Maximum Cup Depth Research Articles

Quantitative analysis of the optic nerve head parameters in patients with age-related macular degeneration

Background/aimTo evaluate the topographic parameters of the optic disc of patients with age-related macular degeneration (AMD) by performing confocal scanning laser ophthalmoscopy.Materials and methodsThis prospective study included 41 eyes of 41 patients with neovascular AMD, 56 eyes of 56 patients with nonneovascular AMD, and 48 eyes of 48 healthy control subjects. Images of the optic nerve head of all of the participants were obtained using Heidelberg retinal tomography III software 3.1. The following stereometric parameters were measured for each participant: disc area, cup area, rim area, cup volume, rim volume, cup-to-disc ratio, mean cup depth, maximum cup depth, cup shape, and mean retinal nerve fiber layer thickness.ResultsThe cup shape values ​​of the patients with neovascular and nonneovascular AMD were significantly different from those of the control subjects (P = 0.002 and P < 0.001, respectively). The cup-to-disc ratio was significantly higher in the patients with nonneovascular AMD when compared with the control subjects (P = 0.013), but no difference was found between the patients with neovascular AMD and the control subjects (P > 0.05). No significant differences were observed among the 3 groups with respect to the other optic disc parameters (P > 0.05).ConclusionThese data showed that the deterioration of the cup shape was an important finding in patients with AMD. Because AMD manifests with progressive ocular damage, including the optic nerve head, examination of the cup shape may be important during the follow-up of these patients.

Determinants of maximum cup depth in non-glaucoma and primary open-angle glaucoma subjects: a population-based study

Background/objectivesTo study the associations of intraocular pressure (IOP) and retinal vessel diameters: central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) with the maximum cup depth (MCD) in subjects with and without POAG.Subjects/methodsEligible subjects from the Handan Eye Study. All participants underwent physical and comprehensive eye examinations. Univariable and multivariable linear regression models assessed the association between MCD and other parameters.ResultsFour thousand one hundred and ninety-four eligible nonglaucoma and 40 POAG subjects were analyzed. On univariable analysis, deeper MCD was significantly associated with younger age, male gender, lower systolic blood pressure (BP), higher IOP, higher estimated cerebro-spinal fluid pressure (ECSFP), lower estimated trans-laminal cribrosa pressure difference (ETLCPD), longer axial length, narrower CRAE, narrower CRVE, larger disc area (DA) and a lower prevalence of hypertension and diabetes. On multivariable analysis, significant independent determinants of MCD were larger DA (P < 0.001; beta: 0.042; B: 0.20; 95% CI: 0.19, 0.22), younger age (P < 0.001; beta: −0.09; B: −0.002; 95% CI: −0.003, −0.001), higher IOP (P < 0.01; beta: 0.040; B: 0.003; 95% CI: 0.001, 0.005), and narrower CRAE (P < 0.001; beta: −0.06; B: −0.001; 95% CI: −0.001, −0.0003). On adding ECSFP and ETLCPD to the model, MCD was associated with IOP but not with estimated CSFP and TLCPD. A 1 μm decrease in CRAE or 1 mmHg increase of IOP was associated with a 1 μm increase of MCD (P < 0.001) and 3 μm increase of MCD respectively (P = 0.009).ConclusionsNarrow CRVE and higher IOP are associated with an increase in MCD.

Phacoemulsification with Peripheral Iridectomy and Trabeculectomy: Comparing the Two Procedures in Management of Angle-Closure Glaucoma

Background: glaucoma was ranked as one of the major causes of blindness worldwide. Angle-closure glaucoma (ACG) is a type of glaucoma characterized by narrowing or closure of the anterior chamber angle. Objective: to compare the clinical outcomes of phacoemulsification (Phaco) with peripheral iridectomy versus trabeculectomy in management of ACG. Patients and Methods: this study was a prospective, follow-up nonrandomized clinical trial, carried out on 50 eyes with ACG. Patients were divided into two groups: group A (n= 25); eyes underwent phacoemulsification with peripheral iridectomy, and group B (n= 25); eyes underwent sub-scleral trabeculectomy. Intraocular pressure (IOP), visual outcomes and postoperative complications were assessed. Patients were followed-up for 6 months. Results: postoperative visual acuity was significantly improved in phaco group compared to that of trabeculectomy group (P <0.001). The mean postoperative IOP was reduced significantly (P < 0.05) in both groups at all time intervals compared to their preoperative values. Anterior chamber depth increased significantly postoperatively in group (A) (p<0.001) however, almost no change was noticed in group (B). Meanwhile, postoperative angle opening distance was increased (p<0.001) in both groups. No significant differences were found between both procedures in Rim area, Rim volume, cup/disc area ratio and maximum cup depth. Eight cases (32.0%) in group (A) and 7 cases (28.0%) in group (B) suffered from postoperative complications with insignificant difference. Conclusion: both procedures are effective in lowering IOP in patients with ACG, but phacoemulsification with peripheral iridectomy significantly improved visual acuity compared to sub-scleral trabeculectomy with almost the same rate of complications.

