The purpose of this study was to assess the diagnostic power of the novel two-dimensional parameter Bruch's membrane opening minimal rim area (BMO-MRA) in spectral-domain optical coherence tomography ...(SD-OCT) for detection of glaucoma compared to minimal rim width (BMO-MRW) and retinal nerve fiber layer (RNFL) thickness in large and small optic discs.
In this case-control, cross-sectional study, 207 eyes of 207 participants, including 89 controls and 97 patients with glaucoma and 21 with ocular hypertension (OHT), with a disc size <1.63 mm2 or >2.43 mm2 underwent SD-OCT, confocal laser scanning tomography (CSLT), visual field testing, and clinical examination. Bruch's membrane opening-MRA BMO-MRW, RNFL thickness of SD-OCT and disc margin rim area (DM-RA) of CSLT were evaluated and analyzed for diagnostic power to detect glaucoma.
In healthy eyes with macrodiscs, mean BMO-MRW of 243.14 ± 43.12 μm was significantly smaller than BMO-MRW in microdiscs (338.97 ± 69.39; P < 0.001). Bruch's membrane opening-MRA was comparable between disc size groups with 1.22 ± 0.25 mm2 for macrodiscs and 1.26 ± 0.27 mm2 for microdiscs (P = 0.51), as was RNFL thickness (82.69 ± 15.76 μm versus 78.53 ± 11.01 μm, respectively; P = 0.28). Perimetric mean deviation was -8.7 ± 6.3 dB in glaucoma and -0.6 ± 1.60 dB in OHT patients. Correlation of BMO-MRA and visual field function was rho (ρ) = 0.70 (P < 0.001). Diagnostic power to differentiate glaucoma patients was highest for BMO-MRA. Partial area under the curve (pAUC) for BMO-MRA was 0.14 for specificity between 0.8 and 1.0, exceeding pAUCs of BMO-MRW (P < 0.001), RNFL thickness (P = 0.03), and DM-RA (P = 0.01).
Bruch's membrane opening-based minimum rim area measurements offer advantages compared to one-dimensional parameters assessing neuroretinal rim by SD-OCT. In nonglaucomatous eyes, BMO-MRA values seem comparable for the full range of disc sizes. Bruch's membrane opening-MRA surpasses other parameters in diagnostic power for glaucoma.
To assess the performance of Bruch's membrane opening (BMO)-based spectral domain optical coherence tomography (SD-OCT) of the optic nerve head for glaucoma detection in microdiscs in comparison with ...confocal scanning laser tomography (CSLT).
Retrospective cohort study.
82 eyes of 82 patients with disc size <1.63 mm
underwent SD-OCT and CSLT measurements, visual field testing and clinical examination. BMO-based minimal rim width (BMO-MRW), retinal nerve fibre layer thickness (RNFLT) in SD-OCT and rim area measured in CSLT were compared and correlated with visual field defects.
51 patients with glaucoma, 11 patients with ocular hypertension (OHT) and 20 healthy controls had a mean disc area of 1.36±0.19 mm
in CSLT, and BMO area was 1.45±0.22 mm
(r=0.17; p=0.12). In patients with glaucoma, visual field mean defect was -7.5±6.7 dB. Global BMO-MRW correlated better with visual field function (Spearman's r=0.65; p<0.001) than RNFLT (r=0.58; p≤0.001) and CSLT rim area (r=0.47; p=0.004). BMO-MRW significantly deteriorated with progressive visual field loss (p<0.001). In receiver operating characteristic analysis, sensitivity of BMO-MRW was 68.6% at 95% specificity (area under curve (AUC)=0.87), similar to sensitivity of RNFLT (66.4%; AUC=0.81). Performance of CSLT rim area was significantly worse (AUC=0.70, p=0.008). In healthy controls, mean BMO-MRW was 344.3±64.1 µm, mean RNFLT 78.0±11.3 µm and CSLT mean rim area 1.07±0.18 mm
.
In small optic discs, BMO-MRW and peripapillary RNFLT (OCT) have similar sensitivity to discriminate patients with glaucoma from normal controls; both exceed CSLT rim area in diagnostic power. In glaucomatous patients, BMO-MRW correlates strongest with visual field function.
To analyze the temporal correlations of vascular endothelial growth factor (VEGF) suppression, morphologic recurrence of choroidal neovascularization (CNV), and visual acuity loss in eyes with ...exudative age-related macular degeneration (AMD) treated with ranibizumab.
