Spectral-domain optical coherence tomography for glaucoma diagnosis

·Review·

Parameters of ocular fundus on spectral-domain optical

coherence tomography for glaucoma diagnosis
Yu-Lin Tao1,2, Li-Ming Tao2, Zheng-Xuan Jiang2, He-Ting Liu2, Kun Liang2, Mo-Han Li2, Xuan-
Sheng Zhu2, Yan-Lin Ren2, Bing-Jie Cui2,3
1
Department of Ophthalmology, the First People's Hospital of DOI:10.18240/ijo.2017.06.23
Jiujiang City, Jiujiang 332000, Jiangxi Province, China
2
Department of Ophthalmology, the Second Affiliated Hospital Tao YL, Tao LM, Jiang ZX, Liu HT, Liang K, Li MH, Zhu XS, Ren
of Anhui Medical University, Hefei 230000, Anhui Province, YL, Cui BJ. Parameters of ocular fundus on spectral-domain optical
China coherence tomography for glaucoma diagnosis. Int J Ophthalmol
3
Department of Ophthalmology, the Fuyang Affiliated Hospital 2017;10(6):982-991
of Anhui Medical University, Fuyang 236000, Anhui Province,
China INTRODUCTION
Correspondence to: Li-Ming Tao. Department of Ophthal-
mology, the Second Affiliated Hospital of Anhui Medical
University, Hefei 230000, Anhui Province, China. Lmtao9@
G laucoma is a group of optic neuropathies that is
characterized by progressive degeneration of retinal
ganglion cells (RGCs), slow atrophy and thinning of the retinal
163.com nerve fiber layer (RNFL), irreversible morphological changes
Received: 2016-07-22 Accepted: 2017-02-06 to the optic nerve head (ONH) that contains the narrowing of
disc rim area (RA), and expansion of the optic cup[1-2]. Loss
Abstract and shrinkage of the visual field is another characteristic of
● In this review, we summarize the progression of several glaucoma caused by the degeneration of these nerves, which
parameters assessed by spectral-domain optical coherence can eventually lead to blindness and a decline in the quality
tomography (SD-OCT) in recent years for the detection of life without early and adequate treatment[1]. There are more
of glaucoma. Monitoring the progression of defects in than 70 million people threatened by glaucoma worldwide
the retinal nerve fiber layer (RNFL) thickness is essential. with approximately 10% being blind in both eyes[3], making
Imaging and analysis of retinal ganglion cells (RGCs) it one of the predominant reasons of blindness in the world.
and inner plexiform layer (IPL), respectively, have been Glaucoma, especially primary open angle glaucoma (POAG),
of great importance. Optic nerve head (ONH) topography usually involves both eyes, occurs insidiously, and progresses
obtained from 3D SD-OCT images is another crucial slowly, and is often only detected at an advanced stage where
step. Other important assessments involve locating visual function has already been seriously compromised;
the Bruch’s membrane opening (BMO), estimating the this is because patients with POAG rarely show early-stage
optic disc size and rim area, and measuring the lamina symptoms. Mid- or late-stage glaucoma has poor prognosis
cribrosa displacement. Still other parameters found in despite related treatment, because these patients have a
the past three years for glaucoma diagnosis comprise relatively shrunk visual field and depressed atrophy of the
central retinal artery resistive index, optic disc perfusion optic disc.
in optical coherence tomography angiography (OCTA) Several studies have found that visual field loss in many
study, peripapillary choroidal thickness, and choroidal patients is only detected when a substantial number of RGCs
area in SD-OCT. Recently, several more ocular fundus have been lost and a vast amount of RNFL has thinned[4-8].
parameters have been found, and compared with the Besides, in vivo research in experimental glaucoma (EG)
earlier parameters to judge the accuracy of diagnosis. involving a nonhuman primate (NHP) model of EG has also
While a few of these parameters have been widely used in shown that RNFL impedence and RGC function exhibit
clinical practice, a fair number are still in the experimental progressive loss from baseline before any loss of retinal nerve
stage. fiber layer thickness (RNFLT) or orbital optic nerve axons
● KEYWORDS: glaucoma progression; retinal nerve fiber occurs[9], prior to the loss of visual field. With regard to in vivo
layer; ganglion cells; macular thickness; optic nerve head; measurement, it might serve as potential biomarkers of early-
lamina cribrosa; optical coherence tomography stage glaucomatous damage preceding axon loss and RGC
death[9]. Therefore, it is essential to measure and estimate the
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Tel:8629-82245172 8629-82210956 Email:[email protected]
parameters of ocular fundus from spectral-domain optical source OCT (SS-OCT), and Envisu C-Class SDOIS, with the
coherence tomography (SD-OCT) and apply these findings first four types being more popular than the others[21,24,29,31-43].
to the monitoring and detection of progression of primary Some of these are still in the experimental stage and not widely
glaucoma. used in clinical, e.g. Envisu C-Class SDOIS. Each type offers a
With the rapid development of resolution and scanning speed special function and has its own advantages: RTVue SD-OCT
on OCT imaging and its advantages of non-contact, good is useful for RNFL change analysis and ganglion cell complex
repeatability, and quick imaging, OCT has been widely used (GCC) progression analysis; Cirrus HD-OCT, for guided
in the field of ophthalmology, ranging from time-domain OCT progression analysis (GPA) of RNFL and ONH measurements;
(TD-OCT) to SD-OCT[10-14]. Different parameters in structural Spectralis OCT, for the RNFL change report with fovea-to-
measurements for early glaucoma diagnosis obtained with disc alignment (FoDi); Topcon 3D OCT, for RNFL trend
SD-OCT have emerged in several research articles and been analysis; RS-3000 OCT, for the detection of changes in RNFL
published to evaluate their accuracy[15-18]. This paper critically and complex thicknesses about structures comprising the
reviews and evaluates relevant research of these parameters nerve fiber layer (NFL), ganglion cell layer (GCL), and inner
obtained from SD-OCT for the diagnosis of primary glaucoma. plexiform layer (IPL) and for its multifunctional follow-up;and
We also review issues related to what types of SD-OCT can swept-source OCT, for the detection of axonal damage on the
provide optimal results in the potential ability for diagnosing lamina cribrosa (LC), in vivo glaucoma, and evaluation of
glaucoma, how to evaluate the parameters in glaucoma its ability to qualify lamina cribrosa thickness (LCT)[35]. The
diagnosis, and how these results from SD-OCT could be applied function and current reports of Envisu C-Class SDOIS are not
to clinical practice. available.
TYPES OF SPECTRAL-DOMAIN OPTICAL COHERENCE Several studies have shown and compared some types of
TOMOGRAPHY FOR GLAUCOMA DIAGNOSIS SD-OCT with respect to diagnostic accuracy in glaucoma.
Although currently, some other inspection equipment that Akashi et al[32] who studied glaucomatous eyes, normal eyes
contains scanning laser polarimetry (SLP) and confocal with high myopia, and normal eyes by using RTVue, Cirrus,
scanning laser ophthalmoscopy (CSLO) has been used to and 3D OCT, concluded that the average circumpapillary
detect RNFL thickness clinically[10,19], the most widely used retinal nerve fiber layer (cpRNFL) and GCC thicknesses
tool for glaucoma diagnosis in clinical practice is SD-OCT, displayed similar efficacies in the diagnosis of glaucoma
which can obtain high-resolution images of RNFLT, optic with high myopia. RTVue OCT exhibited the best diagnostic
disc parameters, and macular ganglion cell complex (mGCC) potential when the position was spotted in nasal cpRNFL,
thickness data[12-13,20-24]. Since its introduction in 1991 by Huang whereas when spotted in the macular retinal nerve fiber layer
et al[25], OCT has rapidly emerged and become widespread in (mRNFL), 3D OCT showed better diagnostic potential than
its use as a useful tool in ophthalmology worldwide. Cirrus OCT. Both cpRNFL and GCC measurements obtained
In the past two decades, TD-OCT was clinically applied to from each instrument showed good performance in detecting
obtain images of ocular fundus parameters. TD-OCT can highly myopic glaucoma. The same research team published
also provide the RNFLT, retinal ganglion cell layer thickness another dissertation with the same instruments and showed
(RGCLT), and ONH parameters to differentiate glaucomatous that the abilities for the parameters of GCL/IPL and mRNFL
eyes from people alive and to detect changes over time[14,26-29]. gained from Cirrus and 3D OCT was different[33]. Other groups
However, owing to its limited suboptimal axial resolution (10 μm) have also reviewed the usage of SD-OCT to detect glaucoma
and scan speed (100-400 A-scan/s), acquisition times with TD- progression and analyzed reproducibility and accuracy of
OCT are much longer than SD-OCT. Therefore, its popularity different types of SD-OCT performed on different parameters
in hospitals to detect glaucoma progression has declined. of ocular fundus in glaucoma patients[44]. Thus, it is critical
Nowadays, most commercially available instruments provide to maintain tight surveillance on the progression of early-
a quicker scan speed (26 000-53 000 A-scan/s) and a wider stage glaucoma and correctly diagnose with SD-OCT in order
axial resolution of about 5 μm; hence, aptly named SD-OCT. toprevent or delay vision loss in these patients.
