PURPOSE: To evaluate the usefulness of automated measurements of the localized retinal nerve fiber layer (RNFL) defects area in patients with glaucoma. METHODS: Fifty one patients with localized RNFL defects in RNFL red-free photographs and 53 healthy subjects were included. All participants were imaged with 3D spectral-domain optical coherence tomography (OCT). The area of defects was measured with the RNFL significance map (red = p < 1% and yellow = p < 5%) using Image J manually and Matlab software automatically. The area under the receiver operating characteristic curve (AUC) was calculated for the RNFL defect area of the RNFL photograph and RNFL maps, circumpapillary RNFL thickness, optic disc parameter, and macular inner retina thickness. RESULTS: High correlation was observed between manually and automatically measured defect areas in the significance map (red area r = 0.904, red and yellow area r = 0.890). The AUC for manually and automatically measured defects area (0.987, 0.966; p < 5%, p = 0.31, respectively) in the significance map was comparable. The latter demonstrated slightly higher but insignificant difference in AUC for inferior quadrant circumpapillary RNFL thickness (0.936; p = 0.22) and was significantly higher than the inferior ganglion cell layer plus inner plexiform layer thickness (0.894) and vertical cup to disc ratio (0.869) (p = 0.018, p = 0.008, respectively). CONCLUSIONS: The automated measurements of the RNFL defect area in the significance map performed adequately in detecting localized RNFL defects and had a better performance than macular inner retina and optic nerve parameters.
Area Under Curve ; Ganglion Cysts ; Glaucoma ; Humans ; Nerve Fibers ; Optic Nerve ; Retina ; Retinaldehyde ; ROC Curve ; Tomography, Optical Coherence

PURPOSE: To compare retinal nerve fiber layer (RNFL) thickness measured by time domain (Stratus) and spectral domain (3D) optical coherence tomography (OCT). METHODS: Sixty-nine normal subjects and 92 glaucoma patients were included in the present study. Peripapillary RNFL thickness was measured with Stratus fast RNFL scan and 3D optic disc cube scan on the same day. The relationship between RNFL thickness measurements of the two OCTs were evaluated using a Pearson's correlation analysis. A Bland-Altman plot was used for the comparison of Stratus-OCT and 3D-OCT. RESULTS: In all subjects, average, superior, and inferior quadrant RNFL thicknesses measured by Stratus-OCT were thicker than those measured by 3D-OCT. In contrast, temporal and nasal quadrant RNFL thicknesses measured by 3D-OCT were thicker than those measured by Stratus-OCT. Although there were absolute value differences in RNFL thicknesses, high correlation was observed between Stratus-OCT and 3D-OCT (average: r = 0.897, temporal quadrant: r = 0.728, superior quadrant: r = 0.811, nasal quadrant: r = 0.678, and inferior quadrant: r = 0.905). Bland-Altman plots showed that Stratus-OCT values were greater than 3D-OCT values with relatively high RNFL thickness and the opposite with low RNFL thickness. CONCLUSIONS: For thicker RNFL, Stratus-OCT measurements tend to be greater than 3D-OCT, while for thinner RNFL, 3D-OCT measurements tend to be greater than Stratus-OCT. This difference must be taken into account if comparing measurements made with a Stratus-OCT to the measurements of a 3D-OCT.
Glaucoma ; Humans ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: To compare the ability of three dimensional spectral-domain optical coherence tomography (3D OCT) and Stratus OCT to detect early glaucoma. METHODS: The optic disc topographic and retinal nerve fiber layer (RNFL) thickness parameters were measured by 3D OCT and Stratus OCT in 69 normal eyes and 48 early glaucoma eyes. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC). RESULTS: The best Stratus OCT parameters and criterion that differentiated normal from early glaucoma based on AUC were horizontal integrated rim width (0.85) for optic nerve head parameters, inferior quadrant (0.88) for RNFL parameters, and > or =1 clock-hour abnormal at the 5% level (0.81) based on the normative database for criteria. The best 3D OCT parameters and criterion that differentiated normal from early glaucoma were vertical cup-to-disc ratio (0.85), 11 o'clock RNFL thickness (0.86), and > or =1 clock-hour abnormal at the 1% level (0.78), respectively. When all corresponding the best parameters and criterion were compared, there were no significant differences between the AUCs for Stratus OCT and 3D OCT (p = 0.95, p = 0.73, p = 0.45, respectively). CONCLUSIONS: Stratus OCT and 3D OCT had similar diagnostic ability for detection of early glaucoma.
Area Under Curve ; Eye ; Glaucoma ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; ROC Curve ; Tomography, Optical Coherence

