0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinical Sciences |

Macular Thickness Changes in Glaucomatous Optic Neuropathy Detected Using Optical Coherence Tomography FREE

David S. Greenfield, MD; Harmohina Bagga, MD; Robert W. Knighton, PhD
[+] Author Affiliations

From the Department of Ophthalmology, University of Miami School of Medicine, Bascom Palmer Eye Institute, Miami, Fla. The authors have no financial interest in any device or technique described in this article.


Arch Ophthalmol. 2003;121(1):41-46. doi:10.1001/archopht.121.1.41.
Text Size: A A A
Published online

Objective  To correlate macular thickness and retinal nerve fiber layer (RNFL) thickness in normal and glaucomatous eyes using optical coherence tomography.

Methods  Complete examination, automated achromatic perimetry, and optical coherence tomography of the peripapillary RNFL and macula were performed. Exclusion criteria were visual acuity of less than 20/40, diseases other than glaucoma, and unreliable automated achromatic perimetry. Macular thickness measurements were generated using 6 radial optical coherence tomographic scans (5.9 mm) centered on the fovea, and mean and quadrantic macular thickness values were calculated.

Results  Fifty-nine eyes of 59 patients (29 normal and 30 glaucomatous) were enrolled (mean ± SD age, 56.7 ± 20.3 years; range, 20-91 years). All eyes with glaucoma had associated visual field loss (mean ± SD mean defect, −8.4 ± 5.8 d B). Mean macular thickness was significantly associated with visual field mean defect (R2 = 0.47; P<.001), pattern standard deviation(R2 = 0.32; P<.001), and mean RNFL thickness (R2 = 0.38; P<.001). In glaucomatous eyes with visual field loss localized to 1 hemifield (n = 11), mean ± SD macular thickness in the quadrant associated with the field defect (277 ± 28 µm) was significantly less (P = .005) than in the unaffected quadrant (286± 27 µm). Mean RNFL thickness in the affected quadrant (89 ± 53 µm) was significantly thinner (P = .009) than in the unaffected quadrant (121 ± 39 µm).

Main Outcome Measures  Mean total and quadrantic macular and RNFL thickness measurements.

Conclusions  Macular thickness changes are well correlated with changes in visual function and RNFL structure in glaucoma and may be a surrogate indicator of retinal ganglion cell loss.

Figures in this Article

IN GLAUCOMA, the essential pathologic process is the loss of retinal ganglion cells and their axons.1 Numerous studies have shown that glaucomatous damage to the retinal nerve fiber layer (RNFL) precedes functional loss by as much as 5 years.27 Loss of the retinal ganglion cells and their axons is also known to occur in the posterior pole, where these cells may constitute 30% to 35% of the retinal thickness in the macular region.8 Studies of chronic experimental glaucoma in monkey eyes have shown a substantial loss of retinal ganglion cells in the zone surrounding the fovea.9,10 Furthermore, a significant association exists between loss of retinal thickness in the posterior pole and visual function.8

The size and anatomical distribution of retinal ganglion cells varies throughout the posterior pole.9,11 Approximately 50% of retinal ganglion cells are located in the macular region 4 to 5 mm from the center of the fovea12 with the peak density occurring 750 to 1100 µm from the foveal center where the cell density may be 4 to 6 cell bodies thick.13 Although cell diameter distribution is variable, a skewed distribution toward larger cell diameters (eg, 14-16 µm) exists in the normal retina, and such cells have been shown to be selectively lost in human and experimental models of glaucoma.1,9,11 Postmortem analysis of enucleated human glaucomatous eyes has demonstrated that a 20% loss of retinal ganglion cells throughout the central 30° of the retina was associated with a 5-d B sensitivity loss with automated perimetry; a 40% loss corresponded to a 10-d B loss in sensitivity.1

Optical coherence tomography (OCT) is a noninvasive, noncontact, transpupillary imaging technology that can image retinal structures in vivo with an axial resolution of 10 to 15 µm.14,15 It provides quantitative, objective, and reproducible assessment of retinal and RNFL thickness.1619 Good correlation has been reported between peripapillary RNFL thickness measured by OCT and visual function16,2023 as well as histological measurements of the nerve fiber layer thickness.24

Zeimer et al8 reported a significant correlation between glaucomatous visual field defects and reductions in macular thickness using a retinal topographer (Retinal Thickness Analyzer; Talia Technology Ltd, Neve Ilan, Israel) based on the principles of slitlamp biomicroscopy. Significant losses in retinal thickness at the posterior pole of up to 34% were reported to occur in patients with early glaucoma (mean corrected pattern standard deviation, approximately 5.5 d B). The purpose of this investigation was to evaluate the correlation between macular thickness and RNFL thickness as measured by OCT in normal eyes and eyes with moderate glaucomatous optic neuropathy.

