Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes

Ya Xing Wang; Hongli Yang; Haomin Luo; Seung Woo Hong; Stuart K. Gardiner; Jin Wook Jeoung; Christy Hardin; Glen P. Sharpe; Kouros Nouri-Mahdavi; Joseph Caprioli; Shaban Demirel; Christopher A. Girkin; Jeffrey M. Liebmann; Christian Y. Mardin; Harry A. Quigley; Alexander F. Scheuerle; Brad Fortune; Balwantray C. Chauhan; Claude F. Burgoyne

doi:10.1016/j.ajo.2020.03.050

Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes

Ya Xing Wang, Hongli Yang, Haomin Luo, Seung Woo Hong, Stuart K. Gardiner, Jin Wook Jeoung, Christy Hardin, Glen P. Sharpe, Kouros Nouri-Mahdavi, Joseph Caprioli, Shaban Demirel, Christopher A. Girkin, Jeffrey M. Liebmann, Christian Y. Mardin, Harry A. Quigley, Alexander F. Scheuerle, Brad Fortune, Balwantray C. Chauhan, Claude F. Burgoyne

Medicine

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

Abstract

Purpose: To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design: Cross-sectional, multicenter study. Methods: A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results: Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions: In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.

Original language	English
Pages (from-to)	91-103
Number of pages	13
Journal	American Journal of Ophthalmology
Volume	217
DOIs	https://doi.org/10.1016/j.ajo.2020.03.050
Publication status	Published - Sept 2020

Bibliographical note

Funding Information:
A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research.

Funding Information:
S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering.

Funding Information:
All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Funding/Support: This work was supported by US National Institutes of Health/National Eye Institute, United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.), Financial Disclosures: K.N.M. received support from Heidelberg Engineering. S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering. A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research. Ya Xing Wang and Hongli Yang contributed equally to this work.

Funding Information:
Funding/Support: This work was supported by US National Institutes of Health / National Eye Institute , United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564 ; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.)

Publisher Copyright:
© 2020 Elsevier Inc.

ASJC Scopus Subject Areas

Ophthalmology

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10.1016/j.ajo.2020.03.050

Cite this

Wang, Y. X., Yang, H., Luo, H., Hong, S. W., Gardiner, S. K., Jeoung, J. W., Hardin, C., Sharpe, G. P., Nouri-Mahdavi, K., Caprioli, J., Demirel, S., Girkin, C. A., Liebmann, J. M., Mardin, C. Y., Quigley, H. A., Scheuerle, A. F., Fortune, B., Chauhan, B. C., & Burgoyne, C. F. (2020). Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes. American Journal of Ophthalmology, 217, 91-103. https://doi.org/10.1016/j.ajo.2020.03.050

Wang, YX, Yang, H, Luo, H, Hong, SW, Gardiner, SK, Jeoung, JW, Hardin, C, Sharpe, GP, Nouri-Mahdavi, K, Caprioli, J, Demirel, S, Girkin, CA, Liebmann, JM, Mardin, CY, Quigley, HA, Scheuerle, AF, Fortune, B, Chauhan, BC & Burgoyne, CF 2020, 'Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes', American Journal of Ophthalmology, vol. 217, pp. 91-103. https://doi.org/10.1016/j.ajo.2020.03.050

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title = "Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes",

abstract = "Purpose: To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design: Cross-sectional, multicenter study. Methods: A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results: Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions: In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.",

author = "Wang, {Ya Xing} and Hongli Yang and Haomin Luo and Hong, {Seung Woo} and Gardiner, {Stuart K.} and Jeoung, {Jin Wook} and Christy Hardin and Sharpe, {Glen P.} and Kouros Nouri-Mahdavi and Joseph Caprioli and Shaban Demirel and Girkin, {Christopher A.} and Liebmann, {Jeffrey M.} and Mardin, {Christian Y.} and Quigley, {Harry A.} and Scheuerle, {Alexander F.} and Brad Fortune and Chauhan, {Balwantray C.} and Burgoyne, {Claude F.}",

note = "Funding Information: A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research. Funding Information: S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering. Funding Information: All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Funding/Support: This work was supported by US National Institutes of Health/National Eye Institute, United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.), Financial Disclosures: K.N.M. received support from Heidelberg Engineering. S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering. A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research. Ya Xing Wang and Hongli Yang contributed equally to this work. Funding Information: Funding/Support: This work was supported by US National Institutes of Health / National Eye Institute , United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564 ; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.) Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = sep,

doi = "10.1016/j.ajo.2020.03.050",

language = "English",

volume = "217",

pages = "91--103",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier USA",

}

TY - JOUR

T1 - Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes

AU - Wang, Ya Xing

AU - Yang, Hongli

AU - Luo, Haomin

AU - Hong, Seung Woo

AU - Gardiner, Stuart K.

AU - Jeoung, Jin Wook

AU - Hardin, Christy

AU - Sharpe, Glen P.

AU - Nouri-Mahdavi, Kouros

AU - Caprioli, Joseph

AU - Demirel, Shaban

AU - Girkin, Christopher A.

AU - Liebmann, Jeffrey M.

AU - Mardin, Christian Y.

AU - Quigley, Harry A.

AU - Scheuerle, Alexander F.

AU - Fortune, Brad

AU - Chauhan, Balwantray C.

AU - Burgoyne, Claude F.

N1 - Funding Information: A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research. Funding Information: S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering. Funding Information: All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Funding/Support: This work was supported by US National Institutes of Health/National Eye Institute, United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.), Financial Disclosures: K.N.M. received support from Heidelberg Engineering. S.D. received financial support from Legacy Good Samaritan Foundation, Carl Zeiss Meditec, Heidelberg Engineering, and NIH/NEI R01-EY-019674. C.A.G. received financial support from Heidelberg Engineering. J.M.L. received financial support from Carl Zeiss Meditec, Topcon, Alcon Laboratories, Allergan, Diopsys, Glaucous, Heidelberg Engineering, Merz Pharmaceutical, Optovue, Quark Pharmaceuticals, and SOLX. C.Y.M. has received financial support from Heidelberg Engineering. H.A.Q. has received financial support from Heidelberg Engineering. A.F.S. has received financial support from Heidelberg Engineering. B.F. has received financial support from Legacy Good Samaritan Foundation and Inotek Pharmaceuticals. B.C.C. has received financial support from Heidelberg Engineering. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The sponsors/funding organizations had no role in the design, conduct, analysis, or reporting of this research. Ya Xing Wang and Hongli Yang contributed equally to this work. