Bruch's Membrane Opening-minimum Rim Width Research Articles

Bruch's membrane opening - minimum rim width measurement after acute primary angle-closure.

To evaluate Bruch's membrane opening - minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) following an acute primary angle-closure attack (APAC). Nine consecutive patients with unilateral APAC were included. Patients with a bilateral attack, with signs of glaucomatous optic nerve damage or evidence of a previous APAC in either eye were excluded. Three months after the attack, all eyes underwent BMO-MRW and RNFLT measurements with SDOCT. APAC eyes were compared to the contralateral eyes. Three months after the attack, mean BMO-MRWs were 281.22 ± 56.88 μm and 313.78 ± 43.48 μm (P = 0.009) and mean RNFLTs were 78 ± 15.36 μm vs 95.78 ± 10.81 μm (P = 0.008) in the APAC and contralateral eyes, respectively. RNFLT and BMO-MRW measurements had a strong positive correlation (R = 0.7436, P = 0.013). APAC eyes had a shorter axial length (21.85 ± 1.21 vs 22 ± 1.07, P = 0.042) and shallower anterior chamber depth (2.29 ± 0.21 vs 2.41 ± 0.12, P = 0.039) than contralateral eyes. IOP at presentation showed a strong negative correlation with both BMO-MRW (R = -0.7669, P = 0.009) and RNFLT measurements (R = -0.7723, P = 0.008). BMO-MRW and RNFLT measurements are significantly reduced 3 months after an APAC when compared to the contralateral eye. IOP at presentation may have an impact on the reduction of these parameters.

Bruch membrane opening-minimum rim width and retinal nerve fiber layer thickness in myopic children

Background/objectivesIt is debatable whether the decrease of retinal nerve fiber layer (RNFL) thickness in myopic people under 18 years of age is due to insufficient measurement techniques or to real physical loss of retinal ganglion cells and axons. Hence, to better understand the relationship between the degree of myopia and the neuroretinal rim (NR), we aim to investigate the NR in the eyes of healthy myopic children using the novel measurement algorithms of spectral-domain optical coherence tomography (SD-OCT). Subjects/methodsThis prospective, cross-sectional study includes 378 left eyes of 378 (301 female) participants divided into three groups according to their spherical equivalent (SE) refractive error (RE) [Group-1(G1), -1.00 ≤ SE ≤ 1.00 diopters (D); Group-2 (G2), -4.00 ≤ SE < -1.00 D; Group-3 (G3), SE<-4.00 D]. All participants underwent a full ophthalmic examination, including biometric and pachymetric measurements. Standard peripapillary RNFL, as well as the novel algorithms, Bruch's membrane opening-minimum rim width (BMO-MRW), and RNFL acquired using the anatomic positioning system (APS-RNFL) were obtained by SD-OCT. Nasal, temporal, temporal-inferior, temporal-superior, nasal-inferior, nasal-superior sectors’ and their general (global) averages were recorded. Rim areas and disc sizes were measured via confocal scanning laser ophthalmoscopy. Global and the six sectors’ averages were recorded. ResultsG1 consisted of 141 subjects, G2 consisted of 89, and G3 consisted of 48. The sex distribution (p = 0.112) and mean age (p = 0.129) of the groups were similar. The mean global averages of the standard RNFLs were 96 ± 14.4 µ in G1, 93.8 ± 12.9 µ in G2, and 86 ± 11.8 µ in G3. The mean global averages of the APS-RNFLs were 103.9 ± 97 µ in G1, 103.3 ± 10.6 µ in G2, and 102 ± 10.6 µ in G3. The mean global averages of the BMO-MRW were 374.4 ± 57.7 µ in G1, 373.2 ± 62.2 µ in G2, and 351.9 ± 63.9 µ in G3. For the global averages, APS-RNFL and BMO-MRW did not detect any difference between the three groups (p = 0.563, p = 0.089, respectively), but the standard RNFL did (p < 0.001). Standard RNFL and APS-RNFL were found to be well correlated; however, the correlations between BMO-MRW and standard RNFL or APS-RNFL were either absent or very weak. All three methods showed weak but significant negative correlations with high myopic spherical RE, especially those in the standard RNFL. Moderately negative correlations were found between BMO-MRW and disc size in all sectors (highest in the nasal sector; r = -0.387, p < 0.001). However, there was almost no significant relationship between disc size and standard RNFL or APS-RNFL. Moderately significant negative correlations were observed between the groups categorically and standard RNFL in almost all sectors, while this was much less with APS-RNFL and was not observed in almost any sector with BMO-MRW. ConclusionsWhen evaluating the NR in healthy myopic children, it was found that, in particular, BMO-MRW and APS-RNFL are less effected by RE degree compared to standard RNFL. BMO-MRW and APS-RNFL should be used on these children to avoid the possible misdiagnosis of glaucoma.

