Traditional and modern morphometric characteristics of the neuroretinal rim in early glaucoma diagnosis

PURPOSE:To compare the traditional morphometric characteristics of the neuroretinal rim and the new indicator «Bruch’s membrane opening – minimum rim width» (MRW) in the diagnosis of early primary-open glaucoma.

METHODS: The study included 82 people (82 right eyes, 25 women and 57 men). The main group (group 1) consisted of 45 patients (45 eyes) with the mild stage of primary openangle glaucoma, the control group (group 2) consisted of 37 healthy people (37 eyes). The research was conducted: Maklakov tonometry (10 g.), standard automated perimetry (SAP), contour perimetry (Heidelberg Edge Perimetry, HEP), the Heidelberg retinotomography (HRT) and spectral optical coherence tomography (OCT). The study examined the mean/global and sectoral morphometric parameters of the optic nerve disc: area and cup, the area and volume of the neuroretinal rim, the retinal nerve fiber layer thickness (RNFL) and the new indicator — MRW.

RESULTS: No statistically significant differences were found in the ONH and cup area groups. There was a ten- dency toward RNFL thinning in all sectors in group 1 patients compared to group 2, but statistically significant differences were found in the «classic» sectors: inferior and superior temporal, as well as in global values. Statistically significant differences were found in all sectors of the rim area/volume, except the temporal one. The greatest differences were found when comparing the superior temporal sector (p<0.00007; Z=3.96). The rim thinning of the in this sector are corresponded to the changes in the thickness of the RNFL detected above. The analysis of the characteristics determining the state of the minimum distance from the edge of the MRW established the reliability of differences in the superior temporal sector (p<0.04; Z=2.07), but at the same time, in other cases, statistically significant differences between the studied groups were not found.

CONCLUSION:The results of the study found that in the majority of cases, changes in patients with early glaucoma are found in the analysis of traditional rim parameters (area and volume), as well as in the study of the RNFL in the specific rim sectors. The study of a new index of the rim — MRW, has established its importance in the diagnosis of the early glaucoma, but so far only in the analysis of a limited number of rim sectors.

1. Egorov E.A., Astahov Yu.S., Erichev V.P. Natsional’noe rukovodstvo po glaukome dlya praktikuyushchikh vrachei [National guidelines on glaucoma for practitioners]. Moscow, GEOTAR-MEDIA Publ., 2015. 456 p. (In Russ.).

2. Avetisov S.E., Egorov E.A., Moshetova L.K., Neroev V.V., Takhchidi Kh.P. Oftal’mologiya: natsional’noe rukovodstvo. [Оphthalmology: National guidance]. Moscow, GEOTAR-Media Publ., 2018; 904 p. (In Russ.).

3. Weinreb R.N., Garway-Heath T., Leung C. et al. Diagnosis of primaryopen glaucoma: WGA consensus series-10. Amsterdam, Kugler Publications, 2017. 228 p.

4. Kurysheva N.I. Glaukomnaya opticheskaya neiropatiya [Glaucoma optic neuropathy]. Moscow, MEDpress-inform Publ., 2006. 136 p. (In Russ.).

5. Kuroyedov A.V., Gorodnichy V.V., Aleksandrov A.S. et al. Information indicators of glaucoma development at structural topographic analysis of ONH (as an example study the results of laser scanning polarimetry and Heidelberg Retina Tomography). Glaucoma. 2007; 3:10-16. (In Russ.).

6. Kuroyedov A.V., Gorodnichy V.V. Komp’yuternaya retinotomografiya(HRT): diagnostika, dinamika, dostovernost’ [Computerized Retinotomography (HRT): diagnosis, dynamics, reliability]. Moscow, Publishing Center of Fyodorov Eye Microsurgery Complex; 2007. 236 p. (In Russ.).

7. Kuroyedov A.V., Gorodnichy V.V. Informativity of stereometric and integral indices of topographic optic nerve disc structure by computer retinotomography in glaucoma patients. RMJ. Clinical ophthalmology. 2007; 3:92-97. (In Russ.).