Normal (control) and glaucomatous eyes meeting the eligibility criteria were enrolled in this prospective study. Informed consent was obtained from all subjects by means of a consent form approved by the Institutional Review Board for Human Research of the University of Miami School of Medicine, Miami, Fla. All patients underwent complete ophthalmic examination, including slitlamp biomicroscopy, gonioscopy, Goldmann applanation tonometry, dilated stereoscopic examination of the optic disc and fundus, and achromatic automated perimetry.

Control subjects had no history of ocular disease. All had intraocular pressure of 21 mmHg or less by Goldmann applanation tonometry, normal optic disc appearance based on clinical stereoscopic examination and review of stereo disc photography, and normal perimetry. Absence of glaucomatous optic neuropathy was defined as vertical cup-disc asymmetry of less than 0.2, a cup-disc ratio of less than 0.6, and an intact neuroretinal rim without peripapillary hemorrhages, notches, localized pallor, or RNFL defect. Normal visual field indices were defined as a mean defect and corrected pattern standard deviation within 95% confidence limits and a glaucoma hemifield test result within normal limits.

Glaucomatous optic neuropathy was defined as either cup-disc asymmetry between fellow eyes of greater than 0.2, rim thinning, notching, excavation, or RNFL defect. Patients with glaucoma had glaucomatous optic nerve damage and associated achromatic visual field loss in the corresponding hemifield location. Patients with achromatic visual field abnormalities had at least 1 confirmatory visual field examination. Eyes with visual acuity of less than 20/40, retinal disease, or unreliable perimetry (greater than 25% fixation losses or false-positive and false-negative rates) were excluded from this investigation.

Optical coherence tomographic imaging (OCT 1; Zeiss-Humphrey Systems, Dublin, Calif) of the macular and peripapillary RNFL was performed in all patients within 6 months of clinical examination; OCT was performed using near-infrared, low-coherence illumination (840 nm) with a tissue resolution of approximately 10 to 17 µm.14,17,18 Image acquisition was performed by one of us (H.B.) and analyzed with version A6.1 software. After pupillary dilation to a minimum diameter of 5 mm, three 360° circular scans with a diameter of 3.4 mm centered on the optic disc were performed. Scan acquisition time was 1.0 second. Each scan consisted of 100 individual A-scan samples evenly distributed along the circle circumference. Mean RNFL thickness was calculated from the values of the 3 scans. Macular thickness measurements were generated using 6 radial scans (each 5.9 mm) centered on the fovea (Figure 1). These scans are processed to produce a topographic map of the macula (Figure 2B). Mean quadrantic measurements were generated from the retinal map consisting of sectoral measurements located 0.5 mm to 1.7 mm outside the center of the fovea.

Place holder to copy figure label and caption
Figure 1.

Optical coherence tomographic imaging was performed using a 3.4-mm-diameter peripapillary measurement circle and 6 radial scans (5.9-mm diameter) centered on the fovea to generate a macular thickness map.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

An optic disc photograph (A) demonstrates a glaucomatous eye with loss of the inferior neural rim associated with a visible wedge-shaped retinal nerve fiber layer (RNFL) defect (arrows) and a corresponding superior arcuate depression. An optical coherence tomography–generated macular map (B) and RNFL image (C) demonstrate thinning of the inferior macular quadrant and peripapillary RNFL (arrows), respectively. The macular topography map consists of 3 concentric areas (1.0-mm, 2.2-mm, and 3.4-mm diameters) from which quadrantic measurements are generated after excluding the central 1.0-mm area that contains few or no retinal ganglion cells.