Clinical Utility of Bruch Membrane Opening-Minimum Rim Width for Detecting Early Glaucoma in Myopic Eyes.

Bruch membrane opening-minimum rim width (BMO-MRW) is overall a useful parameter for diagnosing early glaucoma in myopic eyes. The aim of this study was to determine the diagnostic value of BMO-MRW compared with peripapillary retinal nerve fiber layer (pRNFL) thickness for detecting early glaucoma in patients with moderate to severe myopia. One eye was randomly selected from each of the 253 subjects (127 normal controls, 82 with glaucoma suspect, and 44 with early glaucoma). All patients underwent visual acuity testing, refractive error assessment, slit-lamp inspection, intraocular pressure measurement, fundus photography, perimetry. BMO-MRW and pRNFL thickness data were obtained using spectral-domain optical coherence tomography. Area under the receiver operating characteristic curves (AUC) for global and sectoral thickness parameters were calculated. Global analyses for the discrimination of early glaucoma in all myopic subjects showed comparable AUCs between BMO-MRW and pRNFL thickness [AUC 0.952 (95% confidence interval, 0.918-0.975) and 0.934 (95% confidence interval, 0.896-0.961), respectively, P=0.345]. However, in sectoral analysis, BMO-MRW showed significantly better diagnostic performance than pRNFL thickness except for the superotemporal sector. The AUC for discriminating early glaucoma from glaucoma suspect, BMO-MRW showed statistically better diagnostic performance in the inferotemporal, inferonasal, superonasal, and nasal sectors. When dividing the subject based on a threshold Bruch membrane opening (BMO) area of 2.5 mm2, the diagnostic power of BMO-MRW was generally lower except for the inferonasal sector in the subgroup with a large BMO area. BMO-MRW was overall a useful parameter for diagnosing early glaucoma in myopic eyes. However, its diagnostic performance was decreased in myopic eyes with large BMO and there were no significant differences from pRNFL thickness.

Diagnostic Classification of Bruch's Membrane Opening-Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Myopic Eyes by Optical Coherence Tomography.

Purpose: This study was conducted in order to compare the diagnostic classification of Bruch's membrane opening-minimum rim width (BMO-MRW) and RNFL thickness in normal myopic subjects by using optical coherence tomography (OCT).Methods: This cross-sectional study involved 75 healthy myopic subjects [spherical equivalent (SE) ≤ −0.5D] from April 2019 to January 2020. One eye of each subject was randomly selected for examination. BMO-MRW and peripapillary RNFL thickness were measured by spectral-domain OCT (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany). All the subjects were divided into three groups: low myopic group (SE > −3D), moderate myopic group (−6D < SE ≤ −3D), and high myopic group (SE ≤ −6D). A nonparametric test was used to analyze the difference among groups. Linear regression was used to analyze the relationship between BMO-MRW/RNFL thickness and axial length/spherical equivalent. McNemar test was used to compare the diagnostic classification between BMO-MRW and RNFL thickness.Results: The RNFL thickness classified a significantly higher percentage of eyes as outside normal limits/borderline in at least 1 quadrant (BMO-MRW, 4%; RNFL thickness, 34.67%; p < 0.01). There was no significant correlation between BMO-MRW/RNFL thickness and AL/SE. The low myopia (SE > −3D) had a significantly lower percentage of eyes classified as outside normal limits/borderline in at least 1 quadrant than the moderate myopia (−6D < SE ≤ −3D) and high myopia (SE ≤ −6D) (low myopia, 12.5%; moderate/high myopia, 42.42%/50%; p < 0.05).Conclusion: BMO-MRW had a lower percentage of eyes classified as outside normal limits/borderline in at least 1 quadrant than RNFL thickness in normal myopic subjects. When referring to the diagnostic classification of RNFL thickness in myopic subjects, caution should be exercised in interpreting positive results. Further studies are needed to compare the diagnostic accuracy of these two measurements in myopic glaucoma patients.

