Optical Coherence Tomography Retinal Nerve Fiber Layer Research Articles

7219 Ocular Findings in Jansen Metaphyseal Chondrodysplasia

Abstract Disclosure: F. Obiezu: None. K. Pan: None. A. Ninan: None. K.L. Roszko: None. L.S. Weinstein: None. C.R. Ferreira: None. R.I. Gafni: None. T. Magone De Quadros Costa: None. M.T. Collins: None. S. Jha: None. Jansen Metaphyseal Chondrodysplasia (JMC) is an ultra-rare disorder, with only 30 patients estimated to have the disease globally. It is caused by heterozygous pathogenic variants in PTHR1 that result in constitutive activation of parathyroid hormone type 1 receptor (PTHR1) signaling. A detailed description of craniofacial manifestations of the disease is lacking. Here we characterize the ophthalmological manifestations in patients with JMC. Six patients (4 males, 67%) with genetically confirmed JMC underwent a detailed ophthalmological evaluation, spectral-domain optical coherence tomography (OCT), craniofacial CT and 18F-NaF PET/CT scans. Median age at the time of the visit was 27.5 [IQR: 29] years. On physical examination, all patients were noted to have widely spaced eyes; 5 of the 6 had down slanted palpebral fissures, proptosis, or ptosis. Two patients had incomplete or defective closure of the eyelids (lagophthalmos), of which one had a history of progressive right facial nerve palsy with profuse epiphora. The second patient had central visual field defects, bilateral moderate optic disc pallor and bilateral retinal nerve fiber layer (RNFL) atrophy on OCT exam with bilateral optic canal narrowing on CT. Notably, comparison of these findings with a prior scan performed 5 years earlier showed progressive decrease in RNFL bilaterally. This patient had a history of prolonged intravenous bisphosphonate therapy, initiated in infancy for hypercalcemia and continued for over a decade. A third patient had normal vision, subtle temporal pallor of the optic nerve heads on dilated fundus exam, normal average RNFL, but decreased retinal ganglion cell layer analysis (GCA) on OCT. GCA was decreased in 4 of the 6 patients compared to age-matched reference range indicating a chronic optic nerve atrophic process. These data represent the first comprehensive report of the ophthalmologic findings in a cohort of patients with JMC. They demonstrate that patients with JMC have significant eye findings that appear to be more prevalent and pronounced with age. This suggests age-related, progressive optic neuropathy, which can be assessed by demonstrating OCT retinal GCA and RNFL loss and, may be a feature of JMC. The benefit and effect of long-term bisphosphonate therapy in patients with JMC remains unclear. Patients with JMC should undergo regular ophthalmologic examination including optic nerve OCT, visual field testing, and craniofacial imaging. Presentation: 6/1/2024

Harnessing the power of artificial intelligence for glaucoma diagnosis and treatment

Artificial intelligence (AI) has great potential for diagnosing and managing glaucoma, a disease that causes irreversible vision loss. Early detection is paramount to prevent visual field loss. AI algorithms demonstrate promising capabilities in analyzing various glaucoma investigations. In analyzing retinal fundus photographs, AI achieves high accuracy in detecting glaucomatous optic nerve cupping, a hallmark feature. AI can also analyze optical coherence tomography (OCT) images of the retinal nerve fiber layer(RNFL) and ganglion cell complex, identifying structural changes indicative of glaucoma and also Anterior Segment OCT(AS-OCT) for angle closure disease. OCT interpretation may even be extended to diagnose early features of systemic neurodegenerative diseases such as Alzheimer’s Disease and Parkinson’s Disease. Furthermore, AI can assist in interpreting visual field (VF) tests, including predicting future VF loss patterns for the next 5 years. The ability of AI to integrate data from multiple modalities, including fundus photographs, Intra Ocular Pressure(IOP) measurements, RNFL OCT, AS-OCT, and VF tests, paves the way for a more comprehensive glaucoma assessment. This approach has the potential to revolutionize ophthalmology by enabling teleophthalmology and facilitating the development of personalized treatment plans. However, the authors emphasize the crucial role of human judgement and oversight in interpreting AI-generated results. Ultimately, ophthalmologists must make the final decisions regarding diagnosis and treatment strategies.

Refining glaucoma diagnosis and treatment in cataract surgery candidates: contribution of preoperative OCT retinal nerve fiber layer.