Graphic Jump Location

Statistical analysis was performed using JMP software (SAS Institute Inc, Cary, NC). Analysis of variance was used to compare different measures among the groups. Statistical associations among macular thickness values, peripapillary RNFL thickness, and visual function were evaluated using the Pearson correlation coefficient. No adjustments were made for multiple comparisons. P≤.05 was considered statistically significant.

Fifty-nine eyes of 59 patients (29 normal and 30 glaucomatous) were enrolled (mean ± SD age, 56.7 ± 20.3 years; age range, 20-91 years). All eyes with glaucoma had associated visual field loss (mean ± SD mean defect, –8.4 ± 5.8 d B). Clinical characteristics of the study population are described in Table 1. As illustrated in Table 2, mean macular thickness and mean peripapillary RNFL thickness in glaucomatous eyes were significantly less than mean macular thickness and mean peripapillary RNFL thickness in control subjects. The relationships among visual field defects and RNFL and macular thickness for one case are illustrated in Figure 2.

Table Graphic Jump LocationTable 1. Clinical Characteristics of the Study Population
Table Graphic Jump LocationTable 2. Optical Coherence Tomography−Generated Thickness Values in 59 Normal and Glaucomatous Eyes

Correlations between macular and RNFL thickness values were evaluated among a subgroup of 11 similar patients with glaucoma and visual field loss localized to a single hemifield (Table 3). As illustrated in Figure 3, mean macular thickness in the hemifield associated with the field defect (277± 28 µm) was significantly less compared with the unaffected hemifield (286 ± 27 µm) (P = .005; paired t test). Mean RNFL thickness was significantly less in the affected hemifield (89 ± 53 µm) compared with the unaffected hemifield (121 ± 39 µm) (P = .009; paired t test). Macular thickness was significantly correlated with RNFL thickness in the posterior segment quadrants associated with the field defect (P<.001; paired t test).

Table Graphic Jump LocationTable 3. Optical Coherence Tomography−Generated Thickness Values in 11 Eyes With Visual Field Defects Confined to a Single Hemifield
Place holder to copy figure label and caption
Figure 3.

Retinal nerve fiber layer (RNFL)(A) and macular (B) thickness values were evaluated among a subgroup of 11 patients with glaucoma with visual field loss localized to a single hemifield. The affected hemifield was defined as the macular or RNFL quadrant associated with a corresponding visual field defect; the unaffected hemifield was defined as the macular or RNFL quadrant without a corresponding visual field defect. Mean ± SD macular thickness in the quadrant associated with the field defect (277 ± 28 µm) was significantly less compared with the unaffected quadrant (286 ± 27 µm) (P =.005; paired t test). Mean ± SD RNFL thickness was significantly less in the affected quadrant (89 ± 53 µm) compared with the unaffected quadrant (121 ± 39 µm) (P = .009; paired t test).

Graphic Jump Location

As illustrated in Figure 4, significant correlations were observed between OCT-generated mean macular thickness and visual field mean defect (R2 =0.47; P<.001) and pattern standard deviation (R2 = 0.32; P<.001). Significant correlations were similarly observed between mean peripapillary RNFL thickness and visual field mean defect (R2 = 0.45; P<.001) and pattern standard deviation(R2 = 0.35; P<.001). Mean macular thickness was significantly associated with mean RNFL thickness(R2 = 0.38; P<.001)(Figure 5).

Place holder to copy figure label and caption
Figure 4.

A scattergram illustrates the correlation between visual field mean defect and macular and peripapillary retinal nerve fiber layer (RNFL) thickness. Note the parallel slope of both regression lines.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

A scattergram illustrates the correlation between mean macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness (R2 = 0.38; P<.001).

Graphic Jump Location

Glaucoma is a complex multifactorial disorder characterized by a typical pattern of optic nerve damage and visual field loss that is usually but not always associated with elevated intraocular pressure. Accepted parameters for monitoring glaucoma include descriptions and photography of the optic disc appearance (eg, cup-disc ratio), measurement of intraocular pressure, and periodic threshold perimetry. Advances in posterior segment imaging technology14,15,2528 provide a means for generating structural data useful in monitoring eyes with glaucomatous optic nerve damage. Objective, quantitative measurements of the optic nerve and surrounding RNFL generated with these technologies correlate with known characteristics of optic disc structure and visual function.