We can acquire much clearer and more comprehensible images DETECTION OF RETINAL NERVE FIBER LAYER
from SD-OCT that leads to much improved reproducibility THICKNESS IN GLAUCOMA DIAGNOSIS
and accuracy to differentiate glaucomatous eyes from healthy With the enhancement of OCT resolution and SD-OCT
eyes[18,30]. imaging, the hierarchy of retinal structures and tissues can
Our online search of published articles showed that seven be meticulously visualized, including any pathology. The
types of SD-OCT have been widely popularized to diagnose structures can be distinguished clearly including NFL, GCL,
glaucoma clinically; these include RTVue SD-OCT, Cirrus HD- IPL, and mGCC. After calculating the thickness of each layer,
OCT, Spectralis OCT, Topcon 3D OCT, RS-3000 OCT, swept- the difference between glaucomatous and healthy eyescan
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be evaluated and the above four parameters were seen to
be significantly lower in glaucomatous eyes than healthy
eyes [16,21,24,26,33,38,45-49]. Despite the thinning of the above-
mentioned four parameters and the change of ONH seen
on SD-OCT, RNFL has wider applications in the detection
of glaucomatous degeneration than the other parameters.
Actually, the first and most common parameter analyzed
by OCT is average cpRNFLT to follow the progression of
glaucoma[50]. Detection of RNFL thickness has been accurate
with respect to each quadrant and each hour circled around
the peripapillary in recent years. Before obtaining the optimal
diagnostic parameters using which the thickness differentiation
between glaucoma and healthy eyescan been compared,
theycalculated the specificity and sensitivity for glaucoma
diagnostic parameters and analyzed and compared their area
under the receiver operating characteristic curves (AUC)[51-55].
Many research studies estimate that repeatability changes with
different parameters of quadrants and hours. Vazirani et al[51]
measured 40 normal and 40 glaucomatous eyes (including 14
cases with advanced glaucoma) and reported that the average
RNFLT shows the best reproducibility for longitudinal follow-
up in all quadrants and the parameter of temporal quadrant
yields minimum repeatability. Mansoori et al[52] showed that
inferior RNFL is the thickest quadrants after studying 95
normal eyes and 83 glaucoma eyes in patients aged >40y.
All the parameters in normal and glaucomatous eyes showed
statistically significant differences except for the temporal
quadrant and at the 10 o'clock position. Especially for the
Figure 1 RNFL measurement and analysis printed out of the
temporal side, the test results showed the same results in the
Spectralis OCT in the same patient with glaucoma We detected it
two groups, reflecting that the temporal side exhibits a low
on December 12, 2014 and April 17, 2015, respectively. The images
specificity in identifying patients with early glaucoma in the
show the progression and degeneration in ONH (A, B), cpRNFL
healthy population. They concluded that superior quadrant
images (C, D), thickness graph (E, F), and changes of every quadrant
and mean RNFLT parameters of cpRNFL have the maximum
of RNFL (G, H). In the two spots of detection period, apparent
diagnostic potential for primary glaucoma. Nouri-Mahdavi
advancements of RNFL can be seen in the section of superior and
et al[56] and Leite et al[42] obtained the same results by using
global parameters. Superior RNFLT has exceeded normal limits
the OCT2000 and Spectralis OCT, respectively, that proved (P<0.01) and is temporal-inferior to borderline (P<0.05), while the
superior and average RNFLT have the largest AROC and are other quadrants are still within normal limits (P>0.05). Given a longer
regarded as the best parameters to distinguish between normal follow-up without any intervention in this patient, the progression
and glaucomatous eyes. Park et al[55] compared the diagnostic would be deeper and more severe, thereby requiring more thorough
ability between Stratus OCT and Cirrus HD-OCT and inspection and management.
