Abstract
BackgroundBruch membrane opening–minimum rim width (BMO–MRW) assessment offers a new diagnostic use in glaucoma patients of the Glaucoma Module Premium Edition (GMPE) available for the Spectralis optical coherence tomography (OCT) system. The objective of our research was to evaluate the diagnostic benefits of examining BMO–MRW and peripapillary retinal nerve fibre layer (pRNFL) readings acquired with Spectralis OCT to distinguish between healthy and mild glaucoma patients, comparing those readings with the standard pRNFL application. Moreover, we investigated whether using a particular combination of BMO–MRW and pRNFL parameters with a linear discriminant function (LDF) could further enhance glaucoma diagnosis.MethodsOne hundred thirty-six eyes from 136 individuals were incorporated into this observational, prospective cross-sectional study: 68 mild primary open-angle glaucoma (POAG) patients according to the Hodapp-Parrish-Anderson criteria (mean deviation between 0 and − 6 dB) and 68 healthy control subjects selected by Propensity Score Matching. MRW and pRNFL thickness around the disc (diameters: 3.5 mm, 4.1 mm, and 4.7 mm) were obtained using the BMO–MRW protocol, and pRNFL thickness at 3.5 mm was obtained with the standard glaucoma application. The group data were contrasted. One sample was chosen at random to develop the LDF (teaching set: 34 healthy subjects and 34 POAG patients) using a combination of MRW and pRNFL parameters (acquired with the BMO–MRW protocol); the other sample provided a test of how the LDF performed on an independent group (validating set: 34 healthy subjects and 34 POAG patients). The receiver operating curves (ROCs) were plotted for every measurement and contrasted with the proposed LDF. The OCT parameters with the best area under the receiver operating characteristic curve (AUC) were determined.ResultsGlobal MRW and pRNFL thicknesses were significantly thinner in the POAG group (p < 0.001). The BMO–MRW parameters showed good diagnostic accuracy; the largest AUCs reached 0.875 for the LDF and 0.879 for global RNFL thickness using the standard glaucoma application. There were no statistical differences between the AUCs calculated.ConclusionsBMO–MRW parameters show a strong capability to differentiate between mild glaucoma and control eyes. Our LDF based on the new BMO–MRW OCT protocol did not perform better than isolated parameters.
Highlights
Bruch membrane opening–minimum rim width (BMO–MRW) assessment offers a new diagnostic use in glaucoma patients of the Glaucoma Module Premium Edition (GMPE) available for the Spectralis optical coherence tomography (OCT) system
This study examined the diagnostic capability of BMO– MRW analysis and peripapillary retinal nerve fibre layer (pRNFL) evaluation using Spectral Domain Optical Coherence Tomography (SD-OCT) anatomic positioning system (APS) software to differentiate healthy subjects from mild glaucoma patients, as compared with the standard pRNFL application
This study is the first to compare the diagnostic capability of an linear discriminant function (LDF) designed for the Spectralis OCT and based exclusively on results obtained with the novel BMO–MRW protocol
Summary
Bruch membrane opening–minimum rim width (BMO–MRW) assessment offers a new diagnostic use in glaucoma patients of the Glaucoma Module Premium Edition (GMPE) available for the Spectralis optical coherence tomography (OCT) system. The Glaucoma Module Premium Edition (GMPE) of the Spectralis version 6.0 SD-OCT software (Heidelberg Engineering, Inc), which includes an anatomic positioning system (APS), accurately determines neuroretinal rim tissue by measuring the minimum distance between the Bruch membrane opening (BMO) and the internal limiting membrane (ILM). This BMO–minimum rim width (MRW) provides the most geometrically accurate measurement of the neuroretinal rim [3, 4]. BMO–MRW showed high intraday repeatability, similar to the RNFL thickness parameters, and independence from intraindividual intraocular pressure (IOP) changes [10]
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