To evaluate the clinical significance of preoperative spectral domain optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) thickness in identifying glaucoma and better managing patients scheduled for routine cataract surgery. Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. Retrospective cohort study. Consecutive patients scheduled for cataract surgery were enrolled from February 2022 to August 2022. Participants underwent routine OCT RNFL studies which were evaluated by a glaucoma specialist. Findings were compared with those of preoperative fundus biomicroscopic examinations conducted by the referring ophthalmologist. The main outcomes were the incidence of newly detected glaucoma based on OCT RNFL findings and the consequent changes in patient management. In total, 486 patients met the inclusion criteria of whom 112 (23%) had abnormal RNFL. 31 patients (6.4%) had abnormal OCT RNFL findings attributed to comorbidities other than glaucoma, and 81 patients (16.7%) were suspected to have glaucoma based on their OCT RNFL findings, from which 44 patients (9%) were newly diagnosed with glaucoma or as glaucoma suspects, resulting in management modifications that included routine glaucoma follow-up (25 patients, 5.1%), initiation of intraocular pressure-lowering treatment (12 patients, 2.5%), and conversion to combined cataract-glaucoma surgery (7 patients, 1.4%). OCT RNFL for cataract surgery candidates proved valuable in detecting glaucoma that had not been revealed by standard fundus biomicroscopic examination. The additional information provided by OCT RNFL can potentially enhance patient management and optimize outcomes.

Correlation of Retinal Nerve Fibre Layer Thickness in Optical Coherence Tomography with Visual Outcome in Optic Neuritis

Abstract Purpose: In this study, the changes in optical coherence tomography (OCT) were correlated with the post-treatment visual outcome of optic neuritis, thereby determining the patients who are at risk of optic atrophy. Design: Prospective observational study. Methodology: All patients presenting to the outpatient department (OPD) with acute visual loss, pain on ocular movements and colour desaturation were subjected to comprehensive ophthalmic examination and OCT retinal nerve fibre layer (RNFL) analysis. All patients were treated with an Optic Neuritis Treatment Trial (ONTT) regimen and followed for one year. Results: Of 25 patients, 40% were 20 to 40 years of age, and females outnumbered males by 28%. The right eye had 48% unilateral affection and 12% bilateral affection; 56% had a central scotoma, and 24% had a centrocaecal scotoma. The most common aetiologies are as follows: idiopathic (84%), multiple sclerosis (MS) (12%) and Devic’s disease (4%). 60% presented with a visual acuity of 6/60–1/60 and 32% with a visual acuity of 6/18–6/36. Patients whose RNFL thickness was below 90 microns post-treatment had poorer visual outcome. Conclusion: In this study, optic neuritis was more common in females of 20 to 45 years with unilateral affection in the right eye. The most common field defect was central scotoma, and the most common cause of optic neuritis was idiopathic. It was also found that the visual acuity in optic neuritis can range from 6/18 to no PL. Of the 25 patients in the study, three patients had retrobulbar neuritis and six patients developed disc pallor during recovery after treatment.

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL,SEMARANG

Introduction and Objective: The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-operative and post-operative from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL). Method: A retrospective study of the medical record from January 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size >1cm) and were histologically confirmed. Visual acuity before and after surgery was evaluated along with the patient’s OCT value. Result: The thinner pre-operative RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-operative RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-operative GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151). Conclusion: The visual recovery after pituitary adenoma surgery is likely to be predicted by pre-operative OCT RNFL. Patients with normal RNFL thickness show an increased tendency in visual recovery after surgery. Keywords: Optical coherence tomography , visual acuity, pituitary adenoma

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL RECOVERY OF PATIENTS WITH PITUITARY ADENOMA FOLLOWING SURGERY IN DR KARIADI HOSPITAL SEMARANG

Abstract
 Introduction & Objectives : The characteristics, symptoms, and clinical manifestations of pituitary adenoma in Indonesia have not been widely studied. In 26 patients undergoing pituitary surgery at Dr. Kariadi Hospital, we compared visual acuity pre-surgery and post-surgery from normal and thin optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell layer-internal plexiform layer (GCL-IPL).
 Methods : A retrospective study from medical record from Januari 2020 to December 2022 was done. 21 of the 26 patients had surgery by the transsphenoidal route and the rest by craniotomy. All patients had macroadenoma (tumor size >1cm) and histologically confirmed. Visual acuity before and after surgery was evaluated along with patient’s OCT value.
 Results : The thinner pre-surgery RNFL thickness was associated with worse visual acuity (VA). Patients with normal RNFL had a median VA of 20/200 while those with thin RNFL had to count their fingers (CF). The patients with normal pre-surgery RNFL had a significant improvement in median VA after surgery, from 20/200 to 20/32 (p=0.022), whereas the patients with thin RNFL did not improve (CF to CF, p=0.026). The patients with normal pre-surgery GCL-IPL had non-significant improvement in median VA after surgery from CF to 20/20 (p=0.505), also the patients with thin GCL-IPL from CF to 20/200 (p=0.151).
 Conclusion : Based on this study, the visual recovery after pituitary adenoma surgery is likely to be predicted by pre-surgery OCT RNFL. Patients with normal RNFL thickness show an increase propensity in visual recovery after surgery.

OPTIC DISK PIT STUFFING-TO DO OR NOT TO DO.

Optic disk pit (ODP) is a subset of spectrum of congenital cavitary anomalies. Optic disk pit maculopathy causes progressive visual deterioration and is addressed with pars plana vitrectomy (PPV) with or without ODP stuffing. We report a case of progressive ODP maculopathy who was taken up for 23-G 3-port PPV, with complete vitreous removal and stuffing of the ODP with autologous sclera and sequential analysis of change in the retinal nerve fiber layer (RNFL) thickness. Spectral-domain optical coherence tomography RNFL analysis at 1 and 12 months follow-up postoperatively showed total RNFL thickness decrease from 130 µm to 103 µm respectively. Hemiquadrant analysis showed slight reduction of superior RNFL thickness from 142 µm to 139 µm. However, in the inferior hemiquadrant, the reduction in mean RNFL thickness seems to be significant from 133 µm to 100 µm at 1 and 12 months respectively. Sector-wise analysis of the RNFL thickness showed maximum reduction in the inferotemporal quadrant and other sectors seemed to be relatively preserved corresponding to the area of scleral stuffing. Retrospective or prospective analysis of RNFL health of patients undergoing surgery for ODP-M with stuffing needs to evaluated.

Focused analysis of RNFL decay in glaucomatous eyes using circular statistics on high-resolution OCT data.

We generated Optical Coherence Tomography (OCT) data of much higher resolution than usual on retinal nerve fiber layer (RNFL) thickness of a given eye. These consist of measurements made at hundreds of angular-points defined on a circular coordinate system. Traditional analysis of OCT RNFL data does not utilize insightful characteristics such as its circularity and granularity for common downstream applications. To address this, we present a new circular statistical framework that defines an Angular Decay function and thereby provides a directionally precise representation of an eye with attention to patterns of focused RNFL loss. By applying to a clinical cohort of Asian Indian eyes, the generated circular data were modeled with a finite mixture of von Mises distributions, which led to an unsupervised identification in different age-groups of recurrent clusters of glaucomatous eyes with distinct directional signatures of RNFL decay. New indices of global and local RNFL loss were computed for comparing the structural differences between these glaucoma clusters across the age-groups and improving classification. Further, we built a catalog of directionally precise statistical distributions of RNFL thickness for the said population of normal eyes as stratified by their age and optic disc size.

Impact of Pregnancy on Papilledema and Vision Loss in Idiopathic Intracranial Hypertension Patients: A Chart Review and Case Series of 13 Patients.