PURPOSE: To identify the risk factors associated with false negative findings of optical coherence tomography (Stratus OCT) in patients with photographic localized retinal nerve fiber layer (RNFL) defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects were included in the present study. The patients were divided into 2 groups according to the presence or absence of detection of photographic defects by OCT. Gender, age, refractive error, diabetes, hypertension, central corneal thickness, type of glaucoma, mean deviation, pattern standard deviation, average RNFL thickness, disc area, and photographic RNFL defect related variables (location, number, and angular width) were compared between the 2 groups. Each variable was initially evaluated by univariate analysis and significant variables (p < 0.1) were included in the logistic regression analysis. RESULTS: Photographic RNFL defects were not detected by OCT in 51 (25.9%) of the 197 eyes. The angular locations and widths of RNFL defects by OCT were significantly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient R = 0.98 and 0.64, respectively). Logistic regression analysis revealed the risk factors for false negative findings of OCT included average RNFL thickness (odds ratio = 1.106, 95% confidence interval [CI] = 1.057-1.156, p < 0.001) and angular width of defect (odds ratio = 0.929, 95% CI = 0.884-0.977, p = 0.004). CONCLUSIONS: This present study suggests that false negative findings of OCT in patients with photographic localized RNFL defects were associated with thicker RNFL thickness and smaller angular width of RNFL defect.
Eye ; Glaucoma ; Humans ; Hypertension ; Logistic Models ; Nerve Fibers ; Refractive Errors ; Retinaldehyde ; Risk Factors ; Tomography, Optical Coherence

We report a rare case of optic nerve atrophy with severe disc cupping resulting from methanol poisoning. A 30-year-old man presented to the hospital complaining of decreased visual acuity in both eyes a day after drinking alcohol containing methanol. His initial visual acuity allowed for only visualizing hand motion and not corrected in either eye. Initial intraocular pressure was within normal limits in both eyes. Initial fundus examination showed optic disc swelling in both eyes. Four years later, he visited our hospital for an eye evaluation. Visual acuity in both eyes still only allowed for visualizing hand motion. No nystagmus was observed in either eye during the optokinetic nystagmus test, and no waves were found in a visual evoked potential test. No specific change was noted on brain magnetic resonance imaging. On fundus examination, there was disc pallor in both eyes and disc cupping with a high cup/disc (C/D) ratio above 0.9 in the left eye. C/D ratio of the right eye was 0.5. Methanol poisoning may induce glaucomatous disc cupping in the late stage as well as optic atrophy. One possible mechanism of disc cupping is ganglion cell loss due to acute demyelination of the retrobulbar optic nerve. This report is the first photographic evidence of methanol induced optic disc cupping in Korea.
Adult ; Diagnosis, Differential ; Evoked Potentials, Visual ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Magnetic Resonance Imaging ; Male ; Methanol/*poisoning ; Optic Atrophy/*chemically induced/pathology/physiopathology ; Optic Disk/drug effects/*pathology ; Papilledema/*chemically induced/pathology/physiopathology ; Severity of Illness Index ; Solvents/poisoning ; Tomography, Optical Coherence ; Visual Acuity

A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.
Female ; Humans ; Middle Aged ; Nerve Fibers/*pathology ; Optic Disk/*abnormalities/*pathology ; Optic Nerve Diseases/*diagnosis ; Retinal Ganglion Cells/*pathology ; Retinoschisis/*diagnosis/drug therapy ; Tomography, Optical Coherence

PURPOSE: To generate a map relating visual field (VF) test points to corresponding areas of the retinal nerve fiber layer (RNFL) measured with optical coherence tomography (OCT) in patients with localized RNFL defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects, underwent standard automated perimetry (SAP) and OCT measurements. To define zones of related point, factor analysis of the mean thresholds for the SAP test points was performed, independently for each hemifield. A map relating the VF zones to the 12 OCT sectors was plotted based on the strongest correlations between both techniques. RESULTS: Factor analysis divided the VF points into five VF zones for each hemifield. Distribution of the VF zones for the superior and inferior hemifields was slightly asymmetric. Linear regression results showed that superior VF zones corresponding to the superior arcuate and nasal step regions were best correlated with 6- and 7-o'clock RNFL sectors (inferior and inferior temporal) of thickness (r = 0.51-0.59). RNFL thinning (defined by abnormal sector at p < 5%) and regional decreases in SAP sensitivity (defined by abnormal pattern deviation at p < 5%) were topographically related. CONCLUSIONS: A newly developed VF cluster map revealed significant topographical structure-function relationships, especially in the arcuate and nasal step region of the VF.
Factor Analysis, Statistical ; Glaucoma ; Humans ; Linear Models ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields

PURPOSE: To determine if korean normative database improve diagnostic ability of Stratus OCT for detection of glaucoma. METHODS: Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were measured using a Stratus OCT. The normative data were collected from 129 normal individuals. We obtained values at the 5% and 1% levels according to the disc area stratified into equal thirds to minimize the error by the individual variation of optic disc size and these levels were considered abnormal. One eye of each 94 normal-tension glaucoma patients with early visual field defects (mean deviaton = -3.84+/-1.40dB) and 87 another normal subjects were enrolled. Glaucoma was defined by visual field defects. RESULTS: The use of Korean normative database had higher sensitivity and no significant difference of specificity than that of a Stratus OCT except for a few parameters. The criteria that show the highest diagnostic ability were 1 > or = quadrants RNFL thickness abnormal at the < 5% when using a Korean normative database (sensitivity = 81.9%, specificity = 81.6%) and 1 > or = clock hours abnormal at the < 5% when using a Stratus OCT normative database (sensitivity = 71.3%, specificity = 87.4%) (p=0.004, p=0.180, respectively, McNemar test). CONCLUSIONS: The criterion using a Korean normative database had higher sensitivity and no difference of specificity compared with criterion using a Stratus OCT normative database. The best criterion using a Korean normative database may be helpful for early detection of normal-tension glaucoma.
Eye ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; Sensitivity and Specificity ; Tomography, Optical Coherence ; Visual Fields

PURPOSE: To evaluate the diagnostic ability of Stratus optical coherence tomography (OCT) parameters to distinguish normal eyes from those with early glaucomatous visual field defects. METHODS: One eye each of 52 normal-tension glaucoma patients with early visual field defects (mean deviation, -3.98+/-1.30dB; range, -0.01 to -5.86dB) and 88 age-matched normal subjects were enrolled. The Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were scanned using the Stratus OCT. Areas under the receiver operating characteristic curve (AROC) and the sensitivity and specificity for various OCT parameters were used to assess the performance of OCT. RESULTS: The AROC for the C/D area ratio was 0.865. Other high AROC values included the vertical C/D ratio (0.848), the average RNFL thickness (0.813), and the RNFL thickness in the inferior quadrant (0.791). A stepwise discriminant analysis found that a combination of the C/D area ratio and RNFL thickness in the inferior quadrant could correctly identify 86.4% of the normals and 80.8% of the glaucoma patients (AROC=0.893). CONCLUSIONS: In our sample of patients with early visual field defects, Stratus OCT parameters showed moderate discriminating abilities. Combining the C/D area ratio and RNFL thickness in the inferior quadrant by discriminant analysis improved the diagnostic ability to detect glaucoma.
Discriminant Analysis ; Discrimination (Psychology)* ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; ROC Curve ; Sensitivity and Specificity ; Tomography, Optical Coherence* ; Visual Fields

PURPOSE: To determine the factors influence retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured by Stratus optical coherence tomography (OCT). METHODS: Topographic RNFL thickness and optic disc parameters of 129 healthy Korean subjects of aged 14 to 87 were measured using the fast retinal nerve fiber layer thickness and fast optic disk algorithms of Stratus OCT. One eye of each subject was randomly selected for statistical analysis. Using multiple linear regression, the effect of optic disc area, age, refractive error, and zone beta on each parameter was analyzed. RESULTS: Large discs had large horizontal integrated rim width (HIRW), cup area, rim area, C/D area ratio, and vertical C/D ratio. The thickness of average, superior, inferior, and nasal quadrant RNFL increased significantly with an increase in optic disc area. Average and superior quadrant RNFL thickness, and HIRW decreased with age. Refractive error showed a correlation with the vertical integrated rim area, horizontal C/D ratio, and temporal quadrant RNFL thickness. Gender and zone beta had no statistically significant influence on ONH and RNFL parameters. CONCLUSIONS: This study shows that optic disc size affects most RNFL thickness and ONH parameters. Because of the relationships revealed in this study, optic disc area in addition to age should be considered when the Stratus OCT RNFL thickness and ONH parameters are interpreted.
Linear Models ; Nerve Fibers* ; Optic Disk ; Refractive Errors ; Retinaldehyde* ; Tomography, Optical Coherence*