Novel area-based optic nerve head parameter to distinguish glaucoma from non-glaucomatous retinal nerve fiber layer defect in branch retinal vein occlusion.

The purpose of this study was to assess the diagnostic ability of the new area-based parameter retinal nerve fiber layer to disc ratio (RDR) for discriminating between glaucoma and non-glaucomatous retinal nerve fiber layer defects (RNFLDs). This retrospective cross-sectional study included 42 branch retinal vein occlusion (BRVO) eyes with RNFLD, 42 open-angle glaucoma (OAG) eyes, and 42 healthy control eyes that were matched with optic disc size. The RDR, peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening-minimum rim width (BMO-MRW), and Bruch's membrane opening-minimum rim area (BMO-MRA) were analyzed. The areas under the receiver operating characteristic curves (AUCs) were calculated for each parameter. The OAG and BRVO groups had similar global pRNFLT (87.57 ± 7.07µm and 89.71 ± 12.21µm, respectively), but these were thinner than those of the healthy group (102.71 ± 8.95µm, p < 0.001 and p < 0.001, respectively). RDR was lowest in the BRVO group (0.755 ± 0.121, p < 0.001) and highest in the OAG group (1.111 ± 0.145, p < 0.001). Global BMO-MRW was significantly lower in the OAG group (194.36 ± 23.09µm) than in the BRVO (269.69 ± 42.77µm, p < 0.001) and healthy (273.48 ± 30.92µm, p < 0.001) groups. Total BMO-MRA of the OAG group (0.88 ± 0.12 mm2) was significantly lower than that of the BRVO (1.32 ± 0.19 mm2, p < 0.001) and healthy (1.30 ± 0.21 mm2, p < 0.001) groups. AUC for discriminating between the OAG and BRVO was 0.986 for total BMO-MRA and 0.970 for RDR (p = 0.192). In clinical practice, RDR may perform well as a parameter to distinguish between glaucoma and non-glaucomatous RNFLD.

Clinical Features of Advanced Glaucoma With Optic Nerve Head Prelaminar Schisis

To investigate the clinical characteristics of optic nerve head (ONH) prelaminar schisis in eyes with advanced glaucoma. Cross-sectional study. One hundred sixteen eyes with advanced glaucoma (30-2 mean deviation <-12 dB) were included. ONH prelaminar schisis was identified using the spectral-domain optical coherence tomography independently by 2 evaluators and only eyes that reached consensus for the presence of ONH prelaminar schisis were included. Bruch membrane opening-minimum rim width (BMO-MRW), thickness and depth of lamina cribrosa (LC), peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness (total, RNFL, ganglion cell layer, inner plexiform layer), and peripapillary and subfoveal choroidal thickness were additionally obtained. Clinical characteristics were compared between the 2 groups based on the presence of ONH prelaminar schisis. ONH prelaminar schisis was identified in 48 of 116 eyes. Multivariate logistic regression analysis revealed that short axial length, thin and deep LC, and thick macula were associated with the presence of ONH prelaminar schisis. When the structure-function relationships were determined, macular structural parameters tended to have a better relationship with functional parameters than the BMO-MRW and peripapillary RNFL thickness parameters in eyes with ONH prelaminar schisis. The ONH prelaminar schisis was associated with thin and deep LC, short axial length, and generally thick macula. In patients with this features, the macular measurements, rather than peripapillary or ONH measurements, better predict the functional status of the eye. Our findings may have significant clinical implications for management of advanced glaucoma eyes with and without ONH prelaminar schisis.

EVALUATION OF GLAUCOMA MODULE PREMIUM EDITION IN EGYPT

The mean prevalence of high myopia increases over time in Egypt Prevalence of high myopia in Egypt which was 0.2%, in 1960 increased to 7.4% in 1976 and 10.8% in 2015. Optical coherence tomography (OCT) is a noninvasive, painless and quick precise technology that can be used for interpreting tissue structure and function. Time-domain OCT was fast enough to scan a circle centered on the optic nerve head (circumpapillary) to assess the retinal nerve fiber layer (RNFL) thickness. Glaucoma Module Premium Edition (GMPE) is a new, objective method of ONH analysis using BMO. The termination of Bruch's membrane at the ONH marks the opening through which RGC axons exit the eye to form the choroidal and scleral portions of the neural canal, this anatomic opening, termed Bruch's membrane opening (BMO). The minimum distance from the BMO to the internal limiting membrane represents the most geometrically accurate measurement of neuroretinal rim width. This neuroretinal rim measurement has been termed Bruch's Membrane Opening-Minimum Rim Width (BMO-MRW).