Studies suggest that weight gain is a prominent risk factor for recurrence of papilledema in idiopathic intracranial hypertension (IIH). Given this information, the significant weight gain that occurs during pregnancy, and the fact that pharmacologic therapy is many times discontinued, raises concerns for worsening edema and vision loss. To examine the impact of pregnancy weight gain on IIH, a retrospective chart review of patients with IIH and pregnancy was performed. Compared with previous studies, we 1) quantified findings with optical coherence tomography (OCT) and Humphrey visual field (HVF) data, 2) Included baseline data before pregnancy, 3) determined excess pregnancy weight gain using body mass index-adjusted weight gain goals, and 4) correlated worsening in IIH symptoms with changes in papilledema. Charts were reviewed for patients with diagnoses of IIH who had at least 2 visits with neuro-ophthalmology during pregnancy. Thirteen patients met inclusion criteria. Data were compared from baseline visits before pregnancy, pregnancy visits, and postpregnancy visits. Comparisons of HVF mean deviation (MD), OCT retinal nerve fiber layer (RNFL), and Max OCT RNFL during pregnancy were not significant compared with baseline ( P = 0.51, 0.41, and 0.25). Three patients were found to have increased papilledema during pregnancy (Max Avg OCT RNFL of 152.5, 129, and 123.5 μm) of which 2 developed new reproducible mild visual field defects (HVF ∆MD -1.78 and -4.49). All patients showed more than the 6% weight gain, typically observed in recurrent IIH. Eleven patients gained more than their weight from initial diagnosis. Eight patients had excess pregnancy weight gain. Six patients discontinued pharmacologic therapy for IIH. Weight gain seems to carry a lower risk in IIH patients when associated with pregnancy. This is suggested by the high rate of stable or even decreased disc edema in patients despite medication discontinuation and excess pregnancy weight gain. We postulate these findings may be related to changes in weight distribution or endocrine changes during pregnancy.

Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width

To compare rates of change (RoC) of peripapillary retinal nerve fiber layer (RNFL) and Bruch membrane opening-based minimum rim width (BMO-MRW) thickness in moderate-to-advanced glaucoma. Prospective cohort study. Longitudinal optical coherence tomography (OCT) optic nerve head volume scans of 113 eyes of 113 glaucoma patients with moderate-to-advanced or central damage were exported. This study estimated and compared global and sectoral RoC with linear mixed effects models and simple linear regression (SLR) of RNFL and BMO-MRW thickness. Permutation analyses were used to test significance of RoC in the SLR model. It also compared longitudinal signal-to-noise ratios (LSNR) defined as RoC divided by residual standard deviation (SD) between the two groups. Mean (SD) follow-up and median (IQR) OCT scan sessions were 5.2 (1.3) years and 10 (8-11), respectively. Baseline average (SD) visual field mean deviation was -9.2 (5.8) dB. Based on SLR, a higher proportion of significant negative RNFL RoC was observed compared to BMO-MRW in the inferotemporal (35% vs 20%; P=.015) and inferonasal (42% vs 17%; P < .001) sectors. Permutation analyses also demonstrated a higher proportion of worsening RNFL RoC than BMO-MRW in the inferotemporal (P=.026) and inferonasal (P < .001) sectors along with overall lower positive RoC. Longitudinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally, and in the inferotemporal, inferonasal, and superonasal sectors (P ≤ .01). Longitudinal RNFL OCT measurements are more likely to detect structural change and demonstrate better LSNR compared with BMO-MRW in eyes with central or moderate-to-advanced glaucoma damage at baseline.

Association of Optic Nerve Head and Macular Optical Coherence Tomography Measures With Glaucoma-Related Disability.

Optical coherence tomography (OCT) estimated retinal nerve fiber layer (RNFL) thickness associated with glaucoma-related disability independent of the visual field (VF) damage and thus may provide additional patient-relevant disability information beyond what is captured by standard VF testing. To examine whether OCT metrics [peripapillary RNFL thickness and macular ganglion cell/inner plexiform layer (GCIPL) thickness] are associated with quality of life (QoL) measures and additional disability metrics, and whether these associations are independent of VF damage. In this cross-sectional study, 156 patients with glaucoma or suspected glaucoma received VF testing and OCT scans to measure RNFL and GCIPL thickness. QoL was assessed using the Glaucoma Quality-of-Life 15 and additional disability measures including fear of falling, reading speed, and steps per day were assessed. Multivariable regression models adjusting for relevant covariates tested whether RNFL or GCIPL thickness from the less-impaired eye were associated with disability measures and whether associations were independent of VF damage. Greater VF damage is associated with worse QoL (95% CI=0.4-1.4; P <0.001) and slower reading speed (CI=-0.06 to -0.02; P <0.001). Lower RNFL and GCIPL thicknesses were associated with lower QoL scores, but not with QoL scores or other disability metrics after correcting for VF damage. However, post hoc analyses in patients with better eye thicknesses between 55 and 75µm demonstrated associations between lower RNFL thickness and worse QoL (CI=-2.2 to -0.1; P =0.04) and greater fear of falling (CI=-6.1 to -0.4; P =0.03) even after accounting for VF damage. No such associations were observed for GCIPL thickness. OCT RNFL, but not GCIPL, thickness is associated with multiple disability measures independent of VF damage severity.

