Effect of individualized compensation for anterior segment birefringence on retinal nerve fiber layer assessments as determined by scanning laser polarimetry

Abstract

Purpose Scanning laser polarimetry estimates retinal nerve fiber layer (RNFL) thickness through measurement of retardation of a polarized laser light passing through the naturally birefringent RNFL and cornea. The commercial instrument, the GDx Nerve Fiber Analyzer (Laser Diagnostic Technologies, Inc., San Diego, CA), uses an anterior segment compensator of fixed magnitude and slow polarization axis to eliminate the contribution of the cornea to the total signal. Previous studies have shown up to 30% of patients are not adequately compensated by this method. The aim of this study was to determine the effect of individualized anterior segment compensation using a newly designed variable compensator on estimates of retinal nerve fiber layer thickness compared with those as determined with the fixed compensator in the commercial device. Design Comparative, observational case series. Participants Twenty-eight eyes from 14 normal participants and 24 eyes from 12 patients with bilateral glaucoma. Methods Using information derived from a scan of the macula, a newly designed variable anterior segment compensator for the GDx was set to neutralize anterior segment birefringence. Normal participants and patients with glaucoma underwent RNFL measurements using the standard (fixed) compensator and the variable compensator. The results were compared using Hotelling’s generalized means test and Bonferroni’s adjustment for multiple comparisons. Main outcome measures Standard GDx modulation and thickness parameters as determined with the fixed and variable compensators. Results All thickness values were statistically significantly lower as determined with the variable compensator, with no discernible differences in any of the modulation parameters. Conclusions Individualized anterior segment compensation lowers the RNFL thickness values as determined by scanning laser polarimetry compared with those determined with the standard fixed compensator. This may narrow the normal range and increase the discriminating ability of scanning laser polarimetry between normal and disease. However, modulation is less affected, and the modulation parameters may thus prove more useful for distinguishing between normal and glaucoma.