Global Bruch's Membrane Opening Minimum Rim Width Research Articles

Diagnostic Accuracy of Optic Nerve Head and Macula OCT Parameters for Detecting Glaucoma in Eyes With and Without High Axial Myopia

PurposeTo characterize structural differences and assess the diagnostic accuracy of optic nerve head (ONH) and macula optical coherence tomography (OCT) parameters to detect glaucoma in eyes with and without high axial myopia. DesignCross-sectional study Methods368 glaucoma and 411 healthy eyes with no axial myopia, 393 glaucoma and 271 healthy eyes with mild axial myopia and 124 glaucoma and 85 healthy eyes with high axial myopia were included. Global and sectoral peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening minimum rim width (BMO-MRW), ganglion cell inner plexiform layer thickness (GCIPLT), and macula RNFLT (mRNFLT) were compared and the diagnostic accuracy for glaucoma detection was evaluated using adjusted area under the receiver operating characteristic curve (AUC). ResultsDiagnostic accuracy for ONH and macula parameters to detect glaucoma was generally high and differed by myopia group. For ONH parameters the diagnostic accuracy was highest for global (AUC=0.95) and inferotemporal (AUC=0.91) pRNFLT for high myopes and global BMO-MRW for non-myopes (AUC=1.0) and mild myopes (AUC=0.97). For macula parameters, the diagnostic accuracy was higher in high myopes with 6 of the 11 GCIPLT global/sectors having adjusted AUCs > 0.90 compared to non-high myopes with no AUCs > 0.90. In all myopia groups, mRNFLT had lower AUCs than GCIPLT. ConclusionsThe diagnostic accuracy for pRNFL and GCIPL was high for high axial myopic eyes and shows promise for glaucoma detection in high myopes. Further analysis is needed to determine whether the high diagnostic accuracy can be confirmed in other populations.

Susceptibility of optic nerve head in children with posture-related elevation of intraocular pressure

Background/AimsThis work aimed to investigate changes in optic nerve head (ONH) morphometry based on Bruch membrane opening in children with extensive nocturnal intraocular pressure (IOP) elevations.MethodsThe course of Bruch membrane opening-based optic nerve head (ONH) morphometry was analysed in thirty-two patients younger than 18 years with evaluable SD-OCT examinations of the ONH and nocturnal posture-dependent IOP elevation above 25 mmHg. Longitudinal changes in neuroretinal rim tissue, as measured by Bruch Membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness, were assessed.ResultsOne year after the 24 h IOP measurement, global BMO-MRW (− 1.61 ± 16.8 µm, n.s.; p = 0.611) and RNFL (+ 0.64 ± 3.17 µm; n.s.; p = 0.292) measurements were not significantly different from the baseline. No significant BMO-MRW reduction (− 3.91 ± 24.3 µm; n.s. p = 0.458) or deviation in RNFL thickness (+ 1.10 ± 3.52 µm) was observed at the four-year follow-up. Absolute IOP values measured in the supine position did not correlate with changes in global BMO-MRW or RNFL thickness.ConclusionPosture-dependent IOP elevations do not seem to influence retinal nerve fibre layer thickness or Bruch membrane opening-based morphometric data in childhood.

Early Detection of Primary Open Angle, Angle Closure, and Normal Tension Glaucoma in an Asian Population Using Optical Coherence Tomography.

Spectral-domain optical coherence tomography (SD-OCT) facilitates early glaucoma detection in the Chinese population in Taiwan. The best parameters for primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), and suspected glaucoma (GS) detection are temporal inferior Bruch's membrane opening-minimum rim width (BMO-MRW), inner temporal macular ganglion cell layer (mGCL), temporal superior Circumpapillary retinal nerve fiber layer (cpRNFL), and mean global BMO-MRW, respectively. We investigated the diagnostic capability of SD-OCT for different types of early glaucoma among the Chinese population in Taiwan. One eye each was assessed from 113 individuals with healthy eyes, 125 individuals with suspected glaucoma (GS), and 156 patients with early glaucoma (POAG, 87; PACG, 50; and NTG, 19). Circumpapillary (cp) RNFL thickness (global and sectoral), BMO-MRW, and macular parameters, including the macular RNFL (mRNFL), mGCL, and macular inner plexiform layer (mIPL), were assessed using SD-OCT. The areas under receiver operator characteristic curves (AUCs) were calculated to evaluate the diagnostic capacity of the parameters to differentiate between healthy and early glaucomatous eyes. The parameters most suitable for detecting early POAG, PACG, NTG, and GS were temporal inferior BMO-MRW (AUC, 0.847), inner temporal mGCL (AUC, 0.770), temporal superior cpRNFL (AUC, 0.861), and mean global BMO-MRW (AUC, 0.768), respectively. Among the macular parameters, the mGCL exhibited the highest diagnostic capacity. The diagnostic capacity of the mGCL was lower than that of cpRNFL and BMO-MRW for POAG and NTG but not PACG. After adjusting for confounding variables in multivariable analysis, the AUC was determined to be 0.935 for POAG and 0.787 for GS. SD-OCT facilitates the detection of early POAG, PACG, and NTG. Using a combination of cpRNFL, BMO-MRW, and macular parameters may enhance their diagnostic capacities. Further studies are necessary to validate these findings.

Racial Differences in Detection of Glaucoma Using Retinal Nerve Fiber Layer Thickness and Bruch Membrane Opening Minimum Rim Width

To compare the sensitivities and specificities of the retinal nerve fiber layer thickness (RNFLT) and Bruch membrane opening minimum rim width (BMO-MRW) reference database-based criteria for detection of glaucoma in individuals of European descent (ED) and individuals of African descent (AD). Comparative diagnostic analysis by race METHODS: 382 eyes of 255 glaucoma patients (ED=170, AD=85) and 94 eyes of 50 healthy individuals (ED=30, AD=20) with global and sectoral RNFLT and BMO-MRW measured with Spectralis optical coherence tomography (OCT) were included. Six diagnostic criteria were evaluated: global measurement below the 5th or 1st percentile, ≥1 of the 6 sector measurements below the 5th or 1st percentile, and superotemporal (ST) and/or inferotemporal (IT) measurement below the 5th or 1st percentile. The sensitivities and specificities of these measurements for detection of glaucoma were compared using bootstrapping methods. ST and/or IT RNFLT below the 5th percentile has the best performance for detection of glaucoma among RNFLT classifications with a sensitivity (95% CI) of 89.5% (86.1, 92.5) and specificity of 87.2% (77.8, 95.1). In AD individuals, sensitivities of ST and IT RNFLT and BMO-MRW measurements below the 5th percentile criteria were lower than in ED individuals (RNFLT: 83.7% vs 92.5%, and BMO-MRW: 72.1% vs 88.5%, respectively), as well as specificities (AD RNFLT: 73.7% and BMO-MRW: 89.5% vs ED RNFLT: 96.4% and BMO-MRW: 98.2%, respectively). RNFLT and BMO-MRW had consistently lower diagnostic performance in AD individuals compared with ED individuals. BMO-MRW criteria might fail to detect as many as one-third of eyes with glaucoma, specifically in AD individuals. With the current reference database, RNFLT, and especially BMO-MRW, criteria are not adequate for diagnosing glaucoma in AD individuals.

Retinal Nerve Fiber Layer-to-Disc Ratio Distinguishing Glaucoma from Nonarteritic Anterior Ischemic Optic Neuropathy

Purpose: To evaluate the diagnostic value of retinal nerve fiber layer-to-disc ratio (RDR) compared to established parameters including retinal nerve fiber layer thickness (RNFLT), Bruch membrane opening-minimum rim width (BMO-MRW), and Bruch membrane opening-minimum rim area (BMO-MRA) for differentiating between open angle glaucoma (OAG) and nonarteritic anterior ischemic optic neuropathy (NAION).Methods: This retrospective study included 23 optic disc size-matched normal control eyes and 23 OAG and NAION eyes matched according to global RNFLT. The RDR, RNFLT, BMO-MRW, and BMO-MRA were analyzed; the diagnostic capabilities of these parameters were compared using the area under the receiver operating characteristic curve (AUC).Results: The global BMO-MRW and total BMO-MRA were lower in the OAG group than in the other two groups (all <i>p</i> < 0.001). RDR was greatest in the OAG group, followed by the healthy and NAION groups (<i>p</i> < 0.001). Between the OAG and NAION groups, the AUCs for temporal inferior BMO-MRW, total BMO-MRA, and RDR were 0.987, 0.996, and 1.000, respectively; these were greater than the temporal inferior RNFLT (0.811; <i>p</i> = 0.005, <i>p</i> = 0.006, and <i>p</i> = 0.006, respectively).Conclusions: RDR could be one of the useful parameters for differential diagnosis in OAG and NAION.

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.

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.

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.

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.

Interocular Asymmetry of Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Healthy Brazilian Individuals

To determine interocular differences in Bruch's membrane opening minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in healthy Brazilian individuals. Both eyes of 220 healthy individuals were included in this observational, cross-sectional study. All individuals had normal clinical examination and visual fields. Global and sectorial interocular BMO-MRW and RNFLT differences, acquired and regionalized relative to the fovea to BMO center (FoBMO) axis, were calculated. The effect of age, axial length, and BMO area asymmetry on the parameters' asymmetry was evaluated. The 95th limits for interocular BMO-MRW and RNFLT global differences were 49 and 9 μm, respectively. BMO-MRW asymmetry was negatively correlated (β=-33.87 μm/mm, R=0.06, P<0.001), whereas RNFLT asymmetry was positively correlated (β= 6.13 μm/mm, R=0.09, P<0.001) with BMO area asymmetry. Neither BMO-MRW nor RNFLT asymmetries were correlated with axial length asymmetry (β=-16.90 μm/mm, R=0.00, P=0.15; β=-1.18 μm/mm, R=0.00, P=0.52, respectively). Similarly, BMO-MRW and RNFLT asymmetries were not correlated with age (β=0.17 μm/y, R=0.01, P=0.22; β=0.0 μm/y, R=0.00, P=0.19, respectively). Our results suggest that global BMO-MRW and RNFLT interocular differences exceeding 49 and 9 μm, respectively, may indicate statistically abnormal asymmetry, which may suggest early structural damage. Asymmetry in BMO area should be accounted for when considering interocular asymmetry in BMO-MRW and RNFLT.

Racial Differences in Rate of Change of Spectral-Domain Optical Coherence Tomography–Measured Minimum Rim Width and Retinal Nerve Fiber Layer Thickness

To compare race-related differences in estimated rate of change of Bruch's membrane opening-minimum rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer thickness (RNFLT) in healthy, glaucoma suspect, and glaucoma eyes of individuals of European (ED) and African descent (AD). Prospective cohort study. This study investigated rate of change of BMO-MRW and RNFLT in 124 healthy, 227 glaucoma suspect, and 177 glaucoma eyes followed for approximately 3 years and tested with optical coherence tomography every 6months. Suspect eyes had a history of untreated intraocular pressure (IOP) ≥ 22mm Hg or suspicion of glaucoma by optic disc photograph assessment without repeatable abnormal standard automated perimetry (SAP) results. Glaucoma eyes had repeatable abnormal SAP results (GHT ONL or PSD ≤ 5%). Mixed-effects models were used to estimate the rate of change after controlling for age, mean follow-up IOP, central corneal thickness, axial length, and BMO area. A race-related difference in rate of change of global BMO-MRW but not average RNFLT in suspect eyes was observed. Rate of change of BMO-MRW was-1.82μm/year and-2.20μm/year in ED and AD suspect eyes, respectively (P= .03). Rate of change of RNFLT was-0.64μm/year and-0.75μm/year in ED and AD suspect eyes, respectively (P= .75). No race-related differences in change rate were found in healthy or glaucoma eyes. Race is an important consideration when assessing structural change, particularly minimum rim width, in glaucoma suspect eyes. Differences in rate of structural change may help explain racial disparities in glaucoma susceptibility.

Bruch's membrane opening-minimum rim width and visual field loss in glaucoma: a broken stick analysis.