Online Circular Contrast Perimetry: A Comparison to Standard Automated Perimetry.

The aim was to validate and compare the diagnostic accuracy of a novel 24-degree, 52-loci online circular contrast perimetry (OCCP) application to standard automated perimetry (SAP). Prospective cohort study. Two hundred and twenty participants (125 normal controls, 95 open angle glaucoma patients) were included. Agreement, correlation, sensitivity, specificity, and area under receiver operating curves (AUC) were compared for parameters of OCCP, SAP, and optical coherence tomography (OCT) for the retinal nerve fiber layer and macular ganglion cell complex inner plexiform layer. Pointwise sensitivity for OCCP was greater than SAP by 1.02 log units (95% CI: 0.95-1.08); 95% limits of agreement 0.860 to 1.17. Correlation and agreement for global indices and regional zones between OCCP and SAP were strong. OCCP mean deviation (MD) AUC was 0.885±0.08, similar to other instruments' parameters with the highest AUC: SAP MD (0.851±0.08), OCT retinal nerve fiber layer inferior thickness (0.908±0.07), OCT ganglion cell complex inner plexiform layer inferior thickness (0.849±0.08), P>0.05. At best cutoff, OCCP MD sensitivity/specificity were comparable to SAP MD (90/74 vs 94/65%). OCCP demonstrates similar perimetric sensitivities to SAP and similar AUC to SAP and OCT in distinguishing glaucoma patients from controls. OCCP holds promise as a glaucoma surveillance and screening tool, with the potential to be utilized for in-clinic and at-home perimetry and expand community testing.

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

BackgroundThere are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors.MethodsA longitudinal prospective cohort study was conducted over 9 years (2012–2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes.ResultsThe cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis.ConclusionsThere is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.

Measurement of retinal nerve fiber layer thickness with a deep learning algorithm in ischemic optic neuropathy and optic neuritis

This work aims at determining the ability of a deep learning (DL) algorithm to measure retinal nerve fiber layer (RNFL) thickness from optical coherence tomography (OCT) scans in anterior ischemic optic neuropathy (NAION) and demyelinating optic neuritis (ON). The training/validation dataset included 750 RNFL OCT B-scans. Performance of our algorithm was evaluated on 194 OCT B-scans from 70 healthy eyes, 82 scans from 28 NAION eyes, and 84 scans of 29 ON eyes. Results were compared to manual segmentation as a ground-truth and to RNFL calculations from the built-in instrument software. The Dice coefficient for the test images was 0.87. The mean average RNFL thickness using our U-Net was not different from the manually segmented best estimate and OCT machine data in control and ON eyes. In NAION eyes, while the mean average RNFL thickness using our U-Net algorithm was not different from the manual segmented value, the OCT machine data were different from the manual segmented values. In NAION eyes, the MAE of the average RNFL thickness was 1.18 ± 0.69 μm and 6.65 ± 5.37 μm in the U-Net algorithm segmentation and the conventional OCT machine data, respectively (P = 0.0001).

Retinal Nerve Fiber Layer Analysis in Children With Migraine With and Without Aura Using Optical Coherence Tomography: A Case-Control Study.

To evaluate retinal nerve fiber layer (RNFL) thickness in children with migraine, with and without aura, compared to healthy controls using optical coherence tomography (OCT). In this cross-sectional case-control study, patients with a diagnosis of migraine with aura (MwA) or without aura (MwoA) were considered and healthy children were included as controls. Age, sex, duration of migraine, number of episodes per month, duration of episodes, and use of prophylactic treatment with magnesium were recorded. All patients underwent complete ophthalmologic, neurologic, and pediatric examination. Optic nerve OCT images were obtained using Heidelberg Spectralis OCT (Heidelberg Engineering) and mean global RNFL thickness and the average thickness for each sector were noted. Thirty-seven children were included: 17 with migraine (9 MwoA and 8 MwA) and 20 controls, the mean age being 13.8 ± 2.9 (range: 8 to 16) and 13.4 ± 2.5 (range: 7 to 16) years, respectively. No significant differences in RNFL thickness were found when comparing all patients who had migraine with healthy controls. However, children with MwA showed statistically significant reductions in RNFL thickness in the temporal (mean difference: 7.83; 95% CI: 0.52 to 15.14, P = .027) and inferior-temporal (mean difference: 16.06; 95% CI: 1.95 to 30.16, P = .027) sectors compared to patients with MwoA. None of the other sectors showed statistically significant differences between groups (all P > .05). In the migraine group, negative correlations were detected between the number of episodes per month and RNFL thickness in the nasal-superior quadrant (r = -.420; P = .021). Children with MwA may present a decrease in RNFL thickness, which is associated with the number of episodes per month. [J Pediatr Ophthalmol Strabismus. 2023;60(3):196-202.].

