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Novel Software Strategy for Glaucoma Diagnosis:  Asymmetry Analysis of Retinal Thickness

Sanjay Asrani, MD; Jullia A. Rosdahl, MD, PhD; R. Rand Allingham, MD
Arch Ophthalmol. 2011;129(9):1205-1211. doi:10.1001/archophthalmol.2011.242.
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The benefits of high-speed, detailed retinal thickness measurement by spectral-domain optical coherence tomography in glaucoma diagnosis have not been fully realized. We have modified the software protocols for such measurement and applied it for diagnosis at different stages of glaucoma. Using the Spectralis SD-OCT (Heidelberg Engineering, Carlsbad, California), we have customized the retinal thickness protocol to acquire detailed retinal thickness measurements of the central 20° of the posterior pole. These custom maps are displayed in a compressed color scale that reveals small losses in retinal thickness. A novel asymmetry analysis protocol was created to highlight differences between the eyes and the 2 hemispheres within each eye. We present case examples illustrating the ability of this strategy to detect glaucomatous defects, showing the promise of the protocol in the diagnosis and management of glaucoma.

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Figure 1. Preperimetric glaucoma. A case of optic cupping asymmetry shows a normal retinal nerve fiber layer (RNFL) in both eyes. The macular retinal thickness map shows an arc of thinning inferotemporally in the right eye. Asymmetry analysis shows the arcuate defect on the right-to-left comparison, as well as the superior-to-inferior comparison. White arrows in the posterior pole optical coherence tomography (OCT) analysis of the right eye indicate an arc of thinning extending inferotemporally from the optic disc. I indicates inferior; N, nasal; OD, right eye; OS, left eye; S, superior; and T, temporal.

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Figure 2. Moderate glaucoma. A patient with glaucoma and a visual field defect in the left eye has superotemporal thinning of the RNFL in the right eye and in all temporal quadrants of the left eye. The macular thickness map indicates extensive loss of thickness superotemporally and inferotemporally in the left eye. The asymmetry analysis demonstrates a significant loss inferiorly in the left eye and an early loss superotemporally in the right eye. Black arrows in the hemisphere asymmetry plot show an early superior defect. See the legend to Figure 1 for an explanation of the abbreviations.

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Figure 3. Moderate glaucoma with paracentral scotoma. The OCT measurements of the RNFL show superior-temporal thinning in each eye. The retinal thickness loss extends into the parafoveal region of the right eye (white arrow in the OD map) and is well represented in the thickness map, as well as on the right-to-left and superior-to-inferior asymmetry analysis of the right eye (black arrow). The left eye shows an early loss in the retinal thickness superotemporally (white arrow in the OS [left eye] map). See the legend to Figure 1 for an explanation of the abbreviations.

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Figure 4. Advanced glaucoma. Bilateral visual field loss with inferotemporal loss of the RNFL in the right eye and loss of temporal and inferior RNFL in the left eye. The macular OCT images show a large, dense inferior defect in the right eye (white arrows), highlighted in the superior-to-inferior hemisphere asymmetry, which corresponds to the nasal step. There is also a loss of the inferior portion of the reddish parafoveal ring corresponding to the superior paracentral loss on the visual field (white arrowhead). The dense superior visual field defect present in the left eye corresponds to a large loss of inferior retinal thickness. See the legend to Figure 1 for an explanation of the abbreviations.

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