Nonrandomized, prospective, clinical study.
Forty-seven eyes of 47 patients with exudative AMD undergoing intravitreal ranibizumab injections.
Aqueous humor specimens were taken before each intravitreal ranibizumab injection. Visual acuity testing, spectral domain optical coherence tomography (SD-OCT), and fundoscopy were performed before each injection. Vascular endothelial growth factor A was measured by Luminex multiplex bead analysis (Luminex Inc., Austin, TX).
Intraocular VEGF concentration, recurrence of CNV activity shown by SD-OCT, and vision loss.
Ranibizumab resulted in complete VEGF suppression within a mean period of 37.8 days (standard deviation SD ± 4.8 days; range, 26-49 days). Recurrences of CNV activity as determined by SD-OCT occurred 93.7 days (SD ± 69.9 days; range, 57-368 days) after the last ranibizumab treatment. The VEGF levels were never suppressed when a recurrence occurred. Functional recurrence (visual acuity) occurred 114.3 days (SD ± 81.4 days; range, 57-398 days) after previous treatment. The VEGF levels did not differ significantly between baseline and recurrence (69.3 pg/ml vs. 74.14 pg/ml; 95% confidence interval, -18.87 to 9.12).
A monthly intravitreal injection of 0.5 mg ranibizumab yields a durable VEGF inhibition. The recurrences of CNV as determined by SD-OCT are always preceded by a loss of intraocular VEGF suppression and usually followed by loss of visual acuity in the further course.
To assess the impact of trabeculectomy for glaucoma on morphometric neuroretinal parameters of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT).
Retrospective, ...interventional case series.
Participants: Eighty-eight eyes of 88 patients who underwent trabeculectomy with mitomycin C in 2016. Intervention: All patients underwent trabeculectomy in 1 eye (study eye) and had evaluable SD-OCT examinations of the ONH to measure neuroretinal tissue before and at least at 1 of the 3-, 6-, and 12-month follow-up time points after surgery. Main Outcome Measures: Longitudinal change in Bruch membrane opening minimum rim width (BMO-MRW), Bruch membrane opening minimum rim area (BMO-MRA), peripapillary retinal nerve fiber layer (RNFL) thickness, intraocular pressure (IOP), and mean deviation in perimetry.
In study eyes, BMO-MRW significantly increased postsurgically comparing baseline and follow-up examinations at 3 months (P = .012), at 6 months (P = .007), and at 1 year (P = .010) after trabeculectomy. The increase in BMO-MRW 6 months after surgery correlated with IOP reduction (r = 0.48; P = .001). BMO-MRA showed an equal increase (P ≤ .034). RNFL thickness remained stable between baseline and follow-up at 3, 6, and 12 months and showed a moderate loss after 18 months (P = .021) of follow-up.
Structural reversal of disc cupping after trabeculectomy markedly influences Bruch membrane opening–based parameters for up to more than 1 year. Improvement in morphometry seems to correlate with the reduction of IOP while visual field function appears not to be influenced. In longitudinal follow-up of glaucoma patients by SD-OCT, evaluation of BMO-based parameters necessitates to reflect bias caused by surgery.
To compare margin-based rim area measurements from confocal scanning laser tomography (CSLT) with Bruch's membrane opening (BMO)-based measurements from spectral domain optical coherence tomography ...(SD-OCT) by analysis of a group of non-glaucomatous eyes with large optic discs, so-called macrodiscs (disc size >2.45 mm
in CSLT). Objective is to create a reference base for large optic nerve heads in SD-OCT diagnostics.
102 eyes received CSLT and SD-OCT measurements and clinical examination on the same day. Visual field testing confirmed absence of glaucomatous defects. Statistical and correlation analysis was performed for rim area by CSLT as well as retinal nerve fibre layer thickness (RNFLT) and BMO minimal rim width (BMO-MRW) by SD-OCT.
Mean disc size in CSLT was 2.98±0.4 mm
(range 2.45-4.23), mean rim area of 1.55±0.4 mm
. BMO area was 2.51±0.33 mm
(range 1.61-3.51), mean global RNFLT was 79.55±17.2 μm, mean global BMO-MRW was 234.84±48.3 μm. Correlation of BMO-MRW to global RNFLT was stronger (r=0.60, p<10
) than correlation of CSLT rim area to global RNFLT (r=0.26, p=0.24). BMO-MRW and CSLT rim area correlated with r=0.59 (p<10
). BMO-MRW and RNFLT significantly decreased with increasing age (p<0.001). Annual loss of BMO-MRW was 0.8 μm/year (R
=0.14, p<0.001), loss of RNFLT was 0.27 μm/year (R
=0.17, p=0.001).
In large optic discs, BMO-MRW is thinner compared with normal-sized discs and correlates better than CSLT parameters with the RNFLT. An age-depended loss of BMO-MRW needs to be taken into account in evaluation of the neuroretinal rim.
Purpose
To characterize the two‐dimensional parameter Bruch's membrane opening minimum rim area (BMO‐MRA) in spectral domain optical coherence tomography (SD‐OCT) of the optic nerve head (ONH) ...compared to minimum rim width (BMO‐MRW) and retinal nerve fibre layer (RNFL) thickness in a large patient cohort.
Methods
Case–control, cross‐sectional study of 705 eyes of 445 participants. A total of 449 eyes with glaucoma, 67 eyes with ocular hypertension and 189 healthy controls, underwent SD‐OCT and confocal laser scanning tomography (CSLT), visual field testing and clinical examination. Morphometric ONH parameters, visual field function and diagnostic power were compared. Main outcome measures were SD‐OCT‐derived BMO‐MRA, BMO‐MRW, RNFL thickness and CSLT‐derived rim area (DM‐RA).
Results
Mean ONH area was 2.11 ± 0.57 mm2; mean BMO area was 1.89 ± 0.45 mm2. Correlation of mean deviation in visual field to morphometric parameters was ρ = 0.70, (p < 0.001) for RNFL thickness, ρ = 0.68 (p < 0.001) for BMO‐MRA, ρ = 0.66 (p < 0.001) for BMO‐MRW. These correlations were not significantly different (p > 0.05), while DM‐RA correlated significantly worse (ρ = 0.55; p < 0.001). In receiver operating characteristics, the calculated area under the curve (AUC) and sensitivity at 90% specificity to differentiate glaucoma were 0.87% and 70.1% for BMO‐MRA, 0.86% and 68.1% for RNFL thickness, 0.84% and 66.0% for BMO‐MRW, 0.82% and 51.3% for DM‐RA.
Conclusions
In a heterogenous clinical cohort of glaucoma patients, all analysed SD‐OCT parameters excel DM‐RA of CSLT. The two‐dimensional parameter BMO‐MRA shows comparable levels of diagnostic power to detect glaucoma compared to established parameters BMO‐MRW and RNFL thickness. Given higher comparability between ONH sizes, BMO‐MRA might become an additional standard tool in SD‐OCT imaging for glaucoma.
To assess possible intraday variability in Bruch's membrane opening-based (BMO) assessment of neuroretinal rim by spectral-domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) ...as well as to evaluate its independence from intraindividual IOP changes.
In this noninterventional, prospective cohort study, 51 consecutively enrolled patients with glaucoma or ocular hypertension underwent standardized SD-OCT of the ONH and IOP assessment at two different time points with a time gap of 5 hours on the same day. Random effects models, intraclass correlation coefficients (ICC) and Bland-Altman plots were used to analyze repeatability of BMO minimum rim width (BMO-MRW) and area (BMO-MRA) and peripapillary retinal nerve fiber layer (RNFL) thickness measurements.
Mean BMO area was 1.86 ± 0.30 mm2. At baseline, mean BMO-MRW was 206.46 ± 0.86 μm, mean BMO-MRA was 0.89 ± 0.34 mm2, and mean RNFL thickness was 71.61 ± 0.20 μm. Within intraindividual measurements, mean difference was 2.95 μm or 1.76% for BMO-MRW, 0.02 mm2 or 2.68% for BMO-MRA, and 1.18 μm or 1.89% for RNFL thickness. Comparing time points, η2 was 0.001 (P = 0.757) for RNFL thickness, 0.043 (P = 0.01) for BMO-MRA, and 0.07 (P = 0.06) for BMO-MRW. Intraclass correlation coefficients were greater than 0.994, respectively. Variability of morphometric parameters did not correlate to intraindividual IOP fluctuations.
Assessment of BMO-MRW by SD-OCT shows high intraday repeatability, which is comparable to the parameter RNFL thickness. Variability seems not to be driven by typical moderate intraday fluctuations of IOP. The two-dimensional parameter BMO-MRA incorporates a fairly higher intraindividual variability.
Background
To identify factors and problems influencing treatment adherence in patients undergoing anti-VEGF therapy for neovascular age-related macular degeneration (AMD) under real-life conditions.
...Methods
Cross-sectional study was conducted of 95 patients receiving ranibizumab therapy on a
pro re nata
(PRN) regimen with monthly controls in a tertiary health care clinic. Monthly controls included best corrected visual acuity, slit-lamp examination and spectral-domain optical coherence tomography. Adherence was measured using Kaplan–Meier time-to-discontinuation analysis. Patients were asked to respond to a 16-item questionnaire covering items such as anxiety, subjective benefit, and financial issues of therapy.
Results
Forty-two men and 53 women were included. After a mean follow-up time of 675 days (range 63–1008), adherence was 81.1 % (77/95). The mean number of follow-up visits was 19 (3–30), the mean number of intravitreal injections was ten (3–23). Seven patients withdrew from treatment due to subjective dissatisfaction with benefit. Other reasons for loss to follow-up were death in one case, serious general disease in three patients, and treatment options closer to home in five cases. Two patients cancelled further follow-up after treatment cessation due to terminal fibrosis. 62.1 % of patients were afraid of a negative examination result, whereas 19.0 % were afraid of intravitreal injections. A major problem was travel to and from the hospital (46.3 %), with 61.5 % of patients requiring escort.
Conclusion
Despite necessary monthly visits, patients showed a high adherence to therapy. The major problem was travel to and from the hospital. From the patients’ point of view, anxiety of a negative examination result was more pronounced than fear of intraocular injections, which would be an argument for continuous injections rather than for a PRN regimen.
Purpose To determine intra-individual long-term stability of vascular endothelial growth factor (VEGF) suppression time in eyes with neovascular age-related macular degeneration (AMD) treated with ...ranibizumab. Design Nonrandomized, prospective clinical study. Methods Eighty-three eyes of 83 patients with neovascular AMD undergoing intravitreal ranibizumab injections were included in the study. A total of 859 aqueous humor specimens were taken before each intravitreal ranibizumab injection. Vascular endothelial growth factor A was measured by multiplex bead analysis. Results Ranibizumab resulted in complete VEGF suppression within a mean period of 36.4 days (standard deviation ±6.7 days; range, 26-69 days). Intra-individual suppression time was stable within a period of up to 3 years. Among 859 VEGF measurements, only 5 (0.58%) deviated from this pattern. Nonsuppressed VEGF levels did not differ significantly between baseline and recurrence (68.0 pg/mL vs 69.3 pg/mL) and did not correlate with choroidal neovascularization size and lesion type. Conclusions Both the long-term stability and the broad range of individual suppression times after ranibizumab injections would allow and justify adjustment of continuous injections individually in order to achieve permanent VEGF suppression in patients.
Background
Complicated approval procedures and limited short-term surgical capacities can result in time delays between the definition of a medical indication for ranibizumab treatment in active ...neovascular age-related macular degeneration (AMD) and the starting of treatment. This study aimed to evaluate changes in visual acuity and central retinal thickness over time, and their consequences for the patients concerned.
Methods
Sixty-nine patients indicated for first-time ranibizumab treatment and 21 patients with necessary re-treatment were included in the study. Visual acuity and spectral domain optical coherence tomography (SD-OCT) central retinal thickness at the time of the indication examination were compared to values at the first-time treatment and during recurrent ranibizumab treatment.
Results
For first-time treatment, the delay between indication and treatment was significantly higher for patients with vision loss compared to those without vision loss (31.6 ± 20.5 vs. 24.0 ± 8.3 days,
p
= 0.012). The increase in OCT central retinal thickness was 50.4 ± 92.8 μm for patients with vision loss compared to 5.1 ± 63.4 μm for those without vision loss,
p
= 0.029. A 1.1 logMAR line difference in vision loss was significant at
p
= 0.01 for patients with a delay in treatment of less than or equal to 28 days (48/69 patients, 69.7%) compared to those with a delay of more than 28 days (21/69 patients, 30.3%).
Conclusions
Even though average visual decay was slow at about one logMAR line over 110 days, individual patients (8.7%) experienced rapid loss of one or more lines within 21 days. Administrative procedures should therefore be expedited so that delays do not exceed 2 weeks for the sake of vision preservation in individual patients.
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