those with GON.
Highlights
Enlargement of optic disc cupping is a classical sign of glaucoma, but it can result from nonglaucomatous neurological lesions, such as ischemic optic neuropathy, hereditary optic neuropathy, traumatic optic neuropathy, and compressive optic neuropathy (CON) [1,2,3,4,5,6]
Trobe and associates showed that pallor of the neuroretinal rim is useful in predicting nonglaucomatous cupping in a review of optic nerve head (ONH) photographs, but such funduscopic characteristics are subjective; the degree of pallor is influenced by disturbances of the ocular media and variations in photographic technique, and even experienced observers often misdiagnose the etiology of the cupping [2]
Mashima and associates compared the ONH between eyes with glaucoma and those with hereditary optic neuropathy using the Heidelberg Retina Tomograph (HRT) parameters [10]. They reported that 73% of eyes with hereditary optic neuropathy were misdiagnosed with glaucoma, but the mean cup depth and maximum cup depth of eyes with hereditary optic neuropathy were significantly smaller than those of eyes with glaucoma
Summary
Enlargement of optic disc cupping is a classical sign of glaucoma, but it can result from nonglaucomatous neurological lesions, such as ischemic optic neuropathy, hereditary optic neuropathy, traumatic optic neuropathy, and compressive optic neuropathy (CON) [1,2,3,4,5,6]. Trobe and associates showed that pallor of the neuroretinal rim is useful in predicting nonglaucomatous cupping in a review of optic nerve head (ONH) photographs, but such funduscopic characteristics are subjective; the degree of pallor is influenced by disturbances of the ocular media and variations in photographic technique, and even experienced observers often misdiagnose the etiology of the cupping [2]. Other clinical findings such as dyscromatopsia or certain visual field characteristics can help differentiate between the two diseases; their usefulness is limited. They reported that 73% of eyes with hereditary optic neuropathy were misdiagnosed with glaucoma, but the mean cup depth and maximum cup depth of eyes with hereditary optic neuropathy were significantly smaller than those of eyes with glaucoma
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