Phacoemulsification with Peripheral Iridectomy and Trabeculectomy: Comparing the Two Procedures in Management of Angle-Closure Glaucoma

Background: glaucoma was ranked as one of the major causes of blindness worldwide. Angle-closure glaucoma (ACG) is a type of glaucoma characterized by narrowing or closure of the anterior chamber angle. Objective: to compare the clinical outcomes of phacoemulsification (Phaco) with peripheral iridectomy versus trabeculectomy in management of ACG. Patients and Methods: this study was a prospective, follow-up nonrandomized clinical trial, carried out on 50 eyes with ACG. Patients were divided into two groups: group A (n= 25); eyes underwent phacoemulsification with peripheral iridectomy, and group B (n= 25); eyes underwent sub-scleral trabeculectomy. Intraocular pressure (IOP), visual outcomes and postoperative complications were assessed. Patients were followed-up for 6 months. Results: postoperative visual acuity was significantly improved in phaco group compared to that of trabeculectomy group (P <0.001). The mean postoperative IOP was reduced significantly (P < 0.05) in both groups at all time intervals compared to their preoperative values. Anterior chamber depth increased significantly postoperatively in group (A) (p<0.001) however, almost no change was noticed in group (B). Meanwhile, postoperative angle opening distance was increased (p<0.001) in both groups. No significant differences were found between both procedures in Rim area, Rim volume, cup/disc area ratio and maximum cup depth. Eight cases (32.0%) in group (A) and 7 cases (28.0%) in group (B) suffered from postoperative complications with insignificant difference. Conclusion: both procedures are effective in lowering IOP in patients with ACG, but phacoemulsification with peripheral iridectomy significantly improved visual acuity compared to sub-scleral trabeculectomy with almost the same rate of complications.

The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy.

To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy. This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation. Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area. Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

Classification of optic disc shape in glaucoma using machine learning based on quantified ocular parameters.

PurposeThis study aimed to develop a machine learning-based algorithm for objective classification of the optic disc in patients with open-angle glaucoma (OAG), using quantitative parameters obtained from ophthalmic examination instruments.MethodsThis study enrolled 163 eyes of 105 OAG patients (age: 62.3 ± 12.6, mean deviation of Humphrey field analyzer: -8.9 ± 7.5 dB). The eyes were classified into Nicolela’s 4 optic disc types by 3 glaucoma specialists. Randomly, 114 eyes were selected for training data and 49 for test data. A neural network (NN) was trained with the training data and evaluated with the test data. We used 91 types of quantitative data, including 7 patient background characteristics, 48 quantified OCT (swept-source OCT; DRI OCT Atlantis, Topcon) values, including optic disc topography and circumpapillary retinal nerve fiber layer thickness (cpRNFLT), and 36 blood flow parameters from laser speckle flowgraphy, to build the machine learning classification model. To extract the important features among 91 parameters, minimum redundancy maximum relevance and a genetic feature selection were used.ResultsThe validated accuracy against test data for the NN was 87.8% (Cohen’s Kappa = 0.83). The important features in the NN were horizontal disc angle, spherical equivalent, cup area, age, 6-sector superotemporal cpRNFLT, average cup depth, average nasal rim disc ratio, maximum cup depth, and superior-quadrant cpRNFLT.ConclusionThe proposed machine learning system has proved to be good identifiers for different disc types with high accuracy. Additionally, the calculated confidence levels reported here should be very helpful for OAG care.

Relationship between anterior segment and optic nerve head parameters in healthy subjects.