The results of this report suggest that macular thickness measurements generated with OCT represent a neglected structural end point for glaucoma. Although glaucoma is an optic nerve disorder, the fundamental defining abnormality is localized at the level of the retinal ganglion cell. Glaucoma is known to cause loss of ganglion cells and their axons, leading to a reduction in the thickness of the RNFL.1,4,29,30 Macular thickness measurements represent a surrogate indicator of retinal ganglion cell thickness and could prove to have clinical value for glaucoma diagnosis and detection of change. Our results support this hypothesis and illustrate a significant correlation between macular thickness and 2 established indicators of glaucomatous damage: RNFL loss and loss of visual field.

We found significant differences in mean macular thickness between control subjects and patients with moderately advanced glaucoma using direct measurements of retinal thickness generated with OCT. As illustrated in Figure 4, both macular and RNFL thickness assessments were strongly correlated with visual field global indices. The parallel slopes of the regression lines suggest that both parameters should be equally robust discriminators for disease detection. Furthermore, macular thickness and RNFL thickness assessments were significantly associated with each other, suggesting concordance between loss of retinal ganglion cells and their axons. These observations were emphasized in patients with visual field loss confined to a single hemifield who illustrated regional reductions in macular thickness that corresponded topographically to regional reductions in RNFL. Longitudinal studies are necessary to determine whether macular thickness reductions precede RNFL loss or vice versa. For macular thickness measurements to be clinically useful, collection of age-corrected normative data with 95% confidence limits is necessary. Furthermore, to detect glaucomatous progression, statistical criteria are necessary to differentiate test-retest variability from true biological change.

Eyes with visual field loss confined to a single hemifield had a mean difference between the affected and unaffected macular quadrant thickness of only 9 µm, suggesting that regional macular thickness data may have limitations. A 3.4-mm diameter macular map corresponds to a visual angle of 6° from fixation.31 Eyes with early visual field defects located far from fixation may have had undetectable ganglion cell loss using a macular map of this diameter. Furthermore, the topographic location of retinal ganglion cell death may have been temporal to the macular quadrant suspected to be associated with the field defect. As illustrated in Figure 2, the inferior macular quadrant was suspected to be associated with the superior field defect; however, perhaps the most significant reduction in macular thickness occurred in the inferior temporal fovea. Finally, although the foveola (diameter approximately 300 to 400 µm)32 is devoid of ganglion cells, relevant data may have been inadvertently eliminated by neglecting the central 1.0-mm diameter of the macular map thought to consist largely of photoreceptor cells. Nevertheless, a statistically significant reduction in thickness was identified in the macular quadrant predicted to be associated with the field defect. Advances in axial resolution of this technology, and software designed to extract data from more pertinent topographic areas, would be expected to improve detection of retinal ganglion cell loss in glaucoma.

Based on the principle of low-coherence interferometry, OCT provides high-resolution, cross-sectional imaging of the retina and the RNFL.1418 A high level of correlation between OCT-generated RNFL thickness and visual function has been reported by several authors.16,21,22,33 As presently configured, OCT employs 100 A-scans with an axial resolution of 10 to 20 µm, which limits the ability to visualize and measure the retinal ganglion cell layer. A modification of this technology that was recently approved by the Food and Drug Administration employs 512 A-scans and has an axial resolution of approximately 8 µm with no need for pupillary dilation. This modification may provide a potential means to directly visualize and measure the retinal ganglion cell layer. Emerging therapeutic strategies such as neuroprotection emphasize the need to identify and measure such cells for glaucoma diagnosis and monitoring.

There is considerable evidence to support the relationship between RNFL loss and reductions in visual function using various posterior segment imaging technologies.20,22,23,28,34,35 The discriminating power of these instruments is limited by the wide distribution of normative RNFL data among the general population as well as technological assumptions.36,37 It remains unclear whether macular thickness loss may be a more robust indicator of early glaucomatous damage. Furthermore, as with RNFL thickness assessments, longitudinal studies are necessary to validate their ability to detect glaucomatous progression. It is important to emphasize that macular thickness measurements have limited use for monitoring glaucoma in eyes with macular comorbidity. Thus, eyes with diabetic or age-related maculopathy are not candidates for monitoring macular thickness changes as a strategy for glaucoma diagnosis or detection of glaucomatous progression.

