Influence of Anterior Segment Power on the Scan Path and RNFL Thickness Using SD-OCT

Abstract

Retinal nerve fiber layer (RNFL) thickness measures with spectral domain-optical coherence tomography (SD-OCT) provide important information on the health of the optic nerve. As with most retinal imaging technologies, ocular magnification characteristics of the eye must be considered for accurate analysis. While effects of axial length have been reported, the effects of anterior segment optical power on RNFL thickness measures have not been described fully to our knowledge. The purpose of our study was to determine the influence of the optical power change at the anterior corneal surface, using contact lenses, on the location of the scan path and measurements of RNFL thickness in normal healthy eyes. We recruited 15 normal subjects with less than 6 diopters (D) of ametropia and no ocular pathology. One eye of each subject was selected randomly for scanning. Baseline SD-OCT scans included raster cubes centered on the optic nerve and macula, and a standard 12-degree diameter RNFL scan. Standard 12-degree RNFL scans were repeated with 10 separate contact lenses, (Proclear daily, Omafilcon A/60%) ranging from +8 to -12 D in 2-D steps. The extent of the retinal scan, and RNFL thickness and area measures were quantified using custom MATLAB programs that included ocular biometry measures (IOL Master). RNFL thickness decreased (0.52 μm/D, r = -0.33, P < 0.01) and the retinal region scanned increased (0.52%/D, r = 0.97, P < 0.01) with increase in contact lens power (-12 to +8). The normalized/percentage rates of change of RNFL thickness (-0.11/mm, r = -0.67, P < 0.01) and image size (0.11/mm, r = 0.96, P < 0.01) were related to axial length. Changes in the retinal region scanned were in agreement with transverse scaling, computed with a three surface schematic eye (R(2) = 0.97, P < 0.01). RNFL area measures, that incorporated the computed transverse scaling, were not related significantly to contact lens power (863 μm(2)/D, r = 0.06, P = 0.47). Measurements of RNFL thickness by SD-OCT are dependent on the optics of the eye, including anterior segment power and axial length. The relationships between RNFL thickness measures and optical power are a direct reflection of scan path location with respect to the optic nerve head rim, caused by relative magnification. An incorporation of transverse scaling to RNFL area measures, based on individualized ocular biometry, eliminated the magnification effect.