To determine the relationship between anterior segment and optic nerve head (ONH) parameters. Two hundred healthy subjects were enrolled in this study. The par-ticipants underwent measurement of anterior segment parameters with a Pentacam Scheimpflug system and imaging of the optic disc with confocal scanning laser ophthalmoscopy. Pearson's correlation coefficient was calculated to assess the associations between ONH and anterior segment parameters. Multivariate regression analyses controlling for age and disc area as confounding factors were also conducted. There were significant negative relationships between optic disc area and corneal thickness (p=0.03, r=-0.217) and volume (p=0.017, r=-0.239). Corneal refractive power was significantly correlated with cup area, rim area, rim volume, and cup/disc ratio (p<0.05 for all). An increase of 1 diopter in anterior corneal refractive power corresponded to a decrease of 0.022 in cup/disc ratio. Rim volume was negatively correlated with anterior chamber depth and anterior chamber volume (p<0.05 for both). A 1-mm3 increase in anterior chamber depth corresponded to a 0.154-mm3 decrease in rim volume. Mean and maximum cup depth measurements were not associated with any of the anterior segment parameters. In nonglaucomatous eyes, the dimensions and shape of the ONH may be related to anterior segment morphology. Therefore, it may be helpful to take anterior segment parameters into consideration in evaluating the OHN.

Comparison of optic nerve head topography in normal eyes using confocal laser scanning tomograph and retinal thickness analyzer

Background: To compare optic nerve head topography measurements by Heidelberg retina tomograph I (HRT) and retinal thickness analyser (RTA) and thereby to determine clinical agreement between the devices. To investigate reproducibility of measurements for HRT and RTA. To obtain our own HRT and RTA database for comparison of healthy and glaucomatous eyes. Methods: The study included 100 normal eyes of 50 white adults of both sexes (mean age of 55.5 [SD 9.5] years). Ophthalmologic examination, fundus photography, HRT and RTA examinations were performed. To determine reproducibility 10 volunteers repeated the examination after a week. For HRT and RTA measurements mean (SD), median, 5th and 95th percentile, range and coefficient of variation were calculated. Differences in topographic parameters between HRT and RTA were tested for significance. Clinical agreement was assessed with »limits of agreement« and reproducibility expressed by repeatability coefficient and intraclass correlation coefficient (ICC). Results: Significant differences (p 0.10 for RTA parameters cup area (0.15), rim area (0.19), maximum cup depth (0.13), height variation contour (0.11) and RNFL cross-sectional area (0.14). ICC was good (> 90%) for all parameters, except for mean RNFL thickness (89%) for HRT and height variation contour (84%) for RTA. Conclusions: The two devices cannot be used interchangeably. At present, clinical usefulness of HRT is superior to RTA due to better reproducibility of measurements, better software support, shorter duration of the examination and good comparability of our HRT database with the database included in the latest HRT software version. At the moment RTA is using the same database as HRT. Therefore, our RTA database provides a new basis for comparison of optic disc characteristics between healthy and glaucomatous eyes.

Age, Maximum Cup Depth, Central Corneal Thickness, Disc Area and Mean Defect in Patients with Open Angle Glaucoma and Ocular Hypertension

Purpose: The main objective was to analyze the relationship between maximum cup depth (MCD), mean defect (MD), central corneal thickness (CCT), age and disc area, in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). Methods: Cross-sectional study of patients diagnosed with OHT and POAG. Visual fields were obtained using an Octopus 300 analyzer, TOP strategy. MCD and disc area were obtained using a Heidelberg Retina Tomograph. Results: The study sample comprised 234 eyes of 143 patients, 91 women and 52 men, mean age 63.55 years (SD 10.49). Mean values were: MCD 0.52 mm (SD 0.27), MD 2.78 dB (SD 5.02), CCT 543.5 μm (SD 36.63), IOP 16.73 mmHg (SD 2.93), and disc area 2.01 mm2 (SD 0.39). A significant correlation was observed between MCD and age in patients under 60 years, between MCD and disc area, and between MD and disc area. Conclusions: Our study showed a correlation between MCD and age which was significant in patients under 60 years of age, between MCD and disc area and between MD and disc area, suggesting that the larger the disc area, the greater the MCD and the MD in patients with OHT and POAG.

Morphometric Optic Nerve Head Analysis in Glaucoma Patients: A Comparison between the Simultaneous Nonmydriatic Stereoscopic Fundus Camera (Kowa Nonmyd WX3D) and the Heidelberg Scanning Laser Ophthalmoscope (HRT III).

