Segmental inner macular layer analysis with spectral-domain optical coherence tomography for early detection of normal tension glaucoma.

Jih-Pin Lin,Jen-Chia Tsai,Ing-Chou Lai,Pei-Wen Lin,Gemmy Cheung

doi:10.1371/journal.pone.0210215

Jih-Pin Lin, Jen-Chia Tsai + Show 3 more

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https://doi.org/10.1371/journal.pone.0210215

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Abstract

PurposeTo segment the inner macular layers (IML) and compare the discriminating abilities of the macular and peripapillary retinal nerve fiber layer (mRNFL and pRNFL, respectively) thicknesses in patients with early-stage normal tension glaucoma (NTG).DesignCross-sectional studyMethodsForty-nine normal subjects and 69 preperimetric glaucoma (PPG) and 60 NTG patients were enrolled. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain pRNFL and macular thickness parameters and segment the IML in all subjects. Area under the receiver operating characteristic (AUROC) curves were used to compare the diagnostic capabilities of different parameters.ResultsThe pRNFL, total macular layer (TML), mRNFL, and macular ganglion cell layer (mGCL) were significantly thinner in the NTG group than in the PPG and normal groups. The global and superotemporal pRNFL and the mGCL in the superior outer area were the three best parameters for detecting early NTG. The discriminating capabilities of the superior and inferior mGCL were comparable to those of the corresponding pRNFL (p = 0.573, 0.841). Concerning location, the mGCL had higher AUROCs in the outer sectors (0.863, 0.837) than in the inner sectors (0.747, 0.747). Pearson’s correlation coefficients also revealed significant correlations between the mGCL and pRNFL (superior: r = 0.499, inferior: r = 0.624). The strongest correlation was between the mGCL and mean deviation (MD) (superior: r = 0.434 and inferior: r = 0.402).ConclusionsThe diagnostic value of mGCL thickness is comparable to that of pRNFL thickness. IMLs in the outer sectors had better diagnostic capabilities than those in the inner sector for detecting early NTG.

Highlights

Glaucoma is the leading cause of irreversible blindness worldwide
The strongest correlation was between the macular ganglion cell layer (mGCL) and mean deviation (MD)
Glaucoma is associated with the progressive loss of retinal ganglion cells (RGC), thinning of the retinal nerve fiber layer (RNFL), notching of the optic nerve head (ONH) and characteristic visual field (VF) defects

Summary

Introduction

Glaucoma is associated with the progressive loss of retinal ganglion cells (RGC), thinning of the retinal nerve fiber layer (RNFL), notching of the optic nerve head (ONH) and characteristic visual field (VF) defects. Some studies [1,2,3] have reported that the pathological structural damage observed in glaucoma can be detected several years before visual field defects occur. Previous studies [4,5] have revealed that axonal degeneration may precede RGC body death. Oxidative stress can lead to cell body death in the retina independent of axonal degeneration [4,5]. The cell bodies are located in the ganglion cell layer (GCL), and their axons are situated in the RNFL [6]. Many studies have explored the use of diagnostic techniques in the macula, few reports have performed layer-by-layer segmented mGCL analyses

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