Repeated Stratus OCT retinal nerve fiber layer thickness measurements

PURPOSE: Assessment of optic disc damage is an essential part of the ocular examination and differential diagnosis between the patient with ocular hypertension and pre-perimetric or perimetric glaucoma. The Stratus optic coherent tomograph (Carl Zeiss Meditec, Inc, Dublin, Calif) is still one of the most used optic nerve imaging technology throughout the world. Therefore, the development of methodology that enhances the utility of optic disc measurements with the Stratus OCT remains a relevant and meaningful goal. In an attempt to determine the optimal number of repeated measurements we investigated how the average of three sets of manually repeated measurements of retina nerve firer layer (RNFL) thickness would compare with a single set. METHODS: A total of 73 individuals (136 eyes) aged 55.3±15.2 years with ocular hypertensive (OHT), pre-peri-metric glaucoma or glaucoma were included in the final analysis. When the data was evaluated using a quadrant analysis we observed that 13.6% of the patients exhibited a clinically meaningful difference of 20% or more in the serial RNFL thickness measurements. RESULTS: The difference ranged from 9.3 to 32.7 microns and in 10 of the 12 quadrants the averaged measurement exceeded the initial measurement. Most of the differences demonstrated in this study occurred in the horizontal meridian and are probably a result of instinctive saccadic eye movements. A difference in the vertical meridian (superior and/or inferior quadrants) which is the more relevant meridian for changes in glaucoma was seen in only 3 patients (4.1%). CONCLUSIONS: One reliable RNFL measurement would be sufficient in most of these cases because in 95.9% of the cases the differences observed for the vertical meridian were less than 20%. Nevertheless, it is important to recognize that there can be more variability in the horizontal meridian and that in cases with visual loss encroaching on fixation serial measurements may be useful. At any rate, as with all ancillary tests, whenever a change is detected, it is wise to repeat the test to verify the results.

glaucoma, Stratus OCT, retina nerve firer layer, глаукома, оптический когерентный томограф Stratus, толщина слоя нервных волокон сетчатки

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