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Original Investigation |

Structural Characteristics of the Acquired Optic Disc Pit and the Rate of Progressive Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma

Seung Hyen Lee, MD1; Eun Ji Lee, MD1; Tae-Woo Kim, MD1
[+] Author Affiliations
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
JAMA Ophthalmol. 2015;133(10):1151-1158. doi:10.1001/jamaophthalmol.2015.2453.
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Importance  The optic disc pit (ODP) has been considered a region of localized susceptibility to the damage of glaucoma.

Objective  To determine whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the presence and structural characteristics of an ODP in primary open-angle glaucoma.

Design, Setting, and Participants  We performed a prospective case-control study that included 163 eyes with primary open-angle glaucoma (83 with an ODP and 80 without an ODP) from Glaucoma Clinic of Seoul National University Bundang Hospital. Participants were enrolled from the ongoing Investigating Glaucoma Progression Study from January 1, 2012, through May 31, 2014. Mean (SD) follow-up was 3.32 (0.49) years (through May 31, 2014). Optic nerve heads underwent swept-source optical coherence tomography (OCT) to determine the presence of focal lamina cribrosa alteration and its structural characteristics. Eyes with and without photographic ODPs and corresponding microscopic laminar alterations were assigned to the ODP and non-ODP groups, respectively. The rates of progressive thinning of global and 6 sectoral spectral-domain OCT RNFL thicknesses were determined by linear regression and compared between the 2 groups. We used a general linear model to determine the factors associated with the rate of RNFL thinning; data obtained from September 21, 2009, through May 31, 2014, were used to calculate the rate of RNFL thinning.

Main Outcomes and Measures  The relationship between the presence and structural characteristics of ODPs and the rate of progressive OCT RNFL thinning.

Results  Thinning of the RNFL was faster in the ODP group than in the non-ODP group in the global (mean [SD], –1.44 [1.31] vs –0.93 [1.10] [95% CI, –0.97 to –0.19] μm/y; P = .008), temporoinferior (mean [SD], –4.17 [4.15] vs –1.97 [3.26] [95% CI, –3.36 to –1.04] μm/y; P < .001), and temporal (mean [SD], –1.92 [2.62] vs –0.89 [1.62] [95% CI, –1.70 to –0.35] μm/y; P = .003) sectors. The rate of RNFL thinning was maximum in the temporoinferior sector (mean [SD], −4.17 [4.15] μm/y) and corresponded to the frequency distribution of ODPs. Regression analysis revealed that faster global RNFL thinning was related to a higher untreated intraocular pressure (β = −0.07; 95% CI, −0.11 to −0.03; P = .001), episodes of disc hemorrhage (β = −0.74; 95% CI, −1.79 to 0.31; P = .003), the presence of β-zone parapapillary atrophy (β = −0.47; 95% CI, −1.13 to 0.20; P = .02), and the presence of ODPs (β = −0.41; 95% CI, −1.14 to 0.32; P = .02). The maximum rate of RNFL thinning was associated with higher untreated intraocular pressure (β = −0.24; 95% CI, −0.35 to −0.13; P < .001), disc hemorrhage (β = −1.54; 95% CI, −2.88 to −0.19; P < .001), and the presence (β = −1.04; 95% CI, −2.14 to 0.07; P = .004), far-peripheral location (β = −1.75; 95% CI, −3.05 to −0.46; P = .008), and partial-thickness depth (β = −1.45; 95% CI, −2.75 to −0.16; P = .03) of an ODP.

Conclusions and Relevance  The presence and structural characteristics of ODPs were associated with global and focal progression as assessed by the rate of OCT RNFL thinning. The assessment of ODP structure using swept-source OCT may help to predict the location of future progression.

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Figure 1.
Evaluation of the Structure of the Optic Disc Pit (ODP) Using Swept-Source Optical Coherence Tomography

A, Photographic ODP (arrowhead). B, Location where the 12 radial scans were obtained. C, Scan image obtained at location 5 in part B. Full-thickness lamina cribrosa alteration is seen at far-peripheral lamina cribrosa (white arrowhead). D-F, When radial scan images could not reveal the detailed ODP structure, 2 sets of 5-line raster scans were additionally obtained at the location of ODP scan images. Images obtained at locations 9 in part E and 4 in part F (green arrows in part D) show full-thickness lamina cribrosa alteration (white arrowheads).

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Figure 2.
Frequency Distributions of the Sector With an Optic Disc Pit (ODP) and the Sector With the Fastest Retinal Nerve Fiber Layer (RNFL) Thinning

Pale-shaded sectors indicate the area where the microscopic alteration of the lamina cribrosa was investigated in swept-source optical coherence tomography images. Numbers indicate the frequency of eyes. N indicates nasal; NI, nasoinferior; NS, nasosuperior; T, temporal; TI, temporoinferior; and TS, temporosuperior.

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Figure 3.
Representative Cases Showing Rapid Retinal Nerve Fiber Layer (RNFL) Thinning at the Optic Disc Pit (ODP) Location

A and F, Photographic ODPs (arrowheads). B and G, Infrared images indicating the location at which the radial images were obtained (arrows). C and H, Swept-source optical coherence tomography (OCT) radial scan images show microscopic ODPs at the far-peripheral lamina cribrosa in the temporoinferior (TI) sectors (large arrowheads). The lamina cribrosa tissue observed at the base of the lamina cribrosa defect indicates a partial-thickness ODP (small arrowheads in part H). D and I, Thinning of the RNFL is seen in the TI sectors. Numbers represent RNFL thickness in micrometers. G indicates global; N, nasal; NI, nasoinferior; NS, nasosuperior; T, temporal; and TS, temporosuperior. E and J, Graphs demonstrate mean (SD) progressive global RNFL thinning and thinning in the sector with the ODP. P values are calculated from linear regression analysis.

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