Purpose. To investigate the agreement between morphometric optic nerve head parameters assessed with the confocal laser ophthalmoscope HRT III and the stereoscopic fundus camera Kowa nonmyd WX3D retrospectively. Methods. Morphometric optic nerve head parameters of 40 eyes of 40 patients with primary open angle glaucoma were analyzed regarding their vertical cup-to-disc-ratio (CDR). Vertical CDR, disc area, cup volume, rim volume, and maximum cup depth were assessed with both devices by one examiner. Mean bias and limits of agreement (95% CI) were obtained using scatter plots and Bland-Altman analysis. Results. Overall vertical CDR comparison between HRT III and Kowa nonmyd WX3D measurements showed a mean difference (limits of agreement) of −0.06 (−0.36 to 0.24). For the CDR < 0.5 group (n = 24) mean difference in vertical CDR was −0.14 (−0.34 to 0.06) and for the CDR ≥ 0.5 group (n = 16) 0.06 (−0.21 to 0.34). Conclusion. This study showed a good agreement between Kowa nonmyd WX3D and HRT III with regard to widely used optic nerve head parameters in patients with glaucomatous optic neuropathy. However, data from Kowa nonmyd WX3D exhibited the tendency to measure larger CDR values than HRT III in the group with CDR < 0.5 group and lower CDR values in the group with CDR ≥ 0.5.

Morphological characteristics of the optic nerve evaluated by confocal laser tomography (HRT3) and laser polarimetry (GDx-VCC) in a normal population from the city of Barcelona

ObjectiveTo evaluate morphological parameters of optic disk and retinal nerve fiber layer (RNFL) examined with confocal laser tomography (HRT3) and laser polarimetry (GDx-VCC) in a normal population, and analyze correlations of these parameters with demographic variables. Patients and methodsCross-sectional study in the context of a glaucoma screening campaign in the primary care center of Barcelona. The individuals selected were non-hypertensive Mediterranean Caucasians with risk for glaucoma development (individuals ≥60 years old or ≥40 years old with family history of glaucoma or intraocular pressure or myopia >3 diopter). All subjects underwent a complete ophthalmic examination, confocal laser tomography (HRT3) and scanning laser polarimetry (GDx-VCC), with subjects having results within normal limits only being included. Structural parameters were analyzed along with age, refraction, and pachymetry based on the Spearman rank correlation test. ResultsA total of 224 subjects were included, with a mean age of 63.4±11.1 years. Disk areas, excavation and ring area were 2.14±0.52mm2, 0.44±0.34mm2 and 1.69±0.38mm2, respectively. The mean RNFL (GDx) was 55.9±6.9μm. Age was correlated with lower ring volume, highest rate of cup shape measure, largest mean and maximum cup depth, lower nerve fiber index (NFI) and RNFL (all p-values below .05). ConclusionThe mean values and distribution of several parameters of the papilla and the RNFL in normal Mediterranean Caucasians population are presented. A loss of thickness of the RNFL, ring thinning, and enlarged cup were observed with increased age.

Retinal Nerve Fiber and Optic Disc Morphology in Patients with Human Immunodeficiency Virus Using the Heidelberg Retina Tomography 3.

PurposeTo use novel confocal scanning ophthalmoscopy technology to test hypothesis that HIV-seropositive patients without history of retinitis with a history of a low CD4 count are more likely to have damage to their retinal nerve fiber layer (RNFL) when compared to patients with high CD4 count. In addition, we compared optic disc morphologic changes with glaucoma.DesignCross-sectional study.Participants and Controls171 patients were divided into four groups. The control group consisted of 40 eyes of 20 HIV-seronegative patients. The second group consisted of 80 eyes of 41 HIV-positive patients whose CD4 cell count never dropped below 100 (1.0 x 109/L). The third group consisted of 44 eyes of 26 HIV-positive patients with a history of low CD4 counts <100. Fourth group consisted of 79 eyes of 79 patients with confirmed glaucoma who served as positive controls.TestingConfocal scanning laser ophthalmoscopy was performed with the Heidelberg Retina Tomograph (HRT3) and data were analyzed with HRT3, software (Heyex version 1.5.10.0).Main Outcome MeasuresDisc area, cup area, cup volume, rim volume, mean cup depth, maximum cup depth, cup-to-disc ration, mean RNFL thickness, and RNFL cross-sectional area.ResultsAnalysis of the global optic nerve and cup parameters showed no difference in disk area among the four groups. There was also no difference in cup, rim volume, mean cup depth, or maximum cup depth among the first three groups but they were all different from glaucoma group. The RNFL was thinner in glaucoma and both HIV-positive groups compared to HIV-seronegative subjects. The cross sectional RNFL area was thinner in both high and low CD4 HIV-positive groups compared to HIV-seronegative group in the nasal and temporal/inferior sectors, respectively. Glaucoma group showed thinning in all sectors.ConclusionsHIV retinopathy results in retinal nerve fiber layer loss without structural optic nerve supportive tissue change. RNFL damage may occur early in HIV disease by mechanism different than in glaucoma.