Contrast-to-Noise Ratios to Evaluate the Detection of Glaucomatous Progression in the Superior and Inferior Hemiretina.

PurposeTo determine the sensitivity of optical coherence tomography (OCT) and standard automated perimetry (SAP) for detecting glaucomatous progression in the superior and inferior hemiretina.MethodsWe calculated contrast-to-noise ratios (CNRs) for OCT retinal nerve fiber layer (RNFL) thickness of hemiretinas and for SAP mean total deviation (MTD) of the corresponding hemifields from longitudinal data (205 eyes, 125 participants). The glaucoma stage for each hemiretina was based on the corresponding hemifield's MTD. Contrast was defined as the difference of the parameter between two consecutive glaucoma stages, whereas noise was the measurement variability of the parameter in those stages. The higher the CNR of a parameter, the more sensitive it is to detecting progression in the transition between successive stages.ResultsThere were no statistically significant differences for the RNFL CNR and MTD CNR between superior and inferior hemiretinas. As the glaucoma stage of the opposite hemiretina worsened, the MTD CNR in the transition from moderate to advanced glaucoma significantly increased. The RNFL CNR in the transition from mild to moderate glaucoma significantly decreased in case of advanced glaucoma in the opposite hemiretina.ConclusionsSimilar to full retinas, detecting conversion to glaucoma in hemiretinas is more sensitive with OCT than SAP, whereas with more advanced disease, SAP is more sensitive for detecting progression. More importantly, the sensitivity for detecting progression in one hemiretina with either technique depends on the glaucoma severity in the opposite hemiretina.Translational RelevanceMonitoring glaucomatous progression with either OCT or SAP partly depends on the glaucoma severity in the opposite hemiretina.

OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS

BackgroundOptic neuritis (ON) is the most common manifestation of myelin oligodendrocyte glycoprotein antibody associated disorder (MOGAD) and multiple sclerosis (MS). Acute ON in MOGAD is thought to be associated with more severe optic disk edema than in other demyelinating diseases, but this has not been quantitatively confirmed. The goal of this study was to determine whether optical coherence tomography (OCT) can distinguish acute ON in MOGAD from MS, and establish the sensitivity of OCT as a confirmatory biomarker of ON in these entities. MethodsThis was a multicenter cross-sectional study of MOGAD and MS patients with peripapillary retinal nerve fiber layer (pRNFL) thickness measured with OCT within two weeks of acute ON symptom. Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA) was used to measure the pRNFL during acute ON. Eyes with prior ON or disk pallor were excluded. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of pRNFL thickness to distinguish MOGAD from MS. ResultsSixty-four MOGAD and 50 MS patients met study inclusion criteria. Median age was 46.5 years (interquartile range [IQR]: 34.3–57.0) for the MOGAD group and 30.4 years (IQR: 25.7–38.4) for the MS group (p<0.001). Thirty-nine (61%) of MOGAD patients were female compared to 42 (84%) for MS (p = 0.007). The median pRNFL thickness was 164 µm (IQR: 116–212) in 96 acute MOGAD ON eyes compared to 103 µm (IQR: 93–113) in 51 acute MS ON eyes (p<0.001). The ROC area under the curve for pRNFL thickness was 0.81 (95% confidence interval 0.74–0.88) to discriminate MOGAD from MS. The pRNFL cutoff that maximized Youden's index was 118 µm, which provided a sensitivity of 74% and specificity of 82% for MOGAD. Among 31 MOGAD and 48 MS eyes with an unaffected contralateral eye or a prior baseline, the symptomatic eye had a median estimated pRNFL thickening of 45 µm (IQR: 17–105) and 7.5 µm (IQR: 1–18), respectively (p<0.001). All MOGAD affected eyes had a ≥ 5 µm pRNFL thickening, whereas 26 (54%) MS affected eyes had a ≥ 5 µm thickening. ConclusionOCT-derived pRNFL thickness in acute ON can help differentiate MOGAD from MS. This can aid with early diagnosis and guide disease-specific therapy in the acute setting before antibody testing returns, and help differentiate borderline cases. In addition, pRNFL thickening is a sensitive biomarker for confirming acute ON in MOGAD, which is clinically helpful and could be used for adjudication of attacks in future MOGAD clinical trials.