In conclusion, macular thickness changes are well correlated with changes in visual function and RNFL structure in glaucoma and may represent a surrogate indicator of retinal ganglion cell loss. Macular thickness measurements with OCT may provide a new approach for the detection and monitoring of glaucomatous damage.

Corresponding author and reprints: David S. Greenfield, MD, Bascom Palmer Eye Institute, 7108 Fairway Dr, Suite 340, Palm Beach Gardens, FL 33418(e-mail: dgreenfield@med.miami.edu).

Submitted for publication March 4, 2002; final revision received June 25, 2002; accepted August 29, 2002.

This study was supported in part by the New York Community Trust, New York; the Kessel Foundation, Bergenfield, NJ; a grant from Barney Donnelley, Palm Beach, Fla; and grant R01-EY08684 from the National Institutes of Health, Bethesda, Md.

Quigley  HADunkelberger  GRGreen  WR Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol. 1989;107453- 464
Hoyt  WFFrisén  LNewman  NM Funduscopy of nerve fiber layer defects in glaucoma. Invest Ophthalmol. 1973;12814- 829
Quigley  HAMiller  NRGeorge  T Clinical evaluation of nerve fiber layer atrophy as an indicator of glaucomatous optic nerve damage. Arch Ophthalmol. 1980;981564- 1571
Link to Article
Sommer  AKatz  JQuigley  HA  et al.  Clinically detectable nerve fiber layer atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991;10977- 83
Link to Article
Quigley  HAKatz  JDerick  RJGilbert  DSommer  A An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage. Ophthalmology. 1992;9919- 28
Link to Article
Airaksinen  PJDrance  SMDouglas  GR  et al.  Diffuse and localized nerve fiber loss in glaucoma. Am J Ophthalmol. 1984;98566- 571
Harwerth  RSCarter-Dawson  LShen  F  et al.  Ganglion cell losses underlying visual field defects from experimental glaucoma. Invest Ophthalmol Vis Sci. 1999;402242- 2250
Zeimer  RAsrani  SZou  SQuigley  HAJampel  H Quantitative detection of glaucomatous damage at the posterior pole by retinal thickness mapping. Ophthalmology. 1998;105224- 231
Link to Article
Glovinsky  YQuigley  HAPease  ME Foveal ganglion cell loss in size dependent in experimental glaucoma. Invest Ophthalmol Vis Sci. 1993;34395- 400
Frishman  LJShen  FFDu  L  et al.  The scotopic electroretinogram of macaque after retinal ganglion cell loss from experimental glaucoma. Invest Ophthalmol Vis Sci. 1996;37125- 141
Glovinsky  YQuigley  HADunkelberger  GR Retinal ganglion cell loss is size dependent in experimental glaucoma. Invest Ophthalmol Vis Sci. 1991;32484- 491
Curcio  CAAllen  KA Topography of ganglion cells in human retina. J Comp Neurol. 1990;3005- 25
Link to Article
Wässle  HGrunert  URoherbbeck  JBoycott  BB Cortical magnification factor and the ganglion cell density of the primate retina. Nature. 1989;341643- 646
Link to Article
Huang  DSwanson  EALin  CP  et al.  Optical coherence tomography. Science. 1991;2541178- 1181
Link to Article
Izatt  JAHee  MRSwanson  EA  et al.  Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography. Arch Ophthalmol. 1994;1121584- 1589
Link to Article
Schuman  JSHee  MRPuliafito  CA  et al.  Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol. 1995;113586- 596
Link to Article
Hee  MRIzatt  JASwanson  EA  et al.  Optical coherence tomography of the human retina. Arch Ophthalmol. 1995;113325- 332
Link to Article
Schuman  JSPedut-Kloizman  THertzmark  E  et al.  Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology. 1996;1031889- 1898
Link to Article
Baumann  MGentile  RCLiebmann  JMRitch  R Reproducibility of retinal thickness measurements in normal eyes using optical coherence tomography. Ophthalmic Surg Lasers. 1998;29280- 285