Características morfológicas del nervio óptico evaluadas por el tomógrafo láser confocal (HRT3) y polarimetría láser (GDx-VCC) en población normal en la ciudad de Barcelona

ObjectiveTo evaluate morphological parameters of optic disc and retinal nerve fiber layer (RNFL) examined with confocal laser tomography (HRT3) and laser polarimetry (GDx-VCC) in a normal population, and analyze correlations of these parameters with demographic variables. Patients and methodsCross-sectional study in the context of a glaucoma screening campaign in the primary care center of Barcelona. The individuals selected were non-hypertensive Mediterranean Caucasians with risk for glaucoma development (individuals≥60 years old or≥40 years old with family history of glaucoma or intraocular pressure or myopia>3diopter). All subjects underwent a complete ophthalmic examination, confocal laser tomography (HRT3) and scanning laser polarimetry (GDX-VCC), subjects with results within normal limits only being included. Structural parameters were analyzed along with age, refraction, and pachymetry based on the Spearman rank correlation test. ResultsA total of 224 subjects included, with a mean age of 63.4±11.1 years. Disc areas, excavation and ring area were 2.14±0.52mm2, 0.44±0.34mm 2 and 1.69±0.38mm2, respectively. The mean RNFL (GDX) was 55.9±6.9μm. Age was correlated with lower ring volume, highest rate of cup shape measure, largest mean and maximum cup depth, lower nerve fiber index (NFI) and RNFL (all p-values below .05). ConclusionThe mean values and distribution of several parameters of the papilla and the RNFL in normal Mediterranean Caucasians population are presented. A loss of thickness of the RNFL, ring thinning, and enlarged cup was observed with increased age.

Evaluation of the Effect of Pan Retinal Photocoagulation on Optic Nerve Head Parameters Using HRT3

To evaluate the optic disc topography after pan retinal photocoagulation (PRP) in diabetic retinopathy patients using confocal scanning laser ophthalmoscopy (HRT3). Thirty eyes of 30 diabetic patients (non-insulin-dependent diabetes mellitus) underwent PRP for proliferative diabetic retinopathy. Subjects with glaucoma or family history of glaucoma, any coexisting neuroophthalmic disease, uveitis, retinal artery or vein occlusion, corneal opacity or lasered previously were excluded from the study. Optic nerve head (ONH) of these patients were evaluated by confocal scanning laser ophthalmoscopy (HRT3) at baseline, 3, and 6 months after completion of PRP. There were 23 males and 7 females with a mean age of 51.8 years (36 to 67 y). The mean intraocular pressure was 13.1±2.57 mm Hg at baseline, 13.4±2.6 mm Hg at 3 months, and 13.3±2.2 mm Hg at 6 months (P=0.6). The global values of ONH parameters showed no significant change from baseline at 3 months. At 6 months, there was a significant increase in vertical cup:disc ratio (P=0.021), cup volume (P=0.036), mean cup depth (P=0.042), and maximum cup depth (P=0.05) as compared with baseline values. PRP induces significant changes in the ONH in patients with diabetic retinopathy as measured with HRT3. This is an important consideration in the diagnosis and evaluation of progression in glaucoma patients with diabetic retinopathy who have undergone PRP.

Heidelberg retina tomography II parameters in evaluating high- and normal-pressure glaucoma progression

Heidelberg retina tomography II (HRT II) haves been employed to quantitatively assess the topography of optic discs in eyes with high-pressure glaucoma (HPG) and normal-pressure glaucoma (NPG), in order to determine which of global and segmental optic disc parameters will prove to be most suitable for monitoring the progression of these two conditions. The results of 73 eyes of 73 patients with HPG and NPG were analyzed in relation to age, refractive error, quality of HRT images and stereometric parameters. A statistically significant difference (p < 0.05) between the global baseline and follow-up results was found in: rim volume, maximum cup depth and cup shape measure (in the HPG group), and C/D ratio, cup volume, rim volume and cup shape measure (in the NPG group). The baseline and follow-up results of the retinal nerve fiber layer in the temporal and inferotemporal sectors show a significant difference in both groups. Several HRT stereometric parameters are useful for monitoring the progression of changes of the optic disc and local retina in eyes with HPG and NPG. Both segmental and global scanning is of importance in glaucoma progression analysis.

The impact of refractive errors and axial length on the structural parameters of the optic disc

Background Heidelberg Retinal Tomograph (HRT) has been widely used in clinical diagnosis of glaucomatous optic neuropathy,importantly,the measurement results of HRT may be affected by myopia.Therefore,studying the effect of different refractive status and axial length on structural parameters of the optic disc is important.Objective This study was to evaluate the influence of refractive error and axial length to optic nerve head parameter measured by HRT.Methods The parents who participate in Guangzhou Twin Study were enrolled in this investigation from July 2006 to August 2011.The regular eye examinations,including visual acuity,slit lamp,fundus,auto-refraction,HRT-Ⅲ and intraocular lens (IOL) Master,were performed on all the subjects.Thc data from right eyes of subjects were collected and analyzed.The linear correlation analysis and multiple linear regression analysis were applied to analyze the correlation between HRT optic papilla configuration parameter and equivalent sphere and ocular axis length.Results A pilot prospective series cases observational study was designed.1748subjects were enrolled in this study.The disc area (DA) (P=0.021),rim area (RA) (P＜0.001),rim volume (RV) (P＜0.001),mean retinal nerve fiber layer thickness (mRNFLt) (P＜0.001) and retinal nerve fiber layer cross section area (RNFLcsa) in the high myopia were greater than those of the emmetropic group,with significant difference between the two groups (P＜0.001).However,the cup area (CA),cup/disk area ratio (C/DAR) and cup volume (CV) were less in the high myopic group than those of the emmetropic group (P=0.004,P＜0.001 and P＜O.001),respectively.In the mild-moderatc myopic group,the RV,mRNFLt and RNFLcsa were greater than those of the emmetropic group (all of the P value less than 0.001),but the numbers of DA,CA,C/DAR,and CV were less than those of the emmetropic group,the differences were significant and their P valuables were 0.038,＜ 0.001,＜0.001 and 0.001 respectively.The differences of structure parameters between the hyperopia group and the emmetropic group were not statistically significant (P＞0.05).The DA,CA,RA,C/DAR,CV,RV,mean cup depth (MCD),maximum cup depth (MxCD),cup shape measure (CSM),mRNFLt and RNTLcsa were (2.04±0.43) mm2,(0.49±0.34) mm2,(1.55 ± 0.34) mm2,0.23-0.13,(0.11 ± 0.12) mm3,(0.45 ± 0.19) mm3,(0.21 ± 0.09) mm,(0.60±0.21) mm,-0.21 ± 0.07,(0.29 ± 0.07) mm and (1.46 ± 0.36)mm2,respectively,in the 1748 eyes of 1748 subjects.No significant correlation was found between the DA value with SE (r=-0.032,P =0.186).However,weaker positive correlations were seen between the CA,C/DAR,CV,MCD,MxCD with SE (r=0.139,0.163,0.130,0.004,0.054,P＜ 0.05) and negative correlation between RA,RV,mRNFLt and RNFLcsa with SE (r =-0.178,-0.331,0.241,-0.239,P＜0.001).With the increase of the ocular axial length,the DA,RA,RV,mRNFLt and RNFLcsa values were enlarged,and the CV value was smaller.With the increase of CA,the RA,C/DAR,CV,RV,MCD,MxCD,CSM and RNFLcsa values elevated,but mRNFLt value was decreased.Conclusions Refractive error is not associated with DA,but the measuring results are different among various refractive groups.Refractive error,ocular axial length and DA affect the measuring result of HRT. Key words: Body layer tomography; Optic nerve head; Refractive error; Axial length; Heidelberg Retinal Tomograph Ⅲ

Topographic Optic Disc Changes After Successful Trabeculectomy Evaluated Using Spectral Domain Optical Coherence Tomography