The influence of axial myopia on optic disc characteristics of glaucoma eyes

This study characterizes differences in glaucomatous eyes with and without high axial myopia using custom automated analysis of OCT images. 452 eyes of 277 glaucoma patients were stratified into non (n = 145 eyes), mild (n = 214 eyes), and high axial myopia (axial length (AL) > 26 mm, n = 93 eyes). Optic disc ovality index, tilt and rotation angle of Bruch´s membrane opening (BMO) and peripapillary choroidal thickness (PCT) were calculated using automated and deep learning strategies. High myopic optic discs were more oval and had larger BMO tilt than mild and non-myopic discs (both p < 0.001). Mean PCT was thinnest in high myopic eyes followed by mild and non-myopic eyes (p < 0.001). BMO rotation angle, global retinal nerve fiber layer (RNFL) thickness and BMO-minimum rim width (MRW) were similar among groups. Temporal RNFL was thicker and supranasal BMO-MRW was thinner in high myopic eyes. BMO tilt and PCT showed moderate and temporal RNFL and nasal BMO-MRW showed weak but significant associations with AL in multivariable analyses (all p < 0.05). Large BMO tilt angle and thin PCT are characteristics of highly myopic discs and were not associated with severity of glaucoma. Caution should be exercised when using sectoral BMO-MRW and RNFL thickness for glaucoma management decisions in myopic eyes.

Diagnostic capability of different morphological parameters for primary open\u2010angle glaucoma in the Chinese population

BackgroundTo assess the diagnostic capability of novel Bruch’s membrane opening (BMO)-based disc parameters, the BMO-minimum rim width (BMO-MRW) and the BMO-minimum rim area (BMO-MRA) in the Chinese population and compare them to the retinal nerve fiber layer (RNFL) from optical coherence tomography (OCT) and the rim area (RA) from the Heidelberg retinal tomograph-III (HRT-III).MethodsIn total, 200 eyes of 77 healthy and 123 primary open-angle glaucoma (POAG) subjects were included in this cross-sectional study. All participants underwent the visual field test and structural measurements by OCT and HRT-III. The areas under the receiver operating characteristic curves (AUCs) of different structural parameters were calculated to assess their diagnostic power and compared using the DeLong test.ResultsIn populations with different characteristics, the BMO-MRW and BMO-MRA had better diagnostic power than the RA. In discriminating between all POAG subjects and healthy controls and between early-stage patients and controls, the global BMO-MRW had comparable AUCs with the RNFL, but the BMO-MRA had lower AUCs than the RNFL. In healthy subjects with macrodiscs, both the global and sectoral BMO-MRW were thinner than those in healthy subjects with normal disc size. The AUCs of BMO-MRA, BMO-MRW and RNFL in subjects with macrodiscs were comparable. Additionally, in the myopic population, the BMO-MRA and BMO-MRW had comparable AUCs with the RNFL.ConclusionsThe BMO-MRW had comparable diagnostic power with the RNFL, and compared with BMO-MRW, the BMO-MRA might have advantages in certain populations, such as macrodiscs. All OCT-derived parameters exceeded the RA in diagnostic capability.

Sites of highest predictability for neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy.

Identifying earlier retinal thickness affection and predictability for diabetic retinal neurodegeneration (DRN) in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy (DR). This is a comparative cross-sectional study. Thirty-eight eyes of 19 patients with DM2 without any signs of DR and 38 eyes of 19 controls underwent retinal evaluation using optical coherence tomography. Macular ganglion cell layer (GCL), macular retinal nerve fiber layer (mRNFL), inner plexiform layer (IPL), total macular thickness, peripapillary retinal nerve fiber layer (pRNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were evaluated. GCL showed significant thickness reduction in the total, superior and inferior halves as well as the 9 ETDRS regions (except the nasal and lower outer regions). The mRNFL showed a significant reduction in the total, superior and inferior halves as well as the lower and nasal outer regions. The IPL showed significant reduction in the 4 inner regions only. The pRNFL showed significant reduction in the total, superotemporal and inferotemporal sectors values. The BMO-MRW did not show any significant thickness change. The total, superior and inferior GCL and mRNFL, in addition to the global pRNFL were the most affected and predictive layers for DRN in patients with DM type 2 without DR. It appears that the GCL is the primary site of DRN and the rest of the changes represented a degeneration of the axonal path between the optic disk and the macular GCL.

