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Clinical Sciences |

Peripapillary Retinal Nerve Fiber Layer Thickness Determined by Spectral-Domain Optical Coherence Tomography in Ophthalmologically Normal Eyes FREE

Hiroyo Hirasawa, MD; Atsuo Tomidokoro, MD; Makoto Araie, MD; Shinsuke Konno, MD; Hitomi Saito, MD; Aiko Iwase, MD; Motohiro Shirakashi, MD; Haruki Abe, MD; Shinji Ohkubo, MD; Kazuhisa Sugiyama, MD; Tomohiro Ootani, MD; Shoji Kishi, MD; Kenji Matsushita, MD; Naoyuki Maeda, MD; Masanori Hangai, MD; Nagahisa Yoshimura, MD
[+] Author Affiliations

Author Affiliations: Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo (Drs Hirasawa, Tomidokoro, Araie, and Konno), Department of Ophthalmology, Tajimi Municipal Hospital, Tajimi (Drs Saito and Iwase), Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata (Drs Shirakashi and Abe), Department of Ophthalmology & Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa (Drs Ohkubo and Sugiyama), Department of Ophthalmology, Gunma University School of Medicine, Maebashi (Drs Ootani and Kishi), Department of Ophthalmology, Osaka University Medical School, Osaka (Drs Matsushita and Maeda), and Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto (Drs Hangai and Yoshimura), Japan.


Arch Ophthalmol. 2010;128(11):1420-1426. doi:10.1001/archophthalmol.2010.244.
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Objectives  To evaluate the peripapillary distribution of retinal nerve fiber layer thickness (RNFLT) in normal eyes using spectral-domain optical coherence tomography and to study potentially related factors.

Methods  In 7 institutes in Japan, RNFLT in 7 concentric peripapillary circles with diameters ranging from 2.2 to 4.0 mm were measured using spectral-domain optical coherence tomography in 251 ophthalmologically normal subjects. Multiple regression analysis for the association of RNFLT with sex, age, axial length, and disc area was performed.

Results  Retinal nerve fiber layer thickness decreased linearly from 125 to 89 μm as the measurement diameter increased (P < .001, mixed linear model). Retinal nerve fiber layer thickness correlated with age in all diameters (partial correlation coefficient [PCC] = −0.40 to −0.32; P < .001) and negatively correlated with disc area in the 2 innermost circles but positively correlated in the 3 outermost circles (PCC = −0.30 to −0.22 and 0.17 to 0.20; P ≤ .005). Sex and axial length did not correlate with RNFLT (P > .08). The decay slope was smallest in the temporal and largest in the nasal and inferior quadrants (P < .001); positively correlated with disc area (PCC = 0.13 to 0.51; P ≤ .04); and negatively correlated with RNFLT (PCC = −0.51 to −0.15; P ≤ .01).

Conclusions  In normal Japanese eyes, RNFLT significantly correlated with age and disc area, but not with sex or axial length. Retinal nerve fiber layer thickness decreased linearly as the measurement diameter increased. The decay slope of RNFLT was steepest in the nasal and inferior quadrants and steeper in eyes with increased RNFLT or smaller optic discs.

Since morphologic changes in the optic disc and the retinal nerve fiber layer (RNFL) often precede observable visual field loss in glaucoma,1,2 early diagnosis of glaucoma requires an intimate knowledge of the configuration of the optic disc and the distribution of the RNFL thickness (RNFLT) in normal subjects. Though many previous studies have analyzed RNFLT in normal subjects using various imaging techniques, the average values of the 360° peripapillary RNFLT were markedly varied, such as approximately 0.3 mm by confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph [HRT]; Heidelberg Engineering, Heidelberg, Germany),3,4 47 to 95 μm by scanning laser polarimetry (GDx Nerve Fiber Analyzer; Laser Diagnostic Technologies, Inc, San Diego, California),317 and 86 to 128 μm by time-domain optical coherence tomography (TD-OCT).35,10,1216,1843 In these reports, RNFLT was measured at the optic disc edge in HRT, at a diameter of 3.2 mm or a diameter of 1.5 or 1.75 times that of the optic disc in GDx, and at a diameter of 3.40 or 3.46 mm in TD-OCT. Thus, knowledge of the distribution of RNFLT in different diameters around the optic disc should play an important role. However, to our knowledge, the distribution of RNFLT in accordance with the distance and direction from the optic disc has never been investigated in a large normal population.

Spectral-domain optical coherence tomography (SD-OCT) is a newly developed technique.4446 Compared with TD-OCT, SD-OCT provides approximately twice the axial resolution and 43 to 100 times the scanning speed and can reveal the 3-dimensional configuration of the retina. To our knowledge, there are no reports of studies of the peripapillary RNFL distribution by SD-OCT in a large group of normal subjects. Further, because a recent study using TD-OCT reported that RNFLT varied significantly among different races or ethnic groups,34 normal RNFLT values should be determined for each ethnic group. The purpose of the present study was to determine the distribution of peripapillary RNFLT in normal Japanese subjects using SD-OCT, as well as the relationship between RNFLT and several demographic factors, such as age, sex, axial length, and disc area.

The data were acquired in 7 institutes in Japan: the University of Tokyo (Tokyo), Kyoto University (Kyoto), Osaka University (Osaka), Niigata University (Niigata), Kanazawa University (Kanazawa), Gunma University (Gunma), and Tajimi Municipal Hospital (Gifu). The study protocol was approved by the institutional review board of each institution and adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from each subject after explanation of the study protocol.