To investigate topographic optic disc changes after surgical intraocular pressure (IOP) reduction in adults with open angle glaucoma (OAG). Optic discs of patients with advanced primary open angle or exfoliation glaucoma were imaged using optical coherence tomography within 1 week before trabeculectomy. Patients were rescanned 1 week, 1 month, and 1 year after surgery. Maximum cup depth (MCD), and average cup depth (ACD) were calculated. Twenty-two eyes from 20 patients (age, 70.5 ± 10.6 years; average mean defect of visual field, -15.0 ± 9.8 dB) were followed up for 1 year. The IOP decreased from 22.1 ± 2.8 mmHg at baseline to 11.5±2.6 mmHg 1 year following surgery (P<0.001). One-week and 1-month postoperative IOPs were 11.2 ± 2.8 and 11.2 ± 3.5 mmHg, respectively (P<0.001). Compared to the baseline values (356 ± 172 μm), postoperative ACD showed a significant decrease at 1 week (312 ± 164 μm; P<0.001) and 1 month (338 ± 175 μm; P=0.007) after surgery, but not at 1 year (339 ± 176 μm; P=0.354). Similarly, MCD significantly decreased from baseline (477 ± 190 μm) 1 week (431 ± 203 μm; P=0.029) and 1 month (448 ± 198 μm; P=0.047) after the surgery, but not after 1 year (479 ± 188 μm; P=1.0). Trabeculectomy reduces IOP in eyes with advanced OAG, which induces topographic optic disc changes. Such optic disc changes became less pronounced over time and were no longer detectable 1 year after surgery.

Measurement and analysis of optic disc parameters in Mongolian and Han healthy subjects with or without family history of glaucoma

Objective To measure optic disc parameters in Mongolian and Han healthy subjects with or without family history of glaucoma,to explore the causes of the differences and their significance in the diagnosis of early glaucoma.Methods Fifteen healthy Mongolian individuals (30 eyes),30 healthy Han individuals (60 eyes) with a family history of open-angle (30 eyes) or angle-closure (30 eyes) glaucoma,and 45 healthy Han individuals (90 eyes) without a family history of glaucoma were enrolled in this study.The 45 healthy Han individuals without a family history of glaucoma included three age-groups:20 to 29 years old group,30 to 39 years old group and 40 to 49 years old group,each group have 15 subjects (30 eyes).Thirteen parameters were measured by Heidelberg retina tomography (HRT) for all subjects,including disc area,cup area,rim area,cup volume,rim volume,cup/disc area ratio,linear cup/disc ratio,mean cup depth,maximum cup depth,cup shape,disc height variation contour,mean retinal nerve fiber layer (RNFL) thickness and optic nerve fiber layer cross-sectional area.The results were analyzed and compared between the above groups.Results There was no statistically significant (t=0.791,P=0.132) of the height variation contour between Mongolian and Han without a family history of glaucoma (20 to 29 years old) group.The other parameters of Mongolian were smaller than Han without a family history of glaucoma (20 to 29 years old) group,but the difference was not statistically significant (t=-1.039,-0.799,-0.840,-1.108,-0.956,-0.695,-0.931,-1.099,-1.074,-0.580,-0.204,-1.425; P＞ 0.05).The parameters in Han with a family history of open-angle glaucoma group were bigger than Han without a family history of glaucoma (30 to 39 years old) group.The differences were statistically significant for disc area,cup area,rim area,cup volume,rim volume,cup area ratio,linear cup/disc ratio,mean cup depth,cup shape measure,nerve fiber layer cross-sectional area (t =4.758,3.187,2.544,2.674,1.798,3.676,2.721,2.715,2.510,2.373; P＜0.05),but were not statistically significant for maximum cup depth,disc height variation contour and mean RNFL thickness (t=1.649,1.565,0.767; P＞0.05).Most parameters in Han with a family history of angle-closure glaucoma group were the same as that in Han without a family history of glaucoma (40 to 49 years old) group,including cup area,rim area,cup volume,rim volume,cup/disc area ratio,linear cup/disc ratio,mean optic cup depth,maximum cup depth,cup shape,disc height variation contour,mean RNFL thickness,optic nerve fiber layer cross-section (t=1.201,1.697,1.000,0.516,0.740,-0.172,-0.070,-0.972,1.530,-0.390,-0.091,0.659; P＞ 0.05) ; but the difference of disc area between these 2 groups was statistically significant (t=2.224,P＜0.05).Conclusions The family history of glaucoma can change the optic disc parameters of healthy individuals,especially those with a family history of open-angle glaucoma.There is no difference of optic disc parameters between healthy Mongolian and Han subjects. Key words: Optic disk/anatomy & histology; Optic disk/physiopathology; Glaucoma/diagnosis