To determine the Bruch's membrane opening-minimum rim width (BMO-MRW) tipping point where corresponding visual field (VF) damages become detectable. A total of 85 normal subjects and 83 glaucoma patients (one eye per participant) were recruited for the study. All of the patients had VF examinations and spectral-domain optical coherence tomography to measure the BMO-MRW. Total deviation values for 52 VF points were allocated to the corresponding sector according to the Garway-Heath distribution map. To evaluate the relationship between VF loss and BMO-MRW measurements, a "broken-stick" statistical model was used. The tipping point where the VF values started to sharply decrease as a function of BMO-MRW measurements was estimated and the slopes above and below this tipping point were compared. A 25.9% global BMO-MRW loss from normative value was required for the VF loss to be detectable. Sectorally, substantial BMO-MRW thinning in inferotemporal sector (33.1%) and relatively less BMO-MRW thinning in the superotemporal sector (8.9%) were necessary for the detection of the VF loss. Beyond the tipping point, the slopes were close to zero throughout all of the sectors and the VF loss was unrelated to the BMO-MRW loss. The VF loss was related to the BMO-MRW loss below the tipping point. The difference between the two slopes was statistically significant (P≤0.002). Substantial BMO-MRW loss appears to be necessary for VF loss to be detectable in patients with open angle glaucoma with standard achromatic perimetry.

Reproducibility of Bruch Membrane Opening-Minimum Rim Width Measurements With Spectral Domain Optical Coherence Tomography.

To evaluate the reproducibility of Bruch membrane opening-minimum rim width (BMO-MRW) measurements obtained with Spectralis optical coherence tomography (OCT) in normal and glaucoma subjects. In total, 123 eyes from 123 subjects (65 healthy, 58 glaucoma subjects) were included. BMO-MRW measurements were repeated 3 times during the same visit using Spectralis OCT. The BMO points and internal limiting membrane were identified with automated software and corrected manually when necessary. The intravisit repeatability, coefficient of variation (CV), and intraclass correlation coefficient were analyzed for each sector and global BMO-MRW. The Spearman rank correlation coefficient was used to estimate correlations between CV and multiple variables. Multiple linear regression analysis was used to identify significant associations. The intravisit repeatability ranged from 2.97 μm (global) to 10.25 μm (inferotemporal sector) in healthy subjects and from 3.31 μm (global) to 12.09 μm (inferonasal sector) in glaucoma subjects. The CVs ranged from 1.17% (global) to 3.56% (inferotemporal sector) in healthy subjects and from 2.57% (global) to 6.46% (superotemporal and inferotemporal sector) in glaucoma subjects. Intraclass correlation coefficients ranged from 0.974 (superotemporal sector) to 0.997 (nasal sector) in normal subjects and from 0.988 (temporal sector) to 0.997 (global and nasal sector) in glaucoma subjects. Multiple regression analysis showed that the CV in global BMO-MRW measurements was inversely associated with global BMO-MRW and visual field mean deviation (P=0.001 and 0.002, respectively). The Spectralis SD-OCT showed excellent reproducibility in BMO-MRW measurements in both normal and glaucoma subjects. The measurements variability was worse in more advanced glaucoma.

Structure-function relationship comparison between retinal nerve fibre layer and Bruch's membrane opening-minimum rim width in glaucoma.

To evaluate and compare structural optical coherence tomography (OCT)-based parameters, such as Bruch's membrane opening-minimum rim width (BMO-MRW), and retinal nerve fiber layer (RNFL) thickness in glaucoma patients with visual field (VF) defects, and to correlate both to mean deviation (MD) values of obtained standard achromatic perimetry (SAP) examinations. Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals. All study participants underwent a full ophthalmic examination and VF testing with SAP. Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT. Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated. A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36 healthy right eyes of 36 individuals in the control group. Global MD of values correlated significantly with global RNFL (Pearson corr. coeff: 0.632, P=0.001) and global BMO-MRW (Pearson corr. coeff: 0.746, P<0.001) values in the glaucoma group. Global MD and sectorial RNFL or BMO-MRW values correlated less significantly. In the control group, MD values did not correlate with RNFL or BMO-MRW measurements. A subgroup analysis of myopic patients (>4 diopters) within the glaucoma group (n=6) revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements. In a clinical setting, RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

Intra- and interobserver reproducibility of Bruch's membrane opening minimum rim width measurements with spectral domain optical coherence tomography.

To investigate the reproducibility of Bruch's membrane opening minimum rim width (BMO-MRW) and retinal nerve fibre layer thickness (RNFLT) measurements using spectral domain optical coherence tomography (SD-OCT). Additionally, to investigate the reproducibility of BMO area measurements and fovea to BMO centre (FoBMO) angle. Participants were healthy subjects (n=30) and patients with glaucoma (n=26). One eye of each participant was scanned to obtain optic nerve head (24 radial B-scans) and peripapillary (one circular B-scan) images by three independent examiners. Additionally, one examiner imaged each participant three times on the same day. Intra- and interobserver reproducibilities were estimated by within-subject standard deviation (SW) and coefficient of variation (COV). Spearman's rank correlation coefficient was used to test the correlation between the magnitude of the parameter and its standard deviation. The global BMO-MRW COVs (%) in healthy/glaucoma subjects were 0.87/1.34 and 1.28/3.13 for intra- and interobserver analyses, respectively, and the corresponding global RNFLT figures were 1.50/2.10 and 2.04/2.87. Global mean BMO-MRW and RNFLT showed no correlation with their respective standard deviations. The reproducibilities of BMO area and FoBMO angle were excellent and similar between the groups. The reproducibilities of BMO-MRW, BMO area measurements and FoBMO angle were excellent in both healthy subjects and patients with glaucoma. Bruch's membrane opening minimum rim width (BMO-MRW) reproducibility is comparable to that of RNFLT measurements.

Bruch's Membrane Opening-Minimum Rim Width Assessment With Spectral-Domain Optical Coherence Tomography Performs Better Than Confocal Scanning Laser Ophthalmoscopy in Discriminating Early Glaucoma Patients From Control Subjects.

To compare the diagnostic performance and evaluate diagnostic agreement for early glaucoma detection between a confocal scanning laser ophthalmoscope (CSLO) and a spectral-domain optical coherence tomography (SD-OCT). Fifty-five eyes of 55 open-angle glaucoma patients and 42 eyes of 42 healthy control subjects were enrolled in this observational, cross-sectional study. All participants underwent comprehensive ophthalmic examination, visual field testing, and optic nerve head and retinal nerve fiber layer imaging by CSLO (HRT3) and SD-OCT (Spectralis OCT). The agreements of categorical classifications were evaluated (κ statistics). Area under receiver operating characteristic curves (AUROC) and sensitivity at 95% fixed specificity were computed. The agreements of HRT3 and Spectralis OCT categorical classifications were fair to moderate (κ ranged between 0.33 and 0.54), except for Moorfields regression analysis of the HRT3 and the OCT global Bruch's membrane opening-minimum rim width (BMO-MRW) (criterion 1 κ=0.63, criterion 2 κ=0.67). The AUROC of OCT global BMO-MRW (0.956) was greater than those of HRT3 cup-to-disc area ratio (0.877, P=0.0063), vertical cup-to-disc ratio (0.872, P=0.0072), and cup area (0.845, P=0.0005). At 95% specificity, Spectralis OCT global BMO-MRW attained a higher sensitivity than HRT3 cup-to-disc area ratio (P<0.001). The BMO-MRW assessment with SD-OCT performed well in discriminating early glaucoma patients from control subjects and had a better performance than CSLO. The diagnostic classifications of HRT3 and Spectralis OCT may reach good agreement.

Comparison of Bruch's Membrane Opening Minimum Rim Width Among Those With Normal Ocular Health by Race

To examine if racial differences in Bruch's membrane opening minimum rim width (BMO-MRW) in spectral-domain optical coherence tomography (SDOCT) exist, specifically between people of African descent (AD) and European descent (ED) in normal ocular health. Cross-sectional study. Patients presenting for a comprehensive eye examination at retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: AD aged ≥40 years, ED aged ≥50 years, diabetes, family history of glaucoma, and/or pre-existing diagnosis of glaucoma. Participants with normal optic nerves on examination received SDOCT of the optic nerve head (24 radial scans). Global and regional (temporal, superotemporal, inferotemporal, nasal, superonasal, and inferonasal) BMO-MRW were measured and compared by race using generalized estimating equations. Models were adjusted for age, sex, and BMO area. SDOCT scans from 269 eyes (148 participants) were included in the analysis. Mean global BMO-MRW declined as age increased. After adjusting for age, sex, and BMO area, there was not a statistically significant difference in mean global BMO-MRW by race (P= .60). Regionally, the mean BMO-MRW was lower in the crude model among AD eyes in the temporal, superotemporal, and nasal regions and higher in the inferotemporal, superonasal, and inferonasal regions. However, in the adjusted model, these differences were not statistically significant. BMO-MRW was not statistically different between those of AD and ED. Race-specific normative data may not be necessary for the deployment of BMO-MRW in AD patients.