Self-reported ophthalmologically healthy subjects at least 20 years of age participated in the study. Ocular examination at the first visit comprised autorefractor keratometry without cycloplegic agents, best-corrected visual acuity measurements, axial length measurement using the IOLMaster (Carl Zeiss Meditec, Dublin, California), slitlamp examination, intraocular pressure measurement using a Goldmann applanation tonometer, dilated funduscopy, and visual field testing using the Humphrey 24-2 Swedish interactive testing algorithm standard strategy (Humphrey Field Analyzer; Carl Zeiss Meditec). Exclusion criteria included contraindication to dilation; intraocular pressure of 22 mm Hg or higher; unreliable Humphrey Field Analyzer results (fixation loss or false-positive or false-negative results >33%); abnormal findings in Humphrey Field Analyzer results suggesting glaucoma according to the Anderson and Patella criteria47; history of intraocular surgery; best-corrected visual acuity worse than 20/25; evidence of vitreoretinal diseases; and optic nerve or RNFL abnormality. Eyes with apparent tilted discs that were thought to be congenital deformation48 were cautiously excluded, while eyes with slightly tilted discs commonly found in low to moderate myopia were included. After eligibility for study entry was confirmed, all subjects underwent imaging with the 3-dimensional OCT-1000 version 2.13 (Topcon Inc, Tokyo, Japan) after mydriasis. This system uses a superluminescent diode with a center wavelength of 840 nm and a bandwidth of 50 nm as the light source and acquires 27 000 axial scans per second. The OCT data sets were obtained using the concentric scan protocol in which 7 concentric circles with diameters of 2.2, 2.5, 2.8, 3.1, 3.4, 3.7, and 4.0 mm are centered on the gravity center of the optic disc. Using the concentric scan protocol, the image acquisition time was approximately 0.26 second. Each measurement circle included 1024 axial scans. The scan points are closer to each other in the inner circles than in the outer circles, resulting in a higher spatial resolution in the inner circles. For analysis, mean 360° RNFLT was defined as the average of all 1024 points, and the mean quadrant RNFLT was defined as the average of the 256 points of the quadrant. To obtain more accurate circle sizes, the magnification effect in each eye was corrected according to the formula provided by the manufacturer (modified Littman method), based on the refractive error, corneal radius, and axial length, which is basically the same as the original Littman method,49 except for small differences in the coefficients of each parameter. To determine the optic disc edge (the inner edge of the scleral rim), 7 points were manually plotted on the optic disc edge of a color fundus photograph obtained by the fundus camera function of the OCT equipment by experienced examiners in each examination site. All of the contour lines of the optic disc were further confirmed by an investigator (A.T.). The center of the optic disc was determined as the barycenter of the closed spline curve fitted to the 7 points, and disc area was determined as the area of the closed curve. During measurements using the concentric scan protocol, the fundus image was continuously monitored to automatically place the concentric circles centered on the thus-determined center of the optic nerve. When eye movement during the measurement was found, the scan was excluded and the measurement was repeated. Criteria for acceptable SD-OCT fundus images were defined as no apparent eye movements during the measurements with a quality factor of more than 60%. The segmentation of the RNFL was performed automatically and an experienced investigator (A.T.) confirmed the segmentations in all scans.

To evaluate the short-term reproducibility of the SD-OCT, measurements were serially repeated 3 times with intervals of less than 1 minute. In some of the subjects, though the numbers were limited because of the time limitation or circumstances of participants, the same protocol was repeated once more by another examiner to test the interoperator reproducibility. Some of the subjects were invited to undergo another set of SD-OCT measurements using the same protocol 1 to 3 months later to test the intervisit reproducibility.

Statistical analysis was performed using SPSS 15.0J (SPSS Institute Inc, Chicago, Illinois). Analysis of variance and the Tukey test were used for the comparison of mean values. Pearson correlation analysis and multiple regression analysis were used to evaluate correlations. Reproducibility was assessed with coefficient of variation. A P value less than .05 was considered statistically significant.

Two hundred fifty-nine subjects were enrolled in the current study, but reliable and acceptable OCT images were not obtained in 9 eyes of 8 subjects. As a consequence, 251 subjects (126 men, 125 women) were included in the analysis (Table 1). The randomly chosen eye of each subject was included in the analyses. Short-term, interoperator, and intervisit reproducibilities were evaluated in 191, 26, and 41 subjects, respectively, and the results are summarized in Table 2. Some of the subjects were overlapped for the 2 or 3 analyses. All coefficients of variation, except those of the innermost circle, were between 1% and 3%, indicating good reproducibility.

Table Graphic Jump LocationTable 1. Demographic Data of Included Subjects Stratified by Age
Table Graphic Jump LocationTable 2. Coefficients of Variation for Short-term, Interoperator, and Intervisit Reproducibility of Mean 360° Retinal Nerve Fiber Layer Thickness in 7 Measurement Circles

Mean 360° RNFLT decreased as the diameter of the measurement circles increased (P < .001) (Table 3). The decay slope was significantly smaller in the temporal quadrant than in the other quadrants (P < .001, analysis of variance and Tukey test), and the slope in the superior quadrant was smaller than those in the inferior and nasal quadrants (P < .001). Age, sex, and axial length did not correlate with the slope (P > .20), whereas disc area significantly correlated with the slope (Table 4), indicating that eyes with a larger optic disc were associated with milder RNFLT decay slopes. Mean total RNFLT also negatively correlated with the slope, indicating that the eyes with greater RNFLT had steeper RNFLT decay slopes.

Table Graphic Jump LocationTable 3. Mean Values of Retinal Nerve Fiber Layer Thickness in the 360° Circle and the 4 Quadrants
Table Graphic Jump LocationTable 4. Results of Multiple Regression Analysis for the Association of the Decay Slope of the RNFLT With Age, Sex, Axial Length, Disc Area, and Total Retinal Nerve Fiber Layer Thicknessa

Mean 360° RNFLT was not different between men and women in any measurement circle after adjusting for age, axial length, and disc area (P > .47). Age was correlated with mean 360° RNFLT in all measurement circles in a simple correlation analysis and multiple regression analysis (P < .001) (Table 5). The rates of RNFL thinning with age were −0.30, −0.27, −0.27, −0.22, −0.19, −0.19, and −0.18 μm/y in the 2.2-, 2.5-, 2.8-, 3.1-, 3.4-, 3.7-, and 4.0-mm measurement circles, suggesting that RNFL thinning was greater in the inner circles. Axial length positively correlated with mean RNFLT in all measurement circles in a simple correlation analysis (P ≤ .01) but not in the multiple regression analysis (P > .08). Optic disc area negatively correlated with mean RNFLT in the 2 innermost circles and positively correlated with mean RNFLT in the outer circles in a simple correlation analysis and multiple regression analysis (P ≤ .04).

Table Graphic Jump LocationTable 5. Results of Simple Correlation Analysis (Pearson Correlation) and Multiple Regression Analysis for the Association of Retinal Nerve Fiber Layer Thickness With Age, Axial Length, and Disc Area

Retinal nerve fiber layer thickness measured by the first-generation OCT (OCT1; Zeiss-Humphrey System, Dublin, California and OCT-2000; Humphrey Instruments, San Leandro, California) in normal subjects averaged between 86 and 153 μm.5,12,1831,35 Only 1 study used the second-generation OCT (OCT II; Carl Zeiss Medeitec) and reported a mean value of 105 μm.32 That measured using the third-generation OCT (Stratus OCT; Carl Zeiss Meditec) ranged from 94 to 123 μm.3,4,1316,18,33,34,3644 If only studies including more than 100 normal subjects are considered, mean RNFLT ranges between 97 and 123 μm.4,34,41,43 In the present study, using SD-OCT, the mean 360° RNFLT in the 3.4-mm diameter circle was 102 μm in 251 normal subjects. Normal subjects in the present study were Japanese and our results are most similar to the average value (100 μm) obtained using Stratus OCT in 162 Japanese subjects.43

Moreover, in the present study, the distributions of RNFLT around the optic disc were documented at diameters between 2.2 and 4.0 mm. Our results indicated a gradual thinning of the RNFL as the distance from the disc center increased in both the 360° circle and in each of the 4 quadrants (Table 3). Varma et al50 reported similar RNFL thinning of the human retina based on histologic analysis, but variations in the decay slope among the different peripapillary directions were not investigated. Gabriele et al44 investigated 12 normal eyes using ultra-high resolution SD-OCT and reported that the RNFLT decay slope was significantly smaller in the temporal quadrant than in the other 3 quadrants. In the present study, the RNFLT decay slope in the temporal quadrant was also smaller than that in the other 3 quadrants; furthermore, the RNFLT decay slope in the superior quadrant was smaller than that in the nasal and inferior quadrants. There was no correlation between the slope of RNFLT and age, though correlation between RNFLT and age was stronger in the inner circles. The range of partial correlation coefficients among the circles was not thought large enough to make the correlation between the slope of RNFLT and age significant. Moreover, the current study first documented that the decay slope positively correlated with disc area and negatively correlated with RNFLT, although the causal factors are not clear.

Most studies2,6,11,19,25,26,31,33,34,41,5161 reported a negative correlation between RNFLT and age, indicating that older subjects have thinner RNFL, although some studies7,36,50,6264 failed to show a significant correlation, probably because of the limited numbers of subjects50,62,64 or the limited range of the subjects' ages.36 Histologic studies2,5254,57 revealed significant declines with age in the number of nerve fibers in the optic nerve, with a decay rate of 4000 to 7205 fibers/y. The decay rates in previous TD-OCT studies ranged from 0.16 to 0.44 μm/y.21,25,34,41 In the present study, significant thinning of the RNFL was associated with an increase in age in the 360° average and all 4 quadrants of all 7 measurement diameters. The rate of the decline in the 3.4-mm diameter circle was 0.19 μm/y, which is consistent with previous reports using Stratus OCT.34,41 Moreover, in the present study, the correlation between age and RNFLT remained significant after adjusting for sex, axial length, and disc area, indicating that the correlation between age and RNFLT might be attributable not only to the cohort effect in the current population but also to the aging process.

Because axial length and refractive error were closely correlated and a cycloplegic agent was not used, only axial length was adopted in the current analyses. Regarding the correlation between RNFLT and axial length (or refractive error), controversial results have been reported. Using Stratus OCT, several studies showed significant correlation,34,36,43 while other studies using GDx, OCT-2000, and/or OCT1 failed to find significant correlation.30,63 In the present study, a significant correlation between RNFLT and axial length was not found after adjusting for age, sex, and disc area. Because axial length differs among different age groups65,66 and RNFLT is significantly influenced by age, correlations between axial length and RNFLT should be adjusted for age. In some of the previous studies using Stratus OCT,34,43 the correlation between axial length and RNFLT was still significant after the adjustment for age and other factors. Stratus OCT is not equipped with a magnification correction procedure. In RNFLT measurements without the magnification correction, circle size can be affected by axial length owing to the magnification effect, and circle size is correlated with the RNFLT owing to the slope of the thickness. As a consequence, even if there is no true correlation between axial length and RNFLT, false statistically significant correlation between them could be observed. Though the magnification effect may not be completely corrected, the correction should give better understanding on the true correlation between RNFLT and axial length. Moreover, Leung et al67 demonstrated that the correlation between refractive error and disc area determined by Stratus OCT was opposite that determined by the HRT II; however, when the magnification correction was applied to the results of Stratus OCT, the correlation determined by Stratus OCT was similar to that by the HRT II. Thus, the lack of magnification correction in Stratus OCT may at least partly explain the difference in the correlation of RNFLT with axial length between the previous report34,43 and the present one.

The relation between disc area and the amount of RNFL is controversial. A few histologic studies50,55,57 with limited numbers of subjects (samples sizes of 10-16) failed to detect a significant correlation. On the other hand, histologic studies with 25 or more subjects (samples sizes of 25 to 56)53,68,69 demonstrated that larger disc area is significantly related to greater nerve fiber counts. Bowd et al22 reported that there is no correlation between disc area and RNFLT measured by OCT-2000, whereas several studies34,38,43,70 using Stratus OCT reported a significant correlation (P < .01). In the present study, after adjusting for age, sex, and axial length, there was a positive significant correlation between disc area and RNFLT measured in the 3.4- to 4.0-mm-diameter circles (P ≤ .008), consistent with the previous results obtained with Stratus OCT. On the other hand, opposite correlations were found in the inner circles within a 2.2- to 2.5-mm diameter. As shown by Gabriele et al,44 RNFLT initially increased in the area just adjacent to the optic disc edge (usually <2.2 mm diameter) and gradually decreased in the outer diameters. Therefore, the initial increase in RNFLT could affect the results in the 2.2- and 2.5-mm-diameter circles, especially in eyes with larger optic discs, resulting in an inverse correlation between RNFLT and disc area.

Previous studies reported the short-term reproducibility (shown by the coefficient of variation) of RNFLT measurement as 3.85% to 8% as measured using OCT-2000,21,31,35,71 while 2.2% to 2.8% by Stratus OCT,42,72 and approximately 2.0% in the peripapillary 3.0- to 6.0-mm area by SD-OCT,73 which is similar to that in the present study. Only 1 study reported the intervisit reproducibility shown by the coefficient of variation using OCT II by 2 operators as 5.3% and 4.3%; however, they did not report interoperator reproducibility.74 In the present study, coefficients of variation for short-term, interoperator, and intervisit reproducibilities at a diameter of 3.4 mm were 2.1%, 2.2%, and 2.3%, respectively, suggesting that short-term reproducibility of SD-OCT was as good as that of TD-OCT, and intervisit reproducibilities of the SD-OCT instrument currently used may be better than that of TD-OCT.

The currently used SD-OCT instrument has 2 scan protocols to evaluate the optic disc and peripapillary retina: the concentric scan protocol with a diameter of 2.2 to 4.0 mm and the raster scan protocol, which provides 3-dimensional reconstruction of the retinal structure. In the present study, the results of the concentric protocol were adopted because changes in RNFLT with respect to the distance from the optic disc center could be more easily analyzed and the results more directly compared with the previous literature using Stratus OCT, GDx, and HRT, in all of which peripapillary RNFLT is expressed in a circular fashion.

A limitation of this study is that only Japanese, ophthalmologically normal subjects were included, because Budenz et al34 reported that RNFLT by Stratus OCT was significantly greater in Hispanic and Asian subjects than in white and African American subjects. Another limitation is that measurements of RNFLT with different types of OCT instruments may vary. The recent study by Savini et al75 found that Cirrus high-definition OCT (Carl Zeiss Meditec) and RTVue (Optovue Inc, Fremont, California) provide slight but statistically different RNFLT in healthy eyes. Therefore, the results of the present study should better be confirmed in other countries and races and using other SD-OCT instruments.

In conclusion, we report the peripapillary distribution of RNFLT based on SD-OCT in a large number of ophthalmologically normal, Japanese subjects. Retinal nerve fiber layer thickness decreased linearly as the distance from the disc center was increased, with different decay slopes in different directions. Retinal nerve fiber layer thickness was significantly correlated with age and disc area but not with axial length after adjusting for other confounding factors.

Correspondence: Atsuo Tomidokoro, MD, Department of Ophthalmology, University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (tomidokoro-tky@umin.ac.jp).

Submitted for Publication: September 28, 2009; final revision received February 5, 2010; accepted March 6, 2010.

Financial Disclosure: All authors have been paid by Topcon Inc to attend meetings regarding acquisition of the data and Drs Araie and Yoshimura are paid members of the advisory board for Topcon Inc, but none of the authors has a proprietary interest in any products described in the article.

Funding/Support: This work was supported by Grant-in-Aid for Scientific Research by the Ministry of Health, Labor, and Welfare of Japan (H18-Sensory-General-001) and Topcon Inc.

Quigley  HADunkelberger  GRGreen  WR Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol 1989;107 (5) 453- 464
PubMed
Kerrigan-Baumrind  LAQuigley  HAPease  MEKerrigan  DFMitchell  RS Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons. Invest Ophthalmol Vis Sci 2000;41 (3) 741- 748
PubMed
Bowd  CZangwill  LMMedeiros  FA  et al.  Structure-function relationships using confocal scanning laser ophthalmoscopy, optical coherence tomography, and scanning laser polarimetry. Invest Ophthalmol Vis Sci 2006;47 (7) 2889- 2895
PubMed
Deleón-Ortega  JEArthur  SN McGwin  G  JrXie  AMonheit  BEGirkin  CA Discrimination between glaucomatous and nonglaucomatous eyes using quantitative imaging devices and subjective optic nerve head assessment. Invest Ophthalmol Vis Sci 2006;47 (8) 3374- 3380
PubMed
Bowd  CZangwill  LMBerry  CC  et al.  Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci 2001;42 (9) 1993- 2003
PubMed
Chi  Q-MTomita  GInazumi  KHayakawa  TIdo  TKitazawa  Y Evaluation of the effect of aging on the retinal nerve fiber layer thickness using scanning laser polarimetry. J Glaucoma 1995;4 (6) 406- 413
PubMed
Funaki  SShirakashi  MAbe  H Relation between size of optic disc and thickness of retinal nerve fibre layer in normal subjects. Br J Ophthalmol 1998;82 (11) 1242- 1245
PubMed
Funaki  SShirakashi  MAbe  H Relationship between age and thickness of the retinal nerve fiber layer in normal subjects [in Japanese]. Nippon Ganka Gakkai Zasshi 1998;102 (6) 383- 388
PubMed
Medeiros  FAZangwill  LMBowd  CBernd  ASWeinreb  RN Fourier analysis of scanning laser polarimetry measurements with variable corneal compensation in glaucoma. Invest Ophthalmol Vis Sci 2003;44 (6) 2606- 2612
PubMed
Melo  GBLibera  RDBarbosa  ASPereira  LMDoi  LMMelo  LA  Jr Comparison of optic disk and retinal nerve fiber layer thickness in nonglaucomatous and glaucomatous patients with high myopia. Am J Ophthalmol 2006;142 (5) 858- 860
PubMed
Poinoosawmy  DFontana  LWu  JXFitzke  FWHitchings  RA Variation of nerve fibre layer thickness measurements with age and ethnicity by scanning laser polarimetry. Br J Ophthalmol 1997;81 (5) 350- 354
PubMed
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;129 (2) 129- 135
PubMed
Sehi  MUme  SGreenfield  DS Scanning laser polarimetry with enhanced corneal compensation and optical coherence tomography in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 2007;48 (5) 2099- 2104
PubMed
Hong  SAhn  HHa  SJYeom  HYSeong  GJHong  YJ Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography. Ophthalmology 2007;114 (2) 210- 215
PubMed
Leung  CKChan  WMChong  KK  et al.  Comparative study of retinal nerve fiber layer measurement by StratusOCT and GDx VCC, I: correlation analysis in glaucoma. Invest Ophthalmol Vis Sci 2005;46 (9) 3214- 3220
PubMed
Leung  CKCheung  CYLin  DPang  CPLam  DSCWeinreb  RN Longitudinal variability of optic disc and retinal nerve fiber layer measurements. Invest Ophthalmol Vis Sci 2008;49 (11) 4886- 4892
PubMed
Bozkurt  BIrkeç  MGedik  S  et al.  Effect of peripapillary chorioretinal atrophy on GDx parametersin patients with degenerative myopia. Clin Experiment Ophthalmol 2002;30 (6) 411- 414
PubMed
Bourne  RRAMedeiros  FABowd  CJahanbakhsh  KZangwill  LMWeinreb  RN Comparability of retinal nerve fiber layer thickness measurements of optical coherence tomography instruments. Invest Ophthalmol Vis Sci 2005;46 (4) 1280- 1285
PubMed
Schuman  JSHee  MRPuliafito  CA  et al.  Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol 1995;113 (5) 586- 596
PubMed
Schuman  JSPedut-Kloizman  THertzmark  E  et al.  Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology 1996;103 (11) 1889- 1898
PubMed
Alamouti  BFunk  J Retinal thickness decreases with age: an OCT study. Br J Ophthalmol 2003;87 (7) 899- 901
PubMed
Bowd  CWeinreb  RNWilliams  JMZangwill  LM The retinal nerve fiber layer thickness in ocular hypertensive, normal, and glaucomatous eyes with optical coherence tomography. Arch Ophthalmol 2000;118 (1) 22- 26
PubMed
Guedes  VSchuman  JSHertzmark  E  et al.  Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes. Ophthalmology 2003;110 (1) 177- 189
PubMed
Kanamori  ANakamura  MEscano  MFSeya  RMaeda  HNegi  A Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography. Am J Ophthalmol 2003;135 (4) 513- 520
PubMed
Kanamori  AEscano  MFEno  A  et al.  Evaluation of the effect of aging on retinal nerve fiber layer thickness measured by optical coherence tomography. Ophthalmologica 2003;217 (4) 273- 278
PubMed
Liu  XLing  YLuo  RGe  JZheng  X Optical coherence tomography in measuring retinal nerve fiber layer thickness in normal subjects and patients with open-angle glaucoma. Chin Med J (Engl) 2001;114 (5) 524- 529
PubMed
Mok  KHLee  VWSo  KF Retinal nerve fiber layer measurement by optical coherence tomography in glaucoma suspects with short-wavelength perimetry abnormalities. J Glaucoma 2003;12 (1) 45- 49
PubMed
Pons  MEIshikawa  HGürses-Ozden  RLiebmann  JMDou  HLRitch  R Assessment of retinal nerve fiber layer internal reflectivity in eyes with and without glaucoma using optical coherence tomography. Arch Ophthalmol 2000;118 (8) 1044- 1047
PubMed
Soliman  MAVan Den Berg  TJIsmaeil  AADe Jong  LADe Smet  MD Retinal nerve fiber layer analysis: relationship between optical coherence tomography and red-free photography. Am J Ophthalmol 2002;133 (2) 187- 195
PubMed
Hoh  STLim  MCSeah  SK  et al.  Peripapillary retinal nerve fiber layer thickness variations with myopia. Ophthalmology 2006;113 (5) 773- 777
PubMed
Varma  RBazzaz  SLai  M Optical tomography-measured retinal nerve fiber layer thickness in normal Latinos. Invest Ophthalmol Vis Sci 2003;44 (8) 3369- 3373
PubMed
Ishikawa  HGabriele  MLWollstein  G  et al.  Retinal nerve fiber layer assessment using optical coherence tomography with active optic nerve head tracking. Invest Ophthalmol Vis Sci 2006;47 (3) 964- 967
PubMed
Ajtony  CBalla  ZSomoskeoy  SKovacs  B Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography. Invest Ophthalmol Vis Sci 2007;48 (1) 258- 263
PubMed
Budenz  DLAnderson  DRVarma  R  et al.  Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology 2007;114 (6) 1046- 1052
PubMed
Jones  ALSheen  NJNorth  RVMorgan  JE The Humphrey optical coherence tomography scanner: quantitative analysis and reproducibility study of the normal human retinal nerve fibre layer. Br J Ophthalmol 2001;85 (6) 673- 677
PubMed
Leung  CKMohamed  SLeung  KS  et al.  Retinal nerve fiber layer measurements in myopia: an optical coherence tomography study. Invest Ophthalmol Vis Sci 2006;47 (12) 5171- 5176
PubMed
Leung  CKChan  WMYung  WH  et al.  Comparison of macular and peripapillary measurements for the detection of glaucoma: an optical coherence tomography study. Ophthalmology 2005;112 (3) 391- 400
PubMed
Savini  GZanini  MCarelli  VSadun  AARoss-Cisneros  FNBarboni  P Correlation between retinal nerve fibre layer thickness and optic nerve head size: an optical coherence tomography study. Br J Ophthalmol 2005;89 (4) 489- 492
PubMed
Savini  GBarboni  PCarbonelli  MZanini  M The effect of scan diameter on retinal nerve fiber layer thickness measurement using stratus optic coherence tomography. Arch Ophthalmol 2007;125 (7) 901- 905
PubMed
Subbiah  SSankarnarayanan  SThomas  PANelson Jesudasan  CA Comparative evaluation of optical coherence tomography in glaucomatous, ocular hypertensive and normal eyes. Indian J Ophthalmol 2007;55 (4) 283- 287
PubMed
Parikh  RSParikh  SRSekhar  GCPrabakaran  SBabu  JGThomas  R Normal age-related decay of retinal nerve fiber layer thickness. Ophthalmology 2007;114 (5) 921- 926
PubMed
Budenz  DLChang  RTHuang  XKnighton  RWTielsch  JM Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 2005;46 (7) 2440- 2443
PubMed
Nagai-Kusuhara  ANakamura  MFujioka  MTatsumi  YNegi  A Association of retinal nerve fibre layer thickness measured by confocal scanning laser ophthalmoscopy and optical coherence tomography with disc size and axial length. Br J Ophthalmol 2008;92 (2) 186- 190
PubMed
Gabriele  MLIshikawa  HWollstein  G  et al.  Peripapillary nerve fiber layer thickness profile determined with high speed, ultrahigh resolution optical coherence tomography high-density scanning. Invest Ophthalmol Vis Sci 2007;48 (7) 3154- 3160
PubMed
Wojtkowski  MSrinivasan  VFujimoto  JG  et al.  Three-dimensional retinal imaging with high-speed ultrahigh-resolution optical coherence tomography. Ophthalmology 2005;112 (10) 1734- 1746
PubMed
Wojtkowski  MLeitgeb  RKowalczyk  ABajraszewski  TFercher  AF In vivo human retinal imaging by Fourier domain optical coherence tomography. J Biomed Opt 2002;7 (3) 457- 463
PubMed
Anderson  DRPatella  VM Automated Static Perimetry. 2nd ed. St Louis, MO Mosby1999;
Apple  DJRabb  MFWalsh  PM Congenital anomalies of the optic disc. Surv Ophthalmol 1982;27 (1) 3- 41
PubMed
Littmann  H Determination of the true size of an object on the fundus of the living eye: by H. Littmann from the original article, “Zur Bestimmung der wahren Grosse eines Objektes auf dem Hintergrund des lebenden Auges,” which originally appeared in Klinisches Monatsblätter für Augenheilkunde 1982; 180:286-9. translated by TD Williams. Optom Vis Sci 1992;69 (9) 717- 720
PubMed
Varma  RSkaf  MBarron  E Retinal nerve fiber layer thickness in normal human eyes. Ophthalmology 1996;103 (12) 2114- 2119
PubMed
Ozdek  SCOnol  MGürelik  GHasanreisoglu  B Scanning laser polarimetry in normal subjects and patients with myopia. Br J Ophthalmol 2000;84 (3) 264- 267
PubMed
Jonas  JBMüller-Bergh  JASchlötzer-Schrehardt  UMNaumann  GO Histomorphometry of the human optic nerve. Invest Ophthalmol Vis Sci 1990;31 (4) 736- 744
PubMed
Jonas  JBSchmidt  AMMüller-Bergh  JASchlötzer-Schrehardt  UMNaumann  GO Human optic nerve fiber count and optic disc size. Invest Ophthalmol Vis Sci 1992;33 (6) 2012- 2018
PubMed
Mikelberg  FSDrance  SMSchulzer  MYidegiligne  HMWeis  MM The normal human optic nerve: axon count and axon diameter distribution. Ophthalmology 1989;96 (9) 1325- 1328
PubMed
Mikelberg  FSYidegiligne  HMWhite  VASchulzer  M Relation between optic nerve axon number and axon diameter to scleral canal area. Ophthalmology 1991;98 (1) 60- 63
PubMed
Quigley  HAAddicks  EMGreen  WR Optic nerve damage in human glaucoma, III: quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. Arch Ophthalmol 1982;100 (1) 135- 146
PubMed
Balazsi  AGRootman  JDrance  SMSchulzer  MDouglas  GR The effect of age on the nerve fiber population of the human optic nerve. Am J Ophthalmol 1984;97 (6) 760- 766
PubMed
Johnson  BMMiao  MSadun  AA Age-related decline of human optic nerve axon populations. Age (Omaha) 1987;10 (1) 5- 910.1007/BF02431765
Tjon-Fo-Sang  MJde Vries  JLemij  HG Measurement by nerve fiber analyzer of retinal nerve fiber layer thickness in normal subjects and patients with ocular hypertension. Am J Ophthalmol 1996;122 (2) 220- 227
PubMed
Weinreb  RNShakiba  SZangwill  L Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes. Am J Ophthalmol 1995;119 (5) 627- 636
PubMed
Pieroth  LSchuman  JSHertzmark  E  et al.  Evaluation of focal defects of the nerve fiber layer using optical coherence tomography. Ophthalmology 1999;106 (3) 570- 579
PubMed
Repka  MXQuigley  HA The effect of age on normal human optic nerve fiber number and diameter. Ophthalmology 1989;96 (1) 26- 32
PubMed
Bowd  CZangwill  LMBlumenthal  EZ  et al.  Imaging of the optic disc and retinal nerve fiber layer: the effects of age, optic disc area, refractive error, and gender. J Opt Soc Am A Opt Image Sci Vis 2002;19 (1) 197- 207
PubMed
Quigley  HADunkelberger  GRGreen  WR Chronic human glaucoma causing selectively greater loss of large optic nerve fibers. Ophthalmology 1988;95 (3) 357- 363
PubMed
Wong  TYFoster  PJNg  TPTielsch  JMJohnson  GJSeah  SK Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001;42 (1) 73- 80
PubMed
Shufelt  CFraser-Bell  SYing-Lai  MTorres  MVarma  RLos Angeles Latino Eye Study Group, Refractive error, ocular biometry, and lens opalescence in an adult population: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2005;46 (12) 4450- 4460
PubMed
Leung  CKCheng  ACChong  KK  et al.  Optic disc measurements in myopia with optical coherence tomography and confocal scanning laser ophthalmoscopy. Invest Ophthalmol Vis Sci 2007;48 (7) 3178- 3183
PubMed
Quigley  HAColeman  ALDorman-Pease  ME Larger optic nerve heads have more nerve fibers in normal monkey eyes. Arch Ophthalmol 1991;109 (10) 1441- 1443
PubMed
Jonas  JBSchmidt  AMMüller-Bergh  JANaumann  GO Optic nerve fiber count and diameter of the retrobulbar optic nerve in normal and glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 1995;233 (7) 421- 424
PubMed
Carpineto  PCiancaglini  MAharrh-Gnama  ACirone  DMastropasqua  L Custom measurement of retinal nerve fiber layer thickness using STRATUS OCT in normal eyes. Eur J Ophthalmol 2005;15 (3) 360- 366
PubMed
Blumenthal  EZWilliams  JMWeinreb  RNGirkin  CABerry  CCZangwill  LM Reproducibility of nerve fiber layer thickness measurements by use of optical coherence tomography. Ophthalmology 2000;107 (12) 2278- 2282
PubMed
Tzamalis  AKynigopoulos  MSchlote  THaefliger  I Improved reproducibility of retinal nerve fiber layer thickness measurements with the repeat-scan protocol using the Stratus OCT in normal and glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 2009;247 (2) 245- 252
PubMed
Menke  MNKnecht  PSturm  VDabov  SFunk  J Reproducibility of nerve fiber layer thickness measurements using 3D Fourier-domain OCT. Invest Ophthalmol Vis Sci 2008;49 (12) 5386- 5391
PubMed
Villain  MAGreenfield  DS Peripapillary nerve fiber layer thickness measurement reproducibility using optical coherence tomography. Ophthalmic Surg Lasers Imaging 2003;34 (1) 33- 37
PubMed
Savini  GCarbonelli  MBarboni  P Retinal nerve fiber layer thickness measurement by Fourier-domain optical coherence tomography: a comparison between cirrus-HD OCT and RTVue in healthy eyes. J Glaucoma 2010;19 (6) 369- 372
PubMed