Valsalva manoeuver, intra‐ocular pressure, cerebrospinal fluid pressure, optic disc topography: Beijing intracranial and intra‐ocular pressure study

To assess whether a Valsalva manoeuver influences intra-ocular pressure (IOP), cerebrospinal fluid pressure (CSF-P) and, by a change in the trans-laminar cribrosa pressure difference, optic nerve head morphology. In the first part of the study, 20 neurological patients (study group 'A') underwent measurement of IOP and lumbar CSF-P measurement in a lying position before and during a Valsalva manoeuver. In the second study part, 20 healthy subjects (study group 'B') underwent ocular tonometry and confocal scanning laser tomography of the optic nerve head before and during a Valsalva manoeuver. During the Valsalva manoeuver in study group 'A', the increase in CSF-P by 10.5±2.7mmHg was significantly (p<0.001) higher than the increase in IOP by 1.9±2.4mmHg. The change in CSF-P was not significantly (p=0.61) correlated with the change in IOP. During the Valsalva manoeuver in study group 'B', IOP increased by 4.5±4.2mmHg and optic cup volume (p<0.001), cup/disc area ratio (p=0.02), cup/disc diameter ratio (p=0.03) and maximum optic cup depth (p=0.01) significantly decreased, while neuroretinal rim volume (p=0.005) and mean retinal nerve fibre layer thickness (p=0.02) significantly increased. The Valsalva manoeuver-associated short-term increase in CSF-P was significantly larger than a simultaneous short-term increase in IOP. It led to a Valsalva manoeuver-associated decrease or reversal of the trans-laminar cribrosa pressure difference, which was associated with a change in the three-dimensional optic nerve head morphology: optic cup-related parameters decreased and neuroretinal rim-related parameters enlarged. These findings may be of interest for the pathogenesis of glaucomatous optic neuropathy.

Tomographic characteristics of optic nerve head on Heidelberg retina tomograph III in healthy Chinese subjects

Background Normal adult optic disc rim width follows inferior ≥ superior ≥ nasal ≥ temporal (ISNT) rule.Analysis of the optic disc structural parameters with Heidelberg retina tomograph (HRT) can understand whether ISNT principle is suitable to other optic disc structure parameters.Objective This study was to investigate the characteristics of optic nerve head structure parameters in normal Chinese adults.Methods The parents of twins who participated Guangzhou Twin Eye Study were enrolled in Zhongshan Ophthalmic Center from 2006 June to 2011 August.All subjects received the routine eye examinations,including visual acuity,slit lamp microscope,direct ophthalmoscope examination,auto-refraction examination and HRT Ⅲ examination.All data from the right eyes were collected and analyzed.HRT values from different quadrants of optical nerve head were compared with one-way analysis of variance,and the multiple comparison between quadrants was carried out by Bonferroni test.The differences of optical nerve head parameters in different gender were analyzed using independent sample t test and Bland-Altman test.Results In this study,1672 eyes of 1672 subjects were included,with the 759 male and 913 female persons and average age of (41.8±5.3)years.No significant differences were seen in the disc area (DA)between the superior and inferior,as well as the nasal and temporal quadrants among the subjects (P＞0.05).In addition,there were not significantly different in the rim area (RA) between the superior and nasal disc as well as the rim volume (RV) among the inferior,superior and nasal disc (P＞O.05).However,significant differences were found in the cup area (CA),cup/disk area ratio (C/DAR),cup volume (CV),mean cupdepth (MCD),maximum cup depth (MxCD),height variation contour (HVC),cup shape measure (CSM),mean retinal nerve fiber layer thickness (mRNFLT) and retinal nerve fiber layer cross section area (RNFLcsa) among the different quadrants (P＜0.001).The local differences from only DA and RA complied with an ordination of the ISNT rule.The values of DA,CA,C/DAR,CV,MCD,MxCD from male individuals were higher,but those of the RV,HVC,mRNFLT RNFLcsa were lower in comparison with female individuals.Nevertheless,all the differences were ＜ 0.1 with a maximal mean difference in DA and CA (both 0.07 mm2).Conclusions The optical nerve head configurations measured by HRT have different distributing characteristics in four quadrants in normal adults.Most parameters show the higher values in the inferior and superior than those in nasal and temporal of disc,but DA and RA meet ISNT rule.The differences of most parameters between male and female subjects can be ignored. Key words: Bio-metrics; Optic nerve head/parameter, structure; Tomography/method; Heidelberg retinal tomograph; Adult; Gender