Abstract
PurposeTo evaluate the changes of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and ganglion cell-inner plexiform layer (GCIPL) thicknesses and compare structure-function relationships of 4 retinal layers using spectral-domain optical coherence tomography (SD-OCT) in macular region of glaucoma patients.MethodsIn cross-sectional study, a total of 85 eyes with pre-perimetric to advanced glaucoma and 26 normal controls were enrolled. The glaucomatous eyes were subdivided into three groups according to the severity of visual field defect: a preperimetric glaucoma group, an early glaucoma group, and a moderate to advanced glaucoma group. RNFL, GCL, IPL, and GCIPL thicknesses were measured at the level of the macula by the Spectralis (Heidelberg Engineering, Heidelberg, Germany) SD-OCT with automated segmentation software. For functional evaluation, corresponding mean sensitivity (MS) values were measured using 24–2 standard automated perimetry (SAP).ResultsRNFL, GCL, IPL, and GCIPL thicknesses were significantly different among 4 groups (P < .001). Macular structure losses were positively correlated with the MS values of the 24–2 SAP for RNFL, GCL, IPL, and GCIPL (R = 0.553, 0.636, 0.648 and 0.646, respectively, P < .001). In regression analysis, IPL and GCIPL thicknesses showed stronger association with the corresponding MS values of 24–2 SAP compared with RNFL and GCL thicknesses (R2 = 0.420, P < .001 for IPL; R2 = 0.417, P< .001 for GCIPL thickness).ConclusionsSegmented IPL thickness was significantly associated with the degree of glaucoma. Segmental analysis of the inner retinal layer including the IPL in macular region may provide valuable information for evaluating glaucoma.
Highlights
Loss of sight exacts a huge economic cost on both the individual and society
retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and ganglion cell-inner plexiform layer (GCIPL) thicknesses were significantly different among 4 groups (P < .001)
Macular structure losses were positively correlated with the mean sensitivity (MS) values of the 24–2 standard automated perimetry (SAP) for RNFL, GCL, IPL, and GCIPL (R = 0.553, 0.636, 0.648 and 0.646, respectively, P < .001)
Summary
This observational cross-sectional study enrolled 85 patients with preperimetric to advanced open angle glaucoma seen by a glaucoma specialist (CKP) and 26 normal controls from a dry eye clinic at Seoul St. For Bland-Altman analysis to validate the segmentation software of Spectralis SD-OCT, we calculated the GCIPL thickness using the GCL and IPL thicknesses. The segmentation software of the Cirrus SD-OCT identified 3 different retinal boundaries: the inner limiting membrane, the outer boundary of the RNFL, and the outer boundary of the IPL. Intraocular pressure, central corneal thickness, spherical equivalent, axial length, mean deviation, pattern standard deviation, and average RNFL, GCL, and IPL thicknesses were. The R squared values of 4 inner retinal thicknesses were statistically significant in all glaucoma groups (R2 = 0.306, P< .001 for RNFL thickness; R2 = 0.404, P< .001 for GCL thickness; R2 = 0.420, P< .001 for IPL thickness; R2 = 0.417, P< .001 for GCIPL thickness). Central cluster MS, dB Average RNFL thickness Average GCL thickness Average IPL thickness Average GCIPL thickness
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