Bowd  CAZangwill  LMBerry  CC  et al.  Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci. 2001;421993- 2003
Zangwill  LMWilliams  JBerry  CCKnauer  SWeinreb  RN A comparison of optical coherence tomography and retinal nerve fiber layer photography for detection of nerve fiber layer damage in glaucoma. Ophthalmology. 2000;1071309- 1315
Link to Article
Hoh  STGreenfield  DSMistlberger  ALiebmann  JMIshikawa  HRitch  R Optical coherence tomography and scanning laser polarimetry in normal, ocular hypertensive, and glaucomatous eyes. Am J Ophthalmol. 2000;129129- 135
Link to Article
Mistlberger  ALiebmann  JMGreenfield  DS  et al.  Heidelberg retina tomography and optical coherence tomography in normal, ocular hypertensive, and glaucomatous eyes. Ophthalmology. 1999;1062027- 2032
Link to Article
Huang  YCideciyan  AVPapastergiou  GI  et al.  Relation of optical coherence tomography to microanatomy in normal and rd chickens. Invest Ophthalmol Vis Sci. 1998;392405- 2416
Weinreb  RNDreher  AWBille  JF Quantitative assessment of the optic nerve head with the laser tomographic scanner. Int Ophthalmol. 1989;1325- 29
Link to Article
Zangwill  LSchakiba  SCaprioli  JWeinreb  RN Agreement between clinicians and a confocal scanning laser ophthalmoscope in estimating cup-to-disc ratios. Am J Ophthalmol. 1995;119415- 421
Dreher  AWReiter  KWeinreb  RN Spatially resolved birefringence of the retinal nerve fiber layer assessed with a retinal ellipsometer. Appl Opt. 1992;313730- 3735
Link to Article
Weinreb  RNShakiba  SZangwill  L Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes. Am J Ophthalmol. 1995;119627- 636
Sommer  AMiller  NRPollack  IMaumenee  AEGeorge  T The nerve fiber layer in the diagnosis of glaucoma. Arch Ophthalmol. 1977;952149- 2156
Link to Article
Quigley  HA Better methods in glaucoma diagnosis. Arch Ophthalmol. 1985;103186- 189
Link to Article
Wyszecki  GStiles  WS The eye. In:Color Science: Concepts and Methods, Quantitative Data and Formulae 2nd New York, NY John Wiley & Sons1982;98- 101
Sjostrand  JPopovic  ZConradi  NMarshall  J Morphometric study of the displacement of retinal ganglion cells subserving cones within the human fovea. Graefes Arch Clin Exp Ophthalmol. 1999;2371014- 1023
Link to Article
Teesalu  PTuulonen  AAiraksinen  PJ Optical coherence tomography and localized defects of the retinal nerve fiber layer. Acta Ophthalmol Scand. 2000;7849- 52
Link to Article
Weinreb  RNShakiba  SSample  PA  et al.  Association between quantitative nerve fiber layer measurement and visual field loss in glaucoma. Am J Ophthalmol. 1995;120732- 738
Zangwill  LMBowd  CBerry  CC  et al.  Discriminating between normal and glaucomatous eyes using the Heidelberg Retina Tomograph, GDx Nerve Fiber Analyzer, and Optical Coherence Tomograph. Arch Ophthalmol. 2001;119985- 993
Link to Article
Greenfield  DSKnighton  RW Stability of corneal polarization axis measurements for scanning laser polarimetry. Ophthalmology. 2001;1081065- 1069
Link to Article
Greenfield  DSHuang  X-RKnighton  RW Effect of corneal polarization axis on assessment of retinal nerve fiber layer thickness by scanning laser polarimetry. Am J Ophthalmol. 2000;129715- 722
Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Optical coherence tomographic imaging was performed using a 3.4-mm-diameter peripapillary measurement circle and 6 radial scans (5.9-mm diameter) centered on the fovea to generate a macular thickness map.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

An optic disc photograph (A) demonstrates a glaucomatous eye with loss of the inferior neural rim associated with a visible wedge-shaped retinal nerve fiber layer (RNFL) defect (arrows) and a corresponding superior arcuate depression. An optical coherence tomography–generated macular map (B) and RNFL image (C) demonstrate thinning of the inferior macular quadrant and peripapillary RNFL (arrows), respectively. The macular topography map consists of 3 concentric areas (1.0-mm, 2.2-mm, and 3.4-mm diameters) from which quadrantic measurements are generated after excluding the central 1.0-mm area that contains few or no retinal ganglion cells.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Retinal nerve fiber layer (RNFL)(A) and macular (B) thickness values were evaluated among a subgroup of 11 patients with glaucoma with visual field loss localized to a single hemifield. The affected hemifield was defined as the macular or RNFL quadrant associated with a corresponding visual field defect; the unaffected hemifield was defined as the macular or RNFL quadrant without a corresponding visual field defect. Mean ± SD macular thickness in the quadrant associated with the field defect (277 ± 28 µm) was significantly less compared with the unaffected quadrant (286 ± 27 µm) (P =.005; paired t test). Mean ± SD RNFL thickness was significantly less in the affected quadrant (89 ± 53 µm) compared with the unaffected quadrant (121 ± 39 µm) (P = .009; paired t test).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

A scattergram illustrates the correlation between visual field mean defect and macular and peripapillary retinal nerve fiber layer (RNFL) thickness. Note the parallel slope of both regression lines.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

A scattergram illustrates the correlation between mean macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness (R2 = 0.38; P<.001).

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Clinical Characteristics of the Study Population
Table Graphic Jump LocationTable 2. Optical Coherence Tomography−Generated Thickness Values in 59 Normal and Glaucomatous Eyes
Table Graphic Jump LocationTable 3. Optical Coherence Tomography−Generated Thickness Values in 11 Eyes With Visual Field Defects Confined to a Single Hemifield

