Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States.
Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
Ophthalmol Glaucoma. 2020 Jan-Feb;3(1):66-75. doi: 10.1016/j.ogla.2019.11.004. Epub 2019 Nov 20.
Describe a new method to analyze retinal nerve fiber layer (RNFL) thickness maps.
Cross-sectional study.
RNFL thickness maps of healthy and glaucomatous eyes.
Optical coherence tomography (OCT) RNFL raster scans from 98 healthy and 50 glaucomatous eyes were analyzed. The RNFL thickness maps were separated into superficial (SNFL) and deep (DNFL) slabs through a partial thickness plane set at the modal thickness (mode). Association between mode and OCT signal strength (SS), age, axial length, and visual field mean deviation (VFMD) was tested (Pearson coefficient, ). Thicknesses of inferior and superior SNFL regions (i-,s-SNFL), and inferior, superior, nasal, and temporal DNFL regions (i-,s-,n-,t-DNFL) were calculated. The regions thicknesses were compared between healthy and glaucomatous eyes (t-test) and between glaucomatous eyes with early, moderate, and severe disease (ANOVA and linear regressions of thickness on VFMD). Diagnostic accuracy and correlation with VFMD of RNFL regions thicknesses were calculated as the area under the receiver operating characteristic curve (AUC) and Pearson respectively. <0.05 was considered significant.
Thickness of regions in SNFL and DNFL slabs.
The mode was not associated with SS, age, axial length, or VFMD, it circumscribed the thicker RNFL around the optic disc of healthy and glaucomatous eyes, and it was used to separate the SNFL and DNFL slabs of RNFL thickness maps. The thickness of the SNFL slab was less in glaucomatous eyes than in healthy eyes (<0.001). S-SNFL and i-SNFL thicknesses (respectively) were 86.0±8.2μm and 87.3±9.6μm in healthy eyes vs. 66.1±9.1μm and 63.4±8.2μm in glaucomatous eyes (<0.001 for both). The thickness of the DNFL slab was similar between groups (=0.19). T-DNFL thickness was 37.0±5.3μm in healthy eyes vs. 33.9±5.0μm in glaucomatous eyes (<0.001); thicknesses of all other DNFL regions were similar. The SNFL regions only thinned with progressively worse glaucoma severity, had excellent AUCs (AUC≥0.95, <0.001), and correlated strongly with VFMD (≥0.60, <0.001).
Glaucomatous RNFL thinning is predominantly detected within a slab with thickness greater than the mode. SNFL thickness has great AUC and correlation with VFMD in glaucomatous eyes. The usefulness for diagnosis and monitoring of glaucoma needs further study.
描述一种新的分析视网膜神经纤维层（RNFL）厚度图的方法。
横断面研究。
健康眼和青光眼眼的 RNFL 厚度图。
对 98 只健康眼和 50 只青光眼眼的 OCT RNFL 光栅扫描进行分析。通过设置在模态厚度（mode）处的部分厚度平面将 RNFL 厚度图分为浅层（SNFL）和深层（DNFL）板。测试 mode 与 OCT 信号强度（SS）、年龄、眼轴长度和视野平均偏差（VFMD）之间的相关性（Pearson 系数，）。计算下侧和上侧 SNFL 区域（i-，s-SNFL）以及下侧、上侧、鼻侧和颞侧 DNFL 区域（i-，s-，n-，t-DNFL）的厚度。比较健康眼和青光眼眼中的区域厚度（t 检验）以及早期、中度和重度疾病的青光眼眼中的区域厚度（ANOVA 和线性回归厚度与 VFMD）。作为接收者操作特征曲线（AUC）下的面积和 Pearson 计算的区域厚度的诊断准确性和与 VFMD 的相关性分别为（）。<0.05 被认为具有统计学意义。
SNFL 和 DNFL 板中各区域的厚度。
模式与 SS、年龄、眼轴长度或 VFMD 无关，它围绕健康眼和青光眼眼的视盘划定了较厚的 RNFL，并用于分离 RNFL 厚度图的 SNFL 和 DNFL 板。与健康眼相比，青光眼眼中 SNFL 板的厚度较薄（<0.001）。健康眼中 s-SNFL 和 i-SNFL 厚度（分别）为 86.0±8.2μm 和 87.3±9.6μm，而青光眼眼中为 66.1±9.1μm 和 63.4±8.2μm（均<0.001）。两组间 DNFL 板的厚度相似（=0.19）。健康眼中的 t-DNFL 厚度为 37.0±5.3μm，而青光眼眼中为 33.9±5.0μm（均<0.001）；所有其他 DNFL 区域的厚度相似。SNFL 区域仅随青光眼严重程度的逐渐加重而变薄，具有极好的 AUC（AUC≥0.95，<0.001），与 VFMD 相关性很强（≥0.60，<0.001）。
青光眼性 RNFL 变薄主要发生在厚度大于模式的板内。SNFL 厚度在青光眼眼中具有较大的 AUC 和与 VFMD 的相关性。在青光眼的诊断和监测中的应用需要进一步研究。