Figures

Tables

Table Graphic Jump LocationTable 1. Demographic Data of Included Subjects Stratified by Age
Table Graphic Jump LocationTable 2. Coefficients of Variation for Short-term, Interoperator, and Intervisit Reproducibility of Mean 360° Retinal Nerve Fiber Layer Thickness in 7 Measurement Circles
Table Graphic Jump LocationTable 3. Mean Values of Retinal Nerve Fiber Layer Thickness in the 360° Circle and the 4 Quadrants
Table Graphic Jump LocationTable 4. Results of Multiple Regression Analysis for the Association of the Decay Slope of the RNFLT With Age, Sex, Axial Length, Disc Area, and Total Retinal Nerve Fiber Layer Thicknessa
Table Graphic Jump LocationTable 5. Results of Simple Correlation Analysis (Pearson Correlation) and Multiple Regression Analysis for the Association of Retinal Nerve Fiber Layer Thickness With Age, Axial Length, and Disc Area

References

Quigley  HADunkelberger  GRGreen  WR Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol 1989;107 (5) 453- 464
PubMed
Kerrigan-Baumrind  LAQuigley  HAPease  MEKerrigan  DFMitchell  RS Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons. Invest Ophthalmol Vis Sci 2000;41 (3) 741- 748
PubMed
Bowd  CZangwill  LMMedeiros  FA  et al.  Structure-function relationships using confocal scanning laser ophthalmoscopy, optical coherence tomography, and scanning laser polarimetry. Invest Ophthalmol Vis Sci 2006;47 (7) 2889- 2895
PubMed
Deleón-Ortega  JEArthur  SN McGwin  G  JrXie  AMonheit  BEGirkin  CA Discrimination between glaucomatous and nonglaucomatous eyes using quantitative imaging devices and subjective optic nerve head assessment. Invest Ophthalmol Vis Sci 2006;47 (8) 3374- 3380
PubMed
Bowd  CZangwill  LMBerry  CC  et al.  Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci 2001;42 (9) 1993- 2003
PubMed
Chi  Q-MTomita  GInazumi  KHayakawa  TIdo  TKitazawa  Y Evaluation of the effect of aging on the retinal nerve fiber layer thickness using scanning laser polarimetry. J Glaucoma 1995;4 (6) 406- 413
PubMed
Funaki  SShirakashi  MAbe  H Relation between size of optic disc and thickness of retinal nerve fibre layer in normal subjects. Br J Ophthalmol 1998;82 (11) 1242- 1245
PubMed
Funaki  SShirakashi  MAbe  H Relationship between age and thickness of the retinal nerve fiber layer in normal subjects [in Japanese]. Nippon Ganka Gakkai Zasshi 1998;102 (6) 383- 388
PubMed
Medeiros  FAZangwill  LMBowd  CBernd  ASWeinreb  RN Fourier analysis of scanning laser polarimetry measurements with variable corneal compensation in glaucoma. Invest Ophthalmol Vis Sci 2003;44 (6) 2606- 2612
PubMed
Melo  GBLibera  RDBarbosa  ASPereira  LMDoi  LMMelo  LA  Jr Comparison of optic disk and retinal nerve fiber layer thickness in nonglaucomatous and glaucomatous patients with high myopia. Am J Ophthalmol 2006;142 (5) 858- 860
PubMed
Poinoosawmy  DFontana  LWu  JXFitzke  FWHitchings  RA Variation of nerve fibre layer thickness measurements with age and ethnicity by scanning laser polarimetry. Br J Ophthalmol 1997;81 (5) 350- 354
PubMed
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;129 (2) 129- 135
PubMed
Sehi  MUme  SGreenfield  DS Scanning laser polarimetry with enhanced corneal compensation and optical coherence tomography in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 2007;48 (5) 2099- 2104
PubMed
Hong  SAhn  HHa  SJYeom  HYSeong  GJHong  YJ Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography. Ophthalmology 2007;114 (2) 210- 215
PubMed
Leung  CKChan  WMChong  KK  et al.  Comparative study of retinal nerve fiber layer measurement by StratusOCT and GDx VCC, I: correlation analysis in glaucoma. Invest Ophthalmol Vis Sci 2005;46 (9) 3214- 3220
PubMed
Leung  CKCheung  CYLin  DPang  CPLam  DSCWeinreb  RN Longitudinal variability of optic disc and retinal nerve fiber layer measurements. Invest Ophthalmol Vis Sci 2008;49 (11) 4886- 4892
PubMed
Bozkurt  BIrkeç  MGedik  S  et al.  Effect of peripapillary chorioretinal atrophy on GDx parametersin patients with degenerative myopia. Clin Experiment Ophthalmol 2002;30 (6) 411- 414
PubMed
Bourne  RRAMedeiros  FABowd  CJahanbakhsh  KZangwill  LMWeinreb  RN Comparability of retinal nerve fiber layer thickness measurements of optical coherence tomography instruments. Invest Ophthalmol Vis Sci 2005;46 (4) 1280- 1285
PubMed
Schuman  JSHee  MRPuliafito  CA  et al.  Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol 1995;113 (5) 586- 596
PubMed
Schuman  JSPedut-Kloizman  THertzmark  E  et al.  Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology 1996;103 (11) 1889- 1898
PubMed
Alamouti  BFunk  J Retinal thickness decreases with age: an OCT study. Br J Ophthalmol 2003;87 (7) 899- 901
PubMed
Bowd  CWeinreb  RNWilliams  JMZangwill  LM The retinal nerve fiber layer thickness in ocular hypertensive, normal, and glaucomatous eyes with optical coherence tomography. Arch Ophthalmol 2000;118 (1) 22- 26
PubMed
Guedes  VSchuman  JSHertzmark  E  et al.  Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes. Ophthalmology 2003;110 (1) 177- 189
PubMed
Kanamori  ANakamura  MEscano  MFSeya  RMaeda  HNegi  A Evaluation of the glaucomatous damage on retinal nerve fiber layer thickness measured by optical coherence tomography. Am J Ophthalmol 2003;135 (4) 513- 520
PubMed
Kanamori  AEscano  MFEno  A  et al.  Evaluation of the effect of aging on retinal nerve fiber layer thickness measured by optical coherence tomography. Ophthalmologica 2003;217 (4) 273- 278
PubMed
Liu  XLing  YLuo  RGe  JZheng  X Optical coherence tomography in measuring retinal nerve fiber layer thickness in normal subjects and patients with open-angle glaucoma. Chin Med J (Engl) 2001;114 (5) 524- 529
PubMed
Mok  KHLee  VWSo  KF Retinal nerve fiber layer measurement by optical coherence tomography in glaucoma suspects with short-wavelength perimetry abnormalities. J Glaucoma 2003;12 (1) 45- 49
PubMed
Pons  MEIshikawa  HGürses-Ozden  RLiebmann  JMDou  HLRitch  R Assessment of retinal nerve fiber layer internal reflectivity in eyes with and without glaucoma using optical coherence tomography. Arch Ophthalmol 2000;118 (8) 1044- 1047
PubMed
Soliman  MAVan Den Berg  TJIsmaeil  AADe Jong  LADe Smet  MD Retinal nerve fiber layer analysis: relationship between optical coherence tomography and red-free photography. Am J Ophthalmol 2002;133 (2) 187- 195
PubMed
Hoh  STLim  MCSeah  SK  et al.  Peripapillary retinal nerve fiber layer thickness variations with myopia. Ophthalmology 2006;113 (5) 773- 777
PubMed
Varma  RBazzaz  SLai  M Optical tomography-measured retinal nerve fiber layer thickness in normal Latinos. Invest Ophthalmol Vis Sci 2003;44 (8) 3369- 3373
PubMed
Ishikawa  HGabriele  MLWollstein  G  et al.  Retinal nerve fiber layer assessment using optical coherence tomography with active optic nerve head tracking. Invest Ophthalmol Vis Sci 2006;47 (3) 964- 967
PubMed
Ajtony  CBalla  ZSomoskeoy  SKovacs  B Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography. Invest Ophthalmol Vis Sci 2007;48 (1) 258- 263
PubMed
Budenz  DLAnderson  DRVarma  R  et al.  Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology 2007;114 (6) 1046- 1052
PubMed
Jones  ALSheen  NJNorth  RVMorgan  JE The Humphrey optical coherence tomography scanner: quantitative analysis and reproducibility study of the normal human retinal nerve fibre layer. Br J Ophthalmol 2001;85 (6) 673- 677
PubMed
Leung  CKMohamed  SLeung  KS  et al.  Retinal nerve fiber layer measurements in myopia: an optical coherence tomography study. Invest Ophthalmol Vis Sci 2006;47 (12) 5171- 5176
PubMed
Leung  CKChan  WMYung  WH  et al.  Comparison of macular and peripapillary measurements for the detection of glaucoma: an optical coherence tomography study. Ophthalmology 2005;112 (3) 391- 400
PubMed
Savini  GZanini  MCarelli  VSadun  AARoss-Cisneros  FNBarboni  P Correlation between retinal nerve fibre layer thickness and optic nerve head size: an optical coherence tomography study. Br J Ophthalmol 2005;89 (4) 489- 492
PubMed
Savini  GBarboni  PCarbonelli  MZanini  M The effect of scan diameter on retinal nerve fiber layer thickness measurement using stratus optic coherence tomography. Arch Ophthalmol 2007;125 (7) 901- 905
PubMed
Subbiah  SSankarnarayanan  SThomas  PANelson Jesudasan  CA Comparative evaluation of optical coherence tomography in glaucomatous, ocular hypertensive and normal eyes. Indian J Ophthalmol 2007;55 (4) 283- 287
PubMed
Parikh  RSParikh  SRSekhar  GCPrabakaran  SBabu  JGThomas  R Normal age-related decay of retinal nerve fiber layer thickness. Ophthalmology 2007;114 (5) 921- 926
PubMed
Budenz  DLChang  RTHuang  XKnighton  RWTielsch  JM Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 2005;46 (7) 2440- 2443
PubMed
Nagai-Kusuhara  ANakamura  MFujioka  MTatsumi  YNegi  A Association of retinal nerve fibre layer thickness measured by confocal scanning laser ophthalmoscopy and optical coherence tomography with disc size and axial length. Br J Ophthalmol 2008;92 (2) 186- 190
PubMed
Gabriele  MLIshikawa  HWollstein  G  et al.  Peripapillary nerve fiber layer thickness profile determined with high speed, ultrahigh resolution optical coherence tomography high-density scanning. Invest Ophthalmol Vis Sci 2007;48 (7) 3154- 3160
PubMed
Wojtkowski  MSrinivasan  VFujimoto  JG  et al.  Three-dimensional retinal imaging with high-speed ultrahigh-resolution optical coherence tomography. Ophthalmology 2005;112 (10) 1734- 1746
PubMed
Wojtkowski  MLeitgeb  RKowalczyk  ABajraszewski  TFercher  AF In vivo human retinal imaging by Fourier domain optical coherence tomography. J Biomed Opt 2002;7 (3) 457- 463
PubMed
Anderson  DRPatella  VM Automated Static Perimetry. 2nd ed. St Louis, MO Mosby1999;
Apple  DJRabb  MFWalsh  PM Congenital anomalies of the optic disc. Surv Ophthalmol 1982;27 (1) 3- 41
PubMed
Littmann  H Determination of the true size of an object on the fundus of the living eye: by H. Littmann from the original article, “Zur Bestimmung der wahren Grosse eines Objektes auf dem Hintergrund des lebenden Auges,” which originally appeared in Klinisches Monatsblätter für Augenheilkunde 1982; 180:286-9. translated by TD Williams. Optom Vis Sci 1992;69 (9) 717- 720