Comparison of Bruch's Membrane Opening Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness in Early Glaucoma Assessment.

To compare the diagnostic value of Bruch's membrane opening minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in patients with ocular hypertension, preperimetric, and perimetric glaucoma. One hundred eighty-one eyes consisting of 40 healthy controls, 41 ocular hypertensive subjects, 50 subjects with preperimetric glaucoma and 50 with perimetric glaucoma were included. One randomly selected eye was included. All patients underwent slit-lamp examination, funduscopy, achromatic perimetry, and 24-hour IOP profile. Bruch's membrane opening-MRW and RNFLT (3 peripapillary circle scans, 12°/14°/16°) data were obtained using spectral domain optical coherence tomography. Areas under the receiver operating characteristics curves (AUROC) as well as sensitivity at fixed specificity were computed globally and for six vertical split sectors. Venn diagrams were plotted to identify patients that were diagnosed by one of the two parameters only. For RNFLT the smallest circle diameter showed highest diagnostic accuracy and was used for comparison with BMO-MRW. Distinguishing perimetric glaucoma, RNFLT and BMO-MRW showed comparable AUROCs in global (AUROC, 95% confidence interval: 0.954, 0.911-0.996 and 0.929, 0.872-0.986) and sectoral (0.929, 0.877-0.981 and 0.946, 0.904-0.996) analysis. For preperimetric glaucoma BMO-MRW and RNFLT also demonstrated comparable performance in global (0.839, 0.757-0.921 and 0.821, 0.731-0.912) and sectoral (0.860, 0.782-0.938 and 0.835, 0.750-0.920) analysis. When identifying ocular hypertensive eyes AUROCs were lower for global RNFLT and BMO-MRW (0.493, 0.365-0.621 and 0.562, 0.433-0.691). A combined parameter showed an AUROC of 0.959, 0.921 to 0.996 for perimetric and 0.849, 0.770 to 0.929 for preperimetric glaucoma. Bruch's membrane opening-MRW and RNFLT are comparably useful parameters for discrimination of preperimetric and perimetric glaucomatous eyes and show potential to assist each other in glaucoma diagnosis. (www.ClinicalTrials.gov number, NTC00494923; Erlangen Glaucoma Registry.).

Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population: A Multicenter Study

Conventional optic disc margin-based neuroretinal rim measurements lack a solid anatomic and geometrical basis. An optical coherence tomography (OCT) index, Bruch's membrane opening minimum rim width (BMO-MRW), addresses these deficiencies and has higher diagnostic accuracy for glaucoma. We characterized BMO-MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) in a normal population. Multicenter cross-sectional study. Normal white subjects. An approximately equal number of subjects in each decade group (20-90 years of age) was enrolled in 5 centers. Subjects had normal ocular and visual field examination results. We obtained OCT images of the optic nerve head (24 radial scans) and peripapillary retina (1 circular scan). The angle between the fovea and BMO center (FoBMO angle), relative to the horizontal axis of the image frame, was first determined and all scans were acquired and analyzed relative to this eye-specific FoBMO axis. Variation in BMO-MRW and RNFLT was analyzed with respect to age, sector, and BMO shape. Age-related decline and between-subject variability in BMO-MRW and RNFLT. There were 246 eyes of 246 subjects with a median age of 52.9 years (range, 19.8-87.3 years). The median FoBMO angle was -6.7° (range, 2.5° to -17.5°). The BMO was predominantly vertically oval with a median area of 1.74 mm(2) (range, 1.05-3.40 mm(2)). Neither FoBMO angle nor BMO area was associated with age or axial length. Both global mean BMO-MRW and RNFLT declined with age at a rate of -1.34 μm/year and -0.21 μm/year, equivalent to 4.0% and 2.1% loss per decade of life, respectively. Sectorially, the most rapid decrease occurred inferiorly and the least temporally; however, the age association was always stronger with BMO-MRW than with RNFLT. There was a modest relationship between mean global BMO-MRW and RNFLT (r = 0.35), whereas sectorially the relationship ranged from moderate (r = 0.45, inferotemporal) to nonexistent (r = 0.01, temporal). There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO-MRW and RNFLT in their relationship with age and between each other. Adjusting BMO-MRW and RNFLT for age and sector is important in ensuring optimal diagnostics for glaucoma.