8. Kuroyedov A.V. Heidelberg Retina Tomograph (HRT): additional potentialities and perspective. Glaucoma. 2007; 4:38-52. (In Russ.).

9. Kurysheva N.I. The role of visualization methods of optic disc and retinal nerve fiber layer in early diagnosis of glaucoma. Glaucoma. 2007; 1:16-20. (In Russ.).

10. Kurysheva N.I. Opticheskaya kogerentnaya tomografiya v diagnostike glaukomy. [Optical coherence tomography in glaucoma diagnosis]. Moscow, AKSI-M Publ., 2015. 148 p. (In Russ.).

11. Kurysheva N.I., Kiseleva T.I., Ardzhevnishvili T.D. et al. The choroid and glaucoma: choroidal thickness measurement by means of optical coherence tomography. Natsional’nyi zhurnal glaukoma. 2013; 3:73-82. (In Russ.).

12. Machehin V.A., Manaenkova G.E. Optic disc parameters at different stages of open-angle glaucoma by laser scanning retinotomography HRT-II. Glaucoma. 2005; 4:3-9. (In Russ.).

13. Povazay B., Hofer B., Hermann B. et al. Minimum distance mapping using three-dimensional optical coherence tomography for glaucoma diagnosis. J Biomed Opt. 2007; 12(4):1-8. doi: org/10.1117/ 1.2773736.

14. Badala F., Nouri-Mahdavi K., Raoof D.A. et al. Optic disk and nerve fiber layer imaging to detect glaucoma. Am J Ophthalmol. 2007; 144(5):724-732. doi: 10.1016/j.ajo.2007.07.010.

15. Saarela V., Karvonen E., Stoor K. et al. The Northern Finland Birth Cohort Eye Study: Design and baseline characteristics. BMC Ophthalmol. 2013; 13(5):51-57. doi: 10.1186/1471-2415-13-51.

16. Reis A.S., O’Leary N., Yang H. et al. Influence of clinically invisible, but optical coherence tomography detected, optic disc margin anatomy on neuroretinal rim evaluation. Invest Ophthalmol Vis Sci.2012; 53(4):1852-1860. doi: 10.1167/iovs.11-9309.

17. Chauhan B.C., Burgoyne C.F. From сlinical examination of the optic disc to clinical assessment of the optic nerve head: a paradigm change. Am J Ophthalmol. 2013; 156(2):218-227. doi: 10.1016/j.ajo.2013.04.016.

18. Choi J.A., Kim J.S., Park H.Y. et al. The foveal position relative to the optic disc and the retinal nerve fiber layer thickness profile in myopia. Invest Ophthalmol Vis Sci.2014; 55(3):1419-1426. doi: 10.1167/iovs.13-13604.

19. Chauhan B.C., O’Leary N., Almobarak F.A. et al. Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter. Ophthalmology. 2013; 120(3):535-543. doi: 10.1016/j.ophtha.2012.09.055.

20. Curcio C.A., Johnson M. Structure, function, and pathology of Bruch’s membrane. In: Eds. Rickmann C.B., LaVail M.M., Anderson R.E. et al. Retinal degenerative diseases. Mechanisms and Experimental Therapy. Springer, 2016. 854 p. doi: 10.1007/978-3-319-17121-0.

21. Belghith А., Bowd С., Medeiros F.A. et al. Does the location of Bruch’s Membrane opening change over time? Longitudinal analysis using San-Diego automated layer segmentation algorithm (SALSA). Invest Ophthalmol Vis Sci. 2016; 57(2):675-682. doi: 10.1167/iovs.15-17671.

22. Kromer R., Spitzer M.S. Bruch’s membrane opening minimum rim width measurement with SD-OCT: a method to correct for the opening size of Bruch’s membrane. Hindawi J Ophthalmol. 2017; 2017:8963267. doi: 10.1155/2017/8963267.

23. Rhodes L.A., Huisingh C.E., Quinn A.E. et al. Comparison of Bruch’s membrane opening-minimum rim width among those with normal ocular health by race. Am J Ophthalmol.2017; 174(2):113-118. doi: 10.1016/j.ajo.2016.10.022.

24. Chauhan B.C., Danthurebandara V.M., Sharpe G.P. et al. Bruch’s membrane opening minimum rim width and retinal nerve fiber layer thickness in a normal white population: A Multicenter Study. Ophthalmology. 2015; 122(9):1786-1794. doi: 10.1016/j.ophtha.2015.06.001.

25. Enders P., Schaub F., Adler W. et al. The use of Bruch’s membrane opening-based optical coherence tomography of the optic nerve head for glaucoma detection in microdiscs. Br J Ophthalmol. 2017; 101(4):530-535. doi: 10.1136/bjophthalmol-2016-308957.

26. Hwang Y.H., Kim M.K., Ahn S.I. Consistency of Bruch membrane opening detection as determined by optical coherence tomography. J Glaucoma.2016; 25(11):873-878. doi: 10.1097/IJG.0000000000000448.

27. Johnstone J., Fazio M., Rojananuangnit K. et al. Variation of the axial location of Bruch’s membrane opening with age, choroidal thickness, and race. Invest Ophthalmol Vis Sci. 2014; 55(3):2004-2009. doi: 10.1167/iovs.13-12937.

28. Nakanishi H., Suda K., Yoshikawa M. et al. Association of Bruch’s membrane opening and optic disc morphology to axial length and visual field defects in eyes with primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2018; 256(3):599-610. doi: 10.1007/s00417-017-3874-8.

29. Park K., Kim J., Lee J. Reproducibility of Bruch’s membrane opening-minimum rim width measurements with spectral domain optical coherence tomography. J Glaucoma. 2017; 26(11):1041-1050. doi: 10.1097/IJG.0000000000000787.10.1097/IJG.0000000000000787.

30. Reis A.S.C., Zangalli C.S., Abe R.Y. et al. Intra- and interobserver reproducibility of Bruch’s membrane opening minimum rim width measurements with spectral domain optical coherence tomography. Acta Ophthalmol.2017; 95(7):548-555. doi: 10.1111/aos.13464.

31. Hua R., Gangwani R., Guo L. et al. Detection of preperimetric glaucoma using Bruch membrane opening, neural canal and posterior pole asymmetry analysis of optical coherence tomography. Sci Rep. 2016; 6:21743. doi: 10.1038/srep21743.

32. Enders P., Adler W., Schaub F. et al. Optimization strategies for Bruch’s membrane opening minimum rim area calculation: sequential versus simultaneous minimization. Sci Rep.2018; 32(2):314-323. doi: 10.1038/eye.2017.306.

33. Strakhov V.V., Korchagin N.V., Popova A.A. The biomechanical aspect of the pathological optic disc cupping development in glaucoma. Natsional’nyi zhurnal glaukoma.2015; 3:58-71. (In Russ.).

34. Kurysheva N.I. The comments to the paper of Prof. Strakhov V.V. “The biomechanical aspect of the pathological optic disc cupping development in glaucoma”. Natsional’nyi zhurnal glaukoma.2015; 4:66-71. (In Russ.).

35. Taniguchi E.V., Paschalis E.I., li D. et al. Thin minimal rim width at Bruch’s membrane opening is associated with glaucomatous paracentral visual field loss. Clin Ophthalmol. 2017; 11:2157-2167. doi: 10.2147/OPTH.S149300.

36. Nesterova A.A., Zagrebin V.L. Aging retina (degeneration, apoptosis, regression) and link with gerontoophthalmics diseases. Volgogradsky nauchno-meditsinsky zhurnal.2012; 1:90-93. (In Russ.).

37. Gaponko O.V., Kuroyedov A.V., Gorodnichy V.V. et al. New morphometric diagnostic markers of glaucoma. RMJ. Clinical ophthalmology. 2016; 1:1-5. (In Russ.).

38. Nesterov A.P., Bunin A.Ja. New classification of primary glaucoma. Vestn oftalmol. 1977; 5:38-42. (In Russ.).

39. Mills R.P., Budenz D.L., Lee P.P. et al. Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol. 2006; 141(1):24-30. doi: 10.1016/j.ajo.2005.07.044.