PubMed
Varma  RSkaf  MBarron  E Retinal nerve fiber layer thickness in normal human eyes. Ophthalmology 1996;103 (12) 2114- 2119
PubMed
Ozdek  SCOnol  MGürelik  GHasanreisoglu  B Scanning laser polarimetry in normal subjects and patients with myopia. Br J Ophthalmol 2000;84 (3) 264- 267
PubMed
Jonas  JBMüller-Bergh  JASchlötzer-Schrehardt  UMNaumann  GO Histomorphometry of the human optic nerve. Invest Ophthalmol Vis Sci 1990;31 (4) 736- 744
PubMed
Jonas  JBSchmidt  AMMüller-Bergh  JASchlötzer-Schrehardt  UMNaumann  GO Human optic nerve fiber count and optic disc size. Invest Ophthalmol Vis Sci 1992;33 (6) 2012- 2018
PubMed
Mikelberg  FSDrance  SMSchulzer  MYidegiligne  HMWeis  MM The normal human optic nerve: axon count and axon diameter distribution. Ophthalmology 1989;96 (9) 1325- 1328
PubMed
Mikelberg  FSYidegiligne  HMWhite  VASchulzer  M Relation between optic nerve axon number and axon diameter to scleral canal area. Ophthalmology 1991;98 (1) 60- 63
PubMed
Quigley  HAAddicks  EMGreen  WR Optic nerve damage in human glaucoma, III: quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. Arch Ophthalmol 1982;100 (1) 135- 146
PubMed
Balazsi  AGRootman  JDrance  SMSchulzer  MDouglas  GR The effect of age on the nerve fiber population of the human optic nerve. Am J Ophthalmol 1984;97 (6) 760- 766
PubMed
Johnson  BMMiao  MSadun  AA Age-related decline of human optic nerve axon populations. Age (Omaha) 1987;10 (1) 5- 910.1007/BF02431765
Tjon-Fo-Sang  MJde Vries  JLemij  HG Measurement by nerve fiber analyzer of retinal nerve fiber layer thickness in normal subjects and patients with ocular hypertension. Am J Ophthalmol 1996;122 (2) 220- 227
PubMed
Weinreb  RNShakiba  SZangwill  L Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes. Am J Ophthalmol 1995;119 (5) 627- 636
PubMed
Pieroth  LSchuman  JSHertzmark  E  et al.  Evaluation of focal defects of the nerve fiber layer using optical coherence tomography. Ophthalmology 1999;106 (3) 570- 579
PubMed
Repka  MXQuigley  HA The effect of age on normal human optic nerve fiber number and diameter. Ophthalmology 1989;96 (1) 26- 32
PubMed
Bowd  CZangwill  LMBlumenthal  EZ  et al.  Imaging of the optic disc and retinal nerve fiber layer: the effects of age, optic disc area, refractive error, and gender. J Opt Soc Am A Opt Image Sci Vis 2002;19 (1) 197- 207
PubMed
Quigley  HADunkelberger  GRGreen  WR Chronic human glaucoma causing selectively greater loss of large optic nerve fibers. Ophthalmology 1988;95 (3) 357- 363
PubMed
Wong  TYFoster  PJNg  TPTielsch  JMJohnson  GJSeah  SK Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001;42 (1) 73- 80
PubMed
Shufelt  CFraser-Bell  SYing-Lai  MTorres  MVarma  RLos Angeles Latino Eye Study Group, Refractive error, ocular biometry, and lens opalescence in an adult population: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2005;46 (12) 4450- 4460
PubMed
Leung  CKCheng  ACChong  KK  et al.  Optic disc measurements in myopia with optical coherence tomography and confocal scanning laser ophthalmoscopy. Invest Ophthalmol Vis Sci 2007;48 (7) 3178- 3183
PubMed
Quigley  HAColeman  ALDorman-Pease  ME Larger optic nerve heads have more nerve fibers in normal monkey eyes. Arch Ophthalmol 1991;109 (10) 1441- 1443
PubMed
Jonas  JBSchmidt  AMMüller-Bergh  JANaumann  GO Optic nerve fiber count and diameter of the retrobulbar optic nerve in normal and glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 1995;233 (7) 421- 424
PubMed
Carpineto  PCiancaglini  MAharrh-Gnama  ACirone  DMastropasqua  L Custom measurement of retinal nerve fiber layer thickness using STRATUS OCT in normal eyes. Eur J Ophthalmol 2005;15 (3) 360- 366
PubMed
Blumenthal  EZWilliams  JMWeinreb  RNGirkin  CABerry  CCZangwill  LM Reproducibility of nerve fiber layer thickness measurements by use of optical coherence tomography. Ophthalmology 2000;107 (12) 2278- 2282
PubMed
Tzamalis  AKynigopoulos  MSchlote  THaefliger  I Improved reproducibility of retinal nerve fiber layer thickness measurements with the repeat-scan protocol using the Stratus OCT in normal and glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 2009;247 (2) 245- 252
PubMed
Menke  MNKnecht  PSturm  VDabov  SFunk  J Reproducibility of nerve fiber layer thickness measurements using 3D Fourier-domain OCT. Invest Ophthalmol Vis Sci 2008;49 (12) 5386- 5391
PubMed
Villain  MAGreenfield  DS Peripapillary nerve fiber layer thickness measurement reproducibility using optical coherence tomography. Ophthalmic Surg Lasers Imaging 2003;34 (1) 33- 37
PubMed
Savini  GCarbonelli  MBarboni  P Retinal nerve fiber layer thickness measurement by Fourier-domain optical coherence tomography: a comparison between cirrus-HD OCT and RTVue in healthy eyes. J Glaucoma 2010;19 (6) 369- 372
PubMed

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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.
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