concluded that the Cirrus HD-OCT showed stronger diagnostic
capability than Stratus OCT, which is related to the result of inferior quadrant of cpRNFL (Figure 1). Because of different
detection technology improvement, a higher resolution of damage scope of visual field on the glaucomatous involved
Cirrus HD-OCT, and more accurate database standards. into studies, the diagnostic capabilities are different among
Previous studies confirmed the superior quadrant[28,52], inferior different quadrants. For example, Mansoori et al[52] included
quadrant [28,55], and average RNFLT [51-52,55] to be the most more patients with visual field damage and more degeneration
valuable parameters in differentiating between normal and in the superior RNFL than the inferior. Visual function
early glaucomatous eyes. Through these measurements, we worsens with glaucoma progression. Diagnostic capabilities of
can explain the degeneration of visual field associated with most OCT on measuring RNFLT parameters have improved
glaucoma that usually first occurs in the superior area, which (although there was no significant increase), as there is more
is in accordance with the initial damage that occurred in the RNFL damage in the early stage of glaucoma than in those
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who have not yet progressed to the period of visual field healthy from primary glaucoma patients has a comparative
defects. advantage when compared to the detection of RNFL.
Several scholars[57] have conducted Meta-analysis about 17 Role and Value in Detecting Ganglion Cell Complex Thickness
parameters of cpRNFL (including the location about the thickness for Primary Glaucoma Diagnosis Studies have confirmed the
of average, superior, inferior, nasal, and temporal quadrants of emergence of RGC apoptosis in GCL in glaucoma patients, and
RNFL, and 12 total hour from 1 to 12). The subjects involved with the progression of the disease, the number of apoptosis of
in this study were included by a random-effects model, and RGCs increased and the thickness of RGC decreased. SD-OCT
the diagnostic performance was evaluated with the area under can clearly display the internal structure and can calculate
the AUC. They also considered a number of important factors the thickness variation accurately, thus playing an important
related to the consequence in the Meta-regression analysis: role in the diagnosis of glaucoma[4,8,31,45,49,53,59-62]. Sung et al[63]
1) severity of glaucoma (divided into five stages); 2) types of examined 98 patients with advanced glaucoma (mean deviation
glaucoma (four types); and 3) ethnicity (four categories). The of visual field, -14.3±5.5 dB) with SD-OCT, and followed-
result obtained was in accordance with the diagnostic capability up for about 2.2y. Finally, they confirmed significant changes
of all parameters followed in descending order as follows: that occurred in the average thickness of the macula (about the
average RNFLT>inferior>superior>7 o’clock>6 o’clock>11 scale of 6×6-mm2 covered with 128 scan lines). On the other
o’clock>12 o’clock>1 o’clock>5 o’clock>nasal>temporal>2 hand, such significant changes in average cpRNFLT could not
o’clock>10 o’clock>8 o’clock>9 o’clock>4 o’clock>3 o’clock. be found between advanced glaucoma and the non-progression
After excluding the influence of the factors mentioned above, group. However, their next study included 162 cases involving
the average RNFLT showed the highest diagnostic accuracy. early and mid-term stages of glaucoma (defined MD of visual
The diagnostic accuracy is significantly lower in Asian field of the two groups, -4.30 and -9.84 dB respectively), and
populations than in the other two categories. Only in this way, the same follow-up period. Eventually, they found significant
we can demonstrate which parameter has the best diagnostic changes that appeared in average cpRNFLT and macular
potential in differentiating glaucomatous from normal eyes. thickness (MT) between the two groups[64]. These results
DETECTION OF RETINAL GANGLION CELL indicate the potential ability of MT detection and the limitation
COMPLEX LAYER THICKNESS IN GLAUCOMA of RNFLT measurement in monitoring the progression of
DIAGNOSIS advanced glaucoma. It is worth noticing that optic nerve
Composition and Fundamental Functions of Ganglion damage in glaucoma may not involve the peripheral retina. In
Cell Complex NFL is mainly composed of ganglion cell addition, it has been confirmed that measurement of macular
axons, efferent fibers, Müller cells, glial cells, and retinal nerve fibers, ganglion cells, and the thickness of the IPL can
blood vessels. GCL is mainly composed of the cell bodies be applied in the detection of glaucoma progression (Figures 2
of ganglion cells, Müller cells, glial cells, and the branch of and 3)[65].
retinal vessels. IPL is the main connection between the first Recent studies have confirmed that the loss of ganglion
and the second neurons of the retinal neurons in the brain, cells mainly contribute to decrease in MT, especially due
comprising the inner nuclear layer (INL) and enormous to the thinning of the GCC and INL[58]. On the basis of this
projections of ganglion cells. IPL is the synaptic site of bipolar conclusion, Firat et al[53] selected 52 healthy subjects, 56 with
cells, amacrine cells, and ganglion cells. These three structures normal tension glaucoma (NTG), and 61 POAG patients
together constitute the GCC [58]. Human retina contains with SD-OCT to detect. After analyzing and comparing MT,
approximately 1.5 million RGCs, which is not limited to only GCC, and RNFL, as well as the AUCs corresponding to these
one layer of the 10 retinal layer structures[11]. Although NFL parameters, they found that GCC and RNFL have similar
and IPL are widely distributed on the inside of the retina, performance and a high degree of consistency with respect to
GCC has the largest thickness in the macula except for parts glaucoma detection (P<0.05). Superior RNFLT is the single
of the area around the optic disc, which plays an important independent variable in the differentiation between POAG and
role in retinal photoreceptors and the conduction of visual NTG with respect to all parameters [odds ratio (OR)=0.942,
signaling, as the densest area of the RGC is distributed in the P=0.004, 95%CI=0.905-0.981]. Yang et al[61] detected the
macular area and shows a multi-layered structure[11,49]. RNFL mGCIPL, mGCC, and cpRNFL thickness of 106 glaucomatous
measurement is susceptible to retinal vascular, peripapillary and 41 normal eyes with SS-OCT and SD-OCT, including the
atrophy arc and other physiological factors, as blood vessels parameters of AUCs, and concluded that average thickness of
are rich around the optic disc. Measurement results obtained in macular ganglion cell inner plexiform layer (mGCIPL) and
the macular area, which is the physiological a vascular zone, mGCC detected by SS-OCT are all smaller than the results of
have the least interference from external factors. Therefore, SD-OCT regardless of the presence or absence of glaucoma.
GCC thickness measurement to identify and differentiate The average diagnostic accuracy of all quadrants of macular
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Spectral-domain optical coherence tomography for glaucoma diagnosis

Figure 2 Thickness image and gray scale map of retina and macular layer obtained from Spectralis OCT in a patient with glaucoma
Thickness image is marked in black and gray, while the scale map is marked with red. Baseline was obtained on December 12, 2014 (A) and
after 4mo of follow up was obtained on April 17, 2015 (B). The macular area is divided into nine sectors including the global part in the center
and average volume marked with red in the top left hand corner of the circle. Over time, the thickness of the retina and macular layer decreased
in the right eye of the patient.

ganglion cell inner plexiform layer thickness (mGCIPLT) OPTIC NERVE HEAD CHANGES IN THE PROGRESSION
in SS-OCT and SD-OCT were extraordinarily similar. OF GLAUCOMA
Statistically significant differences could not be seen in three General Change in Optic Disc Structure Morphological
parameters of AUCs regarding average cpRNFLT, mGCC, structural changes of the optic disc contribute to another
and mGCIPL that were obtained with the two types of OCT. important feature during the progression of primary glaucoma,
Similar diagnostic capabilities were found between RNFL and which can be seen in the ocular fundus as an expanded visual
GCC in the early, mid, and terminal stages of glaucoma in Kim cup, narrowed disc-rim, increased cup-disc ratio (CD), etc.
et al’s[66] study. Another study by Cho et al[67] about the average Lee et al[68] detected optic disc with Cirrus HD-OCT before
sensitivity of vision, GCC, and RNFLT show similar consistent concluding that significant consistency existed between RA
results in glaucoma diagnostics. and RNFLT either in normal population or in glaucoma group
From the above-mentioned findings mGCIPL and mGCC who has less figure significantly. Suh et al[54] who studied
can be proven to have high potential in the diagnosis of 78 patients with early primary glaucoma and 80 individuals
early primary glaucoma, and with great consistency with the with healthy eyes by using the same kind of OCT showed
results of cpRNFL; all of these can be used as significant that the results of AUCs of RA were greater than the AUCs of
and unprecedented parameters in monitoring the changes of the nasal quadrant on RNFL and in the 1-5 o'clock position.
glaucomatous eyes in the long-term clinical follow-up. No significant difference was found in the other regions of
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Figure 3 Over time, the thickness of the retina and macular layer decreased in the left eye of the patient.

cpRNFL. Rate ratio (RR) measurements (integrated calculation out the average lamina cribrosa thickness (avgLCT). They
of the RA and RNFLT) perform better than RA and the 7+11 found a high pertinence between avgLCT and cpRNFLT with
o'clock (regions that contain 7 and 11 o'clock) of RNFLT in the correlation coefficient of both as 0.64 (P<0.01). The former
the level of AUCs (RA: 0.931; RNFLT: 0.933; RR: 0.968). coefficient of variation was 5.0%. There were significant
Berthold et al[17] showed that there was a significant correlation differences in the avgLCT among the normal, preperimetric
(P<0.05) between MD and RNFL (r=0.603), as well as RNFL glaucoma (PPG), and NTG groups, which indicate that LCT
of the inferior quadrant (r=0.620), RA (r=0.552), and average obtained with SS-OCT could be refined as a new parameter
CD ratio (r=-0.551). The best correlation for the ONH analysis for glaucoma diagnosis and follow-up. With images from SD-
was found between MD and vertical CD ratio (r=-0.568). OCT, Shoji et al[69] identified the inner surface of the Bruch’s
Therefore, RA, CD, and other ONH structures detected and membrane opening (BMO) and measured the horizontal and
analyzed on SD-OCT have an important role in the detection vertical intersectional angles between the BMO line and the
of glaucoma progression and have a synergistic effect with edge of LC, which approximately matched with the best-fitting
RNFLT that can also reflect transition in early glaucoma well. line. The parameter of the vertical-inclined angle to the internal
Changes of Internal Morphology of the Optic Nerve Head LC edge was associated with glaucoma and corresponded to
With the continuous improvement of scanning resolution and its pathological changes. Changes in these parameters are of
depth of OCT, its domain applied to glaucoma monitoring great significance in the monitoring of myopia, glaucoma,
has penetrated to the detection and evaluation of LC[35,69-71]. and LC morphological characteristics. Kim et al[70] reached a
Omodaka et al[35] scanned the area measuring 3×3-mm deep similar conclusion with their study. With the LCT measured by
within the ONH, and ultimately, constructed a 3D model SD-OCT, Sawada et al[71] found that the LC of POAG moved
corresponding to this region of the LC structure and calculated backward when compared to healthy eyes.
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Spectral-domain optical coherence tomography for glaucoma diagnosis
These research studies have proved that LC as a portion of the deviation and even significant after adjusting for age, CD
ONH can be used to monitor and identify early glaucomatous area ratio, NFL, and RA. This result also suggests that disc
eyes from normal eyes, because the changes in thickness and blood flow index may contribute to the diagnosis of OAG.
depth of LC attributable to the glaucomatous pathology were Liu et al[77] reported that peripapillary retinal perfusion as well
prominent and conspicuous. We can learn more about the as peripapillary flow index and peripapillary vessel density
variation of retinal and ONH or other structures in glaucoma can be visualized in glaucomatous eyes. They all have high
by using SD-OCT to detect each layer of the retina and repeatability and reproducibility with OCTA in glaucoma
evaluate the relationship between all parameters and glaucoma. evaluation.
OTHER POTENTIAL CHANGEABLE PARAMETERS Optic disc perfusion measured by OCTA is important for the
The Change of Choroidal Thickness and Choroidal Area monitoring and evaluation of glaucoma and its progression.
With the exception of RNFL, GCC, and ONH, peripapillary Quantitative OCT angiography is of great utility to determine
thickness and choroid volume can also be applied to distinguish the value in future studies in glaucoma evaluation. With the
glaucoma and ocular hypertension diseases from healthy improvement of glaucoma, visual function decreased severely,
eyes, by SD-OCT[72]. Several studies have shown its change especially in the advanced period. From the discussion, the
in the progression of glaucoma. Lamparter et al[72] studied 213 progression of OAG could be monitored by OCTA because of
eyes with open angle glaucoma (OAG), 73 eyes with ocular the close correlation between the flow index/vessel density and
hypertension, and 152 healthy control eyes. This prospective MD, RNFL, and GCC thickness. In a subsequent study, we can
data was collected and calculated by a linear mixed model
take optimize this indication for glaucoma diagnosis.
fitted with provision for age and disease. The peripapillary
CONCLUSION AND OUTLOOK
choroidal thickness in glaucomatous eyes was the thinnest,
Developed by Huang et al[25] in the 1990s as a new diagnostic
whereas it was the thickest in eyes with ocular hypertension.
tool, OCT has thus far been extensively used in the clinical
Furthermore, the thickness parameters are different among
diagnosis of related diseases, especially for primary glaucoma.
every sector of peripapillary choroid, thickest in the superior
Use of the Fourier technique results in enhanced resolution,
sector and thinnest in the inferior sector. Most importantly,
scanning speed, and depth of OCT, and come out the Fourier-
the temporal-inferior sector is thinnest in the choroidal area,
domain that is SD-OCT, which can discover the reduction of
which is one of the regions where glaucomatous damage
RNFLT, mGCC, ONH parameters, and LCT before excessive
begins. Chebil et al[73] described macular choroidal thickness
damage to the visual field. This allows us to correctly and
(MCT) in POAG patients with high myopia and confirmed
accurately diagnose glaucoma in the early stages, and offer
that foveal choroidal thickness (FCT) reduced significantly in
appropriate treatment to postpone or prevent further disease
these patients. Choroidal thinning can be a useful parameter
progression. Improvements in OCT-based diagnostics have
for the diagnosis and follow-up of highly myopic patients with
been rapid, with the emergence of more and more parameters
glaucoma.
for more rapid detection of optic neuropathies. Although
Nowadays, the high resolution of choroidal structures can be
acquired by long-wavelength SS-OCT for its higher acquisition abundance of optic nerve related parameters are available to
speed and deeper tissue penetration and will become clearer manage the progression of glaucoma, visual functional damage
in the near future[34]. This study analyzed the visualization still occurs in very few cases of glaucoma-related nerve head
of the choroidal and scleral interface and showed that disease when irreversible atrophic damage occurs in the optic
choroidal thickness and area may have better clinical utility in nerve. There are still plenty of challenges in finding better
chorioretinal diseases including glaucoma. Thus, systematic and improved high-sensitivity parameters that can aid in the
studies are important to excavate the relationship between detection of neural losses that contribute to early primary
choroidal thickness and glaucoma. glaucoma diagnosis. Therefore, glaucomatous patients would
Optic Disc Perfusion in Glaucoma As a consequence of benefit from earlier diagnosis and better therapy with more
increased intraocular pressure, the optic nerve becomes accurate ability of detection with SD-OCT screening.
compressed, which can lead to reduction of optic disc ACKNOWLEDGEMENTS
perfusion and blood supply. Based on this theory, we can Foundations: Supported by the National Natural Science
detect the bloodstream circled ONH and resistive index of the Foundation of China (No.81300755); the Key Project of the
central retinal artery through OCTA[74-77]. The split-spectrum Natural Science Foundation of the Higher Educational Bureau
amplitude-decorrelation angiography (SSADA) algorithm of Anhui Province (No.KJ2013A147).
was used to compute the 3D optic disc angiography. Jia et Conflicts of Interest: Tao YL, None; Tao LM, None; Jiang
al[76] found that the disc flow index reduced in the glaucoma ZX, None; Liu HT, None; Liang K, None; Li MH, None;
group and was highly correlated with VF pattern standard Zhu XS, None; Ren YL, None; Cui BJ, None.
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Tel:8629-82245172 8629-82210956 Email:[email protected]
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