A comparison of posterior segment optical coherence tomography findings in full-term and preterm children without retinopathy of prematurity

Purpose:Structural differences have been described in the retina of prematurely born children, including increased macular thickness caused by failed migration of the inner retina during development and retinal nerve fiber layer (RNFL) thinning related to low birth weight. The present study aimed to evaluate the differences in macular and RNFL optical coherence tomography (OCT) findings between full-term and preterm children without retinopathy of prematurity (ROP).Methods:Thirty-four premature (study group) and 43 full-term patients (control group)—aged 3 to 8 years—were studied. All children underwent a complete ophthalmological exam and OCT of the macula and optic nerve in both eyes to determine macular and RNFL thickness and morphology. Correlation analysis between central macular thickness, age, and visual acuity was also performed.Results:Central macular thickness was greater in the study group than in the control group; a difference of 14.2 μm was observed for the right eye (P = 0.002) and 12.16 μm for the left eye (P = 0.019). The thickness of the parafoveal and the perifoveal zones was consistently greater in the study group. 44.3% of eyes in the study group had mild forms of foveal hypoplasia (grades 1a and 1b) in qualitative description. No correlation between central macular thickness and visual acuity was found. There was no difference in RNFL thickness between both groups.Conclusion:Statistically significant structural differences were found in the macula of premature children, with a greater foveal thickness possibly reflecting retention of the inner retina during development, with no repercussion over visual acuity. RNFL thickness was similar in both groups.

Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Open Angle Glaucoma

To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary open angle glaucoma (POAG). Prospective case series. Sixty-four eyes of 40 patients with POAG (108 quadrants) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, presence of disc hemorrhage, and mean and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation, baseline quadrant optical coherence tomography RNFL and ganglion cell inner plexiform layer thickness), and OMAG (peripapillary and macular perfusion density [PD] and vessel density [VD]) on the rate of RNFL change was evaluated using linear mixed models. Average (±SD) mean deviation, RNFL, and ganglion cell inner plexiform layer thickness of the analyzed quadrants at baseline were -5.5 ± 2.9 dB, 96.5 ± 17.9 µm, and 73.8 ± 8.6 µm, respectively. Peripapillary PD and VD in the quadrant were 44.6% ± 5.9% and 17.5 ± 2.2 mm/mm2, respectively. Rate of quadrant RNFL change was -1.8 ± 0.6 µm/y. Multivariate mixed models showed that lower peripapillary PD (coefficient=0.08, P=.01) and lower VD (coefficient=0.21, P=.02) were significantly associated with a faster rate of RNFL loss. Lower baseline peripapillary PD and VD measured using OMAG were significantly associated with a faster rate of RNFL loss in POAG. OMAG imaging provides useful information about the risk of glaucoma progression and the rate of disease worsening.

Optical coherence tomography in the setting of optic nerve head cupping reversal in secondary childhood glaucoma

Reversal of optic nerve head (ONH) cupping has been considered an important clinical observation that signals surgical success and control of intraocular pressure (IOP) in childhood glaucoma. Many theories based on elasticity of pediatric eyes have been proposed, including anterior movement of the elastic lamina cribrosa or shrinkage of the scleral canal. The relationship between these factors and axonal loss is unclear when reversal of cupping has been observed. Retinal nerve fiber layer (RNFL) optical coherence tomography (OCT) can help to clarify this. We present a case series of 4 pediatric patients with secondary glaucoma that demonstrated ONH cupping reversal with pre- and postoperative clinical images and RNFL OCT.