Abstract
Although early diagnosis and treatment reduce the risk of blindness from glaucoma, the decision on whether or not to begin treatment in patients with suspected glaucoma is often a dilemma because the majority of patients never develop definite glaucoma. A growing body of evidences suggests that posterior bowing of the lamina cribrosa (LC) is the earliest structural change preceding the retinal nerve fiber layer (RNFL) loss in glaucomatous optic neuropathy. Based on this notion, we conducted a prospective study enrolling 87 eyes suspected of having glaucoma to investigate whether the future rate of RNFL loss is associated with the baseline LC curve evaluated by measuring the LC curve index (LCCI) using enhanced depth imaging optical coherence tomography. A faster rate of RNFL loss was significantly associated with greater LCCI (P < 0.001;standardized coefficient beta = −0.392), older age (P = 0.008;beta = −0.314), and greater vertical cup-to-disc ratio (P = 0.040;beta = −0.233). Assessment of LC morphology may help predict the disease outcome in eyes with suspected glaucoma.
Highlights
The lamina cribrosa (LC) is a mesh-like tissue composed of connective tissue, glial cells, and microvessels that support the axons of retinal ganglion cells (RGC)[12,13]
The present study found that the eyes with steeply curved LC lost retinal nerve fiber layer (RNFL) more rapidly compared with eyes with a flat LC measurement among eyes with suspected glaucoma
Considering that eyes with a faster rate of RNFL loss have a higher risk of developing VF loss in patients with suspected glaucoma[22], the notion that steepness of the LC curve is associated with future rate of RNFL loss is clinically meaningful in regards of efficient prevention of glaucomatous VF loss
Summary
The lamina cribrosa (LC) is a mesh-like tissue composed of connective tissue, glial cells, and microvessels that support the axons of retinal ganglion cells (RGC)[12,13]. Vertical Global RNFL thickness (μm) Visual field MD (dB) Visual field PSD (dB) Average LCD Average LCCI Disc hemorrhage during follow-up, (n) Follow-up period (years) Number of SD-OCT RNFL scans These findings suggest that LC deformation, such as posterior LC bowing that leads to an increase in LC curve and LC depth (LCD), may occur in the earliest stage of the disease, and that it may induce subsequent axonal damage. Based on these considerations, it has been proposed that evaluation of LC morphology is useful in predicting progression to manifest glaucoma among patients with suspected glaucoma. The purpose of this study was to investigate whether LC morphology is predictive of the rate of RNFL thinning among patients with suspected glaucoma
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