Comparison of Retinal Nerve Fibre Layer versus Bruch Membrane Opening-Minimum Rim Width as an Optical Coherence Tomography-based Marker for Glaucoma in Myopia.

To compare the reliability of Bruch Membrane Opening-Minimum Rim Width (BMO-MRW) Optical Coherence Tomography (OCT) with Retinal Nerve Fibre Layer (RNFL) in myopic patients. Cross-sectional study. LRBT Free Base Eye Hospital, Karachi, from May 2019 to July 2020. Moderate myopes with refractive errors between -3 to -6 diopters were examined by 2 glaucoma consultants separately, who performed fundoscopy to evaluate the optic nerve head, checked IOP and assessed CCT and visual fields to stratify the eyes into myopic normal and myopic glaucomatous eyes. All eyes were imaged with SD OCT of Spectralis version 1.10.2.0 of Heidelberg Engineering. Two scanning patterns, one for BMO-MRW and the other for RNFL thickness analysis, were performed. Fifty eyes of 50 patients were diagnosed with glaucoma in 50% (25 out of 50 patients). OCT RNFL detected glaucoma in 72% (36 out of 50 patients). While OCT BMO-MRW detected glaucoma in 56% (28 out of 50 patients). There was strong agreement between the consultant's judgements and BMO-based test (κ = 0.800, p <0.001), but the association was comparatively weaker with RNFL-based prediction (κ = 0.480, p <0.001). Specificity was better with OCT BMO-MRW (85.7%) than RNFL (66.7%). There were lower false positive rates with BMO-MRW (14.3%) than RNFL (33.3%). OCT BMO-MRW is a better indicator of glaucomatous damage in moderately myopic eyes as compared to OCT RNFL analysis. Key Words: Glaucoma, Myopia, Optical Coherence Tomography (OCT), Bruch Membrane Opening-Minimum Rim Width (BMO-MRW), Retinal Nerve Fibre Layer (RNFL).

Recent developments in the use of optical coherence tomography for glaucoma.

The aim of this article is to summarize findings of recent reports highlighting the utility of novel optical coherence tomography (OCT) parameters in the diagnosis and monitoring of glaucomatous optic neuropathy. Optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular parameters show high levels of diagnostic capability. The Bruch's membrane opening-minimum rim width (BMO-MRW) measurement is a novel ONH parameter obtained using the Spectralis SD-OCT device (Heidelberg Engineering, Inc., Heidelberg, Germany). The inferotemporal BMO-MRW sector shows the highest diagnostic performance for this parameter. Minimum ganglion cell and inner plexiform layer thickness shows the highest diagnostic performance among macular parameters obtained with the Cirrus HD-OCT (Carl Zeiss, Inc., Dublin, CA, USA). Optic nerve head, macular, and retinal nerve fiber layer parameters are not interchangeable across protocols generated by varying OCT manufacturers. Novel machine-learning algorithms show promise with regards to achieving higher levels of diagnostic accuracy using OCT imaging platforms. Digital imaging in glaucoma continues to evolve with novel parameters of the optic nerve head, retinal nerve fiber layer, and macula. Diagnostic abilities of these parameters are high and complementary to each other.

Bruch Membrane Opening Minimum Rim Width Changes During Scleral Lens Wear.

The purpose of this study was to evaluate the change in Bruch membrane opening minimum rim width (BMO-MRW) during scleral lens (SL) wear. Twenty young white subjects were enrolled (10 women and 10 men); preliminary evaluation consisted of serial measurements of intraocular pressure (IOP) using a dynamic noncontact tonometer (Corvis, Oculus), which also yielded a corneal biomechanical index and central corneal thickness, and BMO-MRW using optical coherence tomography imaging (OCT) imaging (Spectralis, Heidelberg) through 6 hrs to establish normative diurnal curves. The next day, participants were fitted with a 16-mm SL on one eye, and OCT measurements were repeated over the same time span. Statistical analysis was carried out with a two-way analysis of variance. Multiple linear regressions were used to identify significant associations. The average diurnal variation for BMO-MRW without lenses was -4.65 μm (95% confidence interval [CI], 0.52-8.77) after 6 hours, whereas it decreased by 8 μm (95% CI, 3.87-12.12; P<0.001) after 6 hours of SL wear. The difference between variations after 6 hours was then -3.35 μm (P=0.029). Variation of the BMO-MRW did not significantly correlate with corneal rigidity (CR), central corneal thickness (CCT), and refractive error (r=-0.224, -0.054 and -0.085, respectively). Scleral lens wear induces a statistically significant decrease in BMO-MRW that could potentially be attributed to a change in IOP. The change in BMO-MRW was not affected by CR, CCT, or refractive error. Further studies are needed to better understand the significance of the observed changes at the optic nerve head during scleral lens wear.

A Topographic Comparison of OCT Minimum Rim Width (BMO-MRW) and Circumpapillary Retinal Nerve Fiber Layer (cRNFL) Thickness Measures in Eyes With or Suspected Glaucoma.

To understand the differences between 2 optical coherence tomography measures of glaucomatous damage: the BMO-MRW and cRNFL thickness. Optical coherence tomography circle scans were obtained for an early glaucoma group (EG) of 88 eyes (88 patients) with 24-2 mean deviation better than -6.0 dB, and a broader group (BG) of 188 eyes (110 patients) with 24-2 mean deviation from -0.15 to -27.0 dB. On the basis of a commercial report, the cRNFL and BMO-MRW of each hemidisc was classified as abnormal if either of the 2 superior (inferior) sectors, temporal superior and nasal superior (temporal inferior and nasal inferior), was yellow or red (P<5%); and as normal if both were green (P≥5%). In addition, a post hoc analysis identified the reasons for disagreements on the basis of the presence (or absence) of glaucomatous damage at a hemidisc level (consensus of 4 experts). The BMO-MRW and cRNFL measures agreed in 81.9% (broader group) and 73.9% (EG) of the hemidiscs. In both groups, an abnormal-BMO-MRW/normal-cRNFL disagreement was as common as a normal-BMO-MRW/abnormal-cRNFL. Of the 46 EG hemidisc disagreements, the number of "mistakes" for BMO-MRW (28) was nonsignificantly higher than for cRNFL (18) (P=0.15). Primary causes for disagreement were as follows: borderline significance level, a local defect, and aberrant blood vessel location. Although BMO-MRW and cRNFL measures agreed in the majority of hemidiscs, they still disagreed in over 25% of the EG hemidiscs. These measures may be improved by comparing actual probability levels and accounting for blood vessel locations. However, both can miss information available on retinal ganglion cell/retinal nerve fiber layer probability maps.

Comparison of Rate of Change between Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer in Eyes Showing Optic Disc Hemorrhage

To investigate and compare the longitudinal rate of change of Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in eyes showing optic disc hemorrhage(DH). Observational case series. A total of 82 subjects(82 eyes) showing DH who had undergone more than five reliable spectral-domain optical coherence tomography (OCT) tests were included. BMO-MRW and RNFL were measured with OCT at 3-month intervals. The rates of change in global and each Garway-Heath sector were calculated with a linear mixed-effects model after adjusting for age, sex, and BMO area. The mean follow-up period was 21.57 ± 7.88months with a mean number of 7.88 ± 2.39 OCT tests. Baseline demographics were age (58.37 ± 10.65 y); 46.3% were female; and the mean deviation was-4.41 ± 5.04 dB. The global rate of change in BMO-MRW was-3.507 ± 0.675μm/y and in-1.404 ± 0.208μm/y in RNFL. The rate of change was the greatest in the inferotemporal sector, which was-9.141 ± 1.254μm/y in BMO-MRW and-4.204 ± 0.490μm/y in the RNFL. The rate of change was significantly greater in BMO-MRW than in the RNFL in all sectors, except for the nasal sector (P < .05). Percentage of reduction was significantly greater in BMO-MRW than in RNFL in the inferotemporal and superotemporal sectors (P < .05). BMO-MRW showed a significantly greater rate of change than RNFL in eyes showing DH, especially in the inferotemporal and superotemporal sectors in percentage of reduction. Thus, it may be more advantageous to detect glaucomatous progression earlier in BMO-MRW than in the RNFL in eyes showing DH that are more likely to progress.

Dynamics of structural reversal in Bruch's membrane opening-based morphometrics after glaucoma drainage device surgery.

Structural reversal of disc cupping is a known phenomenon after trabeculectomy. The aim of this retrospective, longitudinal, cross-sectional analysis was to evaluate the postoperative dynamics of Bruch's membrane opening-based morphometrics of the optic nerve head following glaucoma drainage device surgery. Forty-three eyes, treated by glaucoma drainage device surgery, were included in the study. Individual changes in the spectral domain optic coherence tomography (SD-OCT) parameters Bruch's membrane opening minimum rim width (BMO-MRW), Bruch's membrane opening minimum rim area (BMO-MRA) and peripapillary retinal nerve fiber layer (RNFL) thickness as well as mean defect in 30-2 perimetry were analyzed. Changes were correlated to postoperative intraocular pressure levels over time. Available follow-up visits were aggregated and grouped into a short-term follow-up (20 to 180days after surgery), a midterm follow-up (181 to 360days after surgery) and a long-term follow-up (more than 360days after surgery). In short-term follow-up, BMO-MRW and BMO-MRA increased significantly (p <= 0.034). This increase correlated negatively with the intraocular pressure at the time of the follow-up (Pearson's rho = - 0.49; p = 0.039). From 6months after surgery on, there was no statistically significant change in BMO-MRW and BMO-MRA (p >=0.207). RNFL thickness and mean defect of 30-2 perimetry showed no significant changes after GDD implantation (p >=0.189). Lowering of intraocular pressure by glaucoma drainage device surgery leads to an increase of Bruch's membrane opening based parameters in the first 6months after surgery. These changes have to be taken into account when evaluating patients' longitudinal follow-up after glaucoma drainage device implantation.

Structure-function relationship between Bruch's membrane opening-minimum rim width and perimetry in open-angle glaucoma subtypes.

To seek the threshold value of Bruch's membrane opening-minimum rim width (BMO-MRW) where visual field (VF) damage occurs in open-angle glaucoma (OAG) and explore whether there are structural differences between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). We recruited 83 healthy and 106 glaucoma (49 with POAG and 57 with NTG) subjects for this study. All subjects underwent optical coherence tomography (OCT), BMO-MRW scans, and Humphrey visual field (VF) analyzer examination. Global and sectoral BMO-MRW was correlated with the corresponding VF according to the Garway-Heath map. Using a broken-stick statistical model, the structure-function relationship of VF values and BMO-MRW, the tipping point where VF defects were associated with a reduction in BMO-MRW and the slopes above and below the tipping point were determined and compared between POAG and NTG. The tipping point of global BMO-MRW for VF impairment was 234.38μm, 228.09μm, and 249.68μm in the OAG, POAG, and NTG groups, respectively. The slope below the tipping point was significantly steeper than the slope above it in all quadrants of each group (p < 0.001). The tipping point in NTG in the inferotemporal and nasal quadrants was smaller than that of POAG, especially in the inferotemporal quadrant. In OAG, BMO-MRW loss seems to occur before the onset of perimetric impairment. Compared with POAG, NTG appears to have more severe rim damage, especially in the inferotemporal quadrant at the onset of detectable VF defects.

Macular Ganglion Cell and Inner Plexiform Layer Thickness Is More Strongly Associated With Visual Function in Multiple Sclerosis Than Bruch Membrane Opening-Minimum Rim Width or Peripapillary Retinal Nerve Fiber Layer Thicknesses.

Optical coherence tomography (OCT) measurements of ganglion cell + inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses are associated with visual function (VF) and disability in multiple sclerosis (MS). However, the value of measuring Bruch membrane opening-minimum rim width (BMO-MRW) thickness in MS remains unclear. Sixty-eight patients with MS and 22 healthy controls (HCs) underwent spectral domain OCT, 100%-contrast visual acuity (VA), 2.5%- and 1.25%-contrast letter acuity (LA), and Expanded Disability Status Scale (EDSS) testing. Mixed-effects linear regression models, accounting for within-subject, intereye correlations, were used to assess relationships. The MS cohort exhibited significantly lower BMO-MRW (P = 0.01), pRNFL at 3.7-, 4.1-, and 4.7-mm diameters surrounding the optic disc (P < 0.001 for all), and GCIPL (P < 0.001) thicknesses than HCs. BMO-MRW thickness was associated with 100%-VA (P < 0.001, R = 0.08), 2.5%-LA (P < 0.001; R = 0.13), and 1.25%-LA (P = 0.002; R = 0.11). All measured pRNFL thicknesses were associated with high- and low-contrast VF (all: P < 0.001). GCIPL thickness was more strongly associated with 100%-VA (P < 0.001; R = 0.23), 2.5%-LA (P < 0.001; R = 0.27), and 1.25%-LA (P < 0.001; R = 0.21) than the other OCT measures assessed. All OCT measures were significantly, but weakly, associated with EDSS scores. BMO-MRW and pRNFL thicknesses are reduced and associated with VF and disability in MS, but GCIPL thickness is a stronger marker of visual impairment. Our findings corroborate the utility of OCT in providing valuable information regarding the MS disease process.

Bruch\u2019s membrane opening enlargement and its implication on the myopic optic nerve head

We examined the association between Bruch’s membrane opening (BMO) area and various ocular parameters and investigated the implication of BMO enlargement on the myopic optic nerve head. One hundred eighty-five myopic eyes were included in this cross-sectional study. Among the included eyes, 53 having axial lengths between 26 and 27 mm were further analyzed to investigate the association between BMO area and various ocular parameters. BMO area, BMO-minimum rim width (BMO-MRW), peripapillary choroidal thickness (pCT), width of β-parapapillary atrophy with and without Bruch’s membrane (PPA+BM and PPA−BM), and presence of lamina cribrosa (LC) defect were evaluated. We found that BMO area tended to increase with increasing axial length, but varied among the highly myopic eyes even though they had similar degrees of myopia. In the subgroup analysis of eyes with axial lengths between 26 and 27 mm, BMO area was highly variable and it significantly correlated with PPA−BM width and temporal-inferior, nasal-inferior, and nasal BMO-MRW and pCT. LC defects were more common in myopic eyes with enlarged BMO. A multivariate regression model revealed that higher intraocular pressure, enlarged BMO, and thinner BMO-MRW were associated with LC defects in highly myopic eyes. These findings should be considered when evaluating myopic eyes.

A Comparison of OCT Parameters in Identifying Glaucoma Damage in Eyes Suspected of Having Glaucoma

To compare retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening minimum rim width (BMO-MRW) measured by spectral domain optical coherence tomography (SDOCT) for diagnosing glaucoma in those suspected of having the disease. Observational cohort study. 113 eyes from 81 patients suspected of having glaucoma based on optic nerve appearance. Participants were imaged using SDOCT and RNFLT and BMO-MRW were measured. All participants had normal visual fields at the time of imaging, but were considered suspects based on the appearance of the optic disc during clinical examination. Eyes were classified as glaucomatous or non-glaucomatous based on documented stereophotographic evidence of progressive glaucomatous change in the appearance of the optic nerve or retinal nerve fiber layer occurring before the imaging session. For each parameter, we calculated the area under the receiver operating characteristic (ROC) curve and the sensitivity with fixed specificities of 80% and 95%. Areas under the ROC curves. Of the 113 eyes suspected of having glaucoma, 52 (46.0%) eyes had progressive glaucomatous optic nerve changes and were classified as having pre-perimetric glaucoma and 61 (54.0%) eyes did not have progressive glaucomatous optic nerve changes (followed untreated for an average of 9.4±3.2 years) and were classified as normal. The areas under the ROC curves were 0.89 (95% CI: 0.84-0.95) for global RNFLT and 0.75 (95% CI: 0.65-0.85) for global BMO-MRW (p=0.006). The sensitivity at 95% specificity was 60% for the global RNFLT parameter and 40% for the global BMO-MRW parameter. The RNFLT parameters that achieved areas under ROC curve ≥0.80 were global (0.89), supero-temporal (0.80), infero-temporal (0.87), and supero-nasal (0.81). The only BMOBRW parameter that achieved area under ROC curve ≥0.80 was infero-temporal (0.82). Our findings suggest that RNFLT parameters may be better able to identify pre-perimetric glaucomatous damage in glaucoma suspects than BMO-MRW.