References

Quigley  HADunkelberger  GRGreen  WR Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol. 1989;107453- 464
Hoyt  WFFrisén  LNewman  NM Funduscopy of nerve fiber layer defects in glaucoma. Invest Ophthalmol. 1973;12814- 829
Quigley  HAMiller  NRGeorge  T Clinical evaluation of nerve fiber layer atrophy as an indicator of glaucomatous optic nerve damage. Arch Ophthalmol. 1980;981564- 1571
Link to Article
Sommer  AKatz  JQuigley  HA  et al.  Clinically detectable nerve fiber layer atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991;10977- 83
Link to Article
Quigley  HAKatz  JDerick  RJGilbert  DSommer  A An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage. Ophthalmology. 1992;9919- 28
Link to Article
Airaksinen  PJDrance  SMDouglas  GR  et al.  Diffuse and localized nerve fiber loss in glaucoma. Am J Ophthalmol. 1984;98566- 571
Harwerth  RSCarter-Dawson  LShen  F  et al.  Ganglion cell losses underlying visual field defects from experimental glaucoma. Invest Ophthalmol Vis Sci. 1999;402242- 2250
Zeimer  RAsrani  SZou  SQuigley  HAJampel  H Quantitative detection of glaucomatous damage at the posterior pole by retinal thickness mapping. Ophthalmology. 1998;105224- 231
Link to Article
Glovinsky  YQuigley  HAPease  ME Foveal ganglion cell loss in size dependent in experimental glaucoma. Invest Ophthalmol Vis Sci. 1993;34395- 400
Frishman  LJShen  FFDu  L  et al.  The scotopic electroretinogram of macaque after retinal ganglion cell loss from experimental glaucoma. Invest Ophthalmol Vis Sci. 1996;37125- 141
Glovinsky  YQuigley  HADunkelberger  GR Retinal ganglion cell loss is size dependent in experimental glaucoma. Invest Ophthalmol Vis Sci. 1991;32484- 491
Curcio  CAAllen  KA Topography of ganglion cells in human retina. J Comp Neurol. 1990;3005- 25
Link to Article
Wässle  HGrunert  URoherbbeck  JBoycott  BB Cortical magnification factor and the ganglion cell density of the primate retina. Nature. 1989;341643- 646
Link to Article
Huang  DSwanson  EALin  CP  et al.  Optical coherence tomography. Science. 1991;2541178- 1181
Link to Article
Izatt  JAHee  MRSwanson  EA  et al.  Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography. Arch Ophthalmol. 1994;1121584- 1589
Link to Article
Schuman  JSHee  MRPuliafito  CA  et al.  Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol. 1995;113586- 596
Link to Article
Hee  MRIzatt  JASwanson  EA  et al.  Optical coherence tomography of the human retina. Arch Ophthalmol. 1995;113325- 332
Link to Article
Schuman  JSPedut-Kloizman  THertzmark  E  et al.  Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology. 1996;1031889- 1898
Link to Article
Baumann  MGentile  RCLiebmann  JMRitch  R Reproducibility of retinal thickness measurements in normal eyes using optical coherence tomography. Ophthalmic Surg Lasers. 1998;29280- 285
Bowd  CAZangwill  LMBerry  CC  et al.  Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci. 2001;421993- 2003
Zangwill  LMWilliams  JBerry  CCKnauer  SWeinreb  RN A comparison of optical coherence tomography and retinal nerve fiber layer photography for detection of nerve fiber layer damage in glaucoma. Ophthalmology. 2000;1071309- 1315
Link to Article
Hoh  STGreenfield  DSMistlberger  ALiebmann  JMIshikawa  HRitch  R Optical coherence tomography and scanning laser polarimetry in normal, ocular hypertensive, and glaucomatous eyes. Am J Ophthalmol. 2000;129129- 135
Link to Article
Mistlberger  ALiebmann  JMGreenfield  DS  et al.  Heidelberg retina tomography and optical coherence tomography in normal, ocular hypertensive, and glaucomatous eyes. Ophthalmology. 1999;1062027- 2032
Link to Article
Huang  YCideciyan  AVPapastergiou  GI  et al.  Relation of optical coherence tomography to microanatomy in normal and rd chickens. Invest Ophthalmol Vis Sci. 1998;392405- 2416
Weinreb  RNDreher  AWBille  JF Quantitative assessment of the optic nerve head with the laser tomographic scanner. Int Ophthalmol. 1989;1325- 29
Link to Article
Zangwill  LSchakiba  SCaprioli  JWeinreb  RN Agreement between clinicians and a confocal scanning laser ophthalmoscope in estimating cup-to-disc ratios. Am J Ophthalmol. 1995;119415- 421
Dreher  AWReiter  KWeinreb  RN Spatially resolved birefringence of the retinal nerve fiber layer assessed with a retinal ellipsometer. Appl Opt. 1992;313730- 3735
Link to Article
Weinreb  RNShakiba  SZangwill  L Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes. Am J Ophthalmol. 1995;119627- 636
Sommer  AMiller  NRPollack  IMaumenee  AEGeorge  T The nerve fiber layer in the diagnosis of glaucoma. Arch Ophthalmol. 1977;952149- 2156
Link to Article
Quigley  HA Better methods in glaucoma diagnosis. Arch Ophthalmol. 1985;103186- 189
Link to Article
Wyszecki  GStiles  WS The eye. In:Color Science: Concepts and Methods, Quantitative Data and Formulae 2nd New York, NY John Wiley & Sons1982;98- 101
Sjostrand  JPopovic  ZConradi  NMarshall  J Morphometric study of the displacement of retinal ganglion cells subserving cones within the human fovea. Graefes Arch Clin Exp Ophthalmol. 1999;2371014- 1023
Link to Article
Teesalu  PTuulonen  AAiraksinen  PJ Optical coherence tomography and localized defects of the retinal nerve fiber layer. Acta Ophthalmol Scand. 2000;7849- 52
Link to Article
Weinreb  RNShakiba  SSample  PA  et al.  Association between quantitative nerve fiber layer measurement and visual field loss in glaucoma. Am J Ophthalmol. 1995;120732- 738
Zangwill  LMBowd  CBerry  CC  et al.  Discriminating between normal and glaucomatous eyes using the Heidelberg Retina Tomograph, GDx Nerve Fiber Analyzer, and Optical Coherence Tomograph. Arch Ophthalmol. 2001;119985- 993
Link to Article
Greenfield  DSKnighton  RW Stability of corneal polarization axis measurements for scanning laser polarimetry. Ophthalmology. 2001;1081065- 1069
Link to Article
Greenfield  DSHuang  X-RKnighton  RW Effect of corneal polarization axis on assessment of retinal nerve fiber layer thickness by scanning laser polarimetry. Am J Ophthalmol. 2000;129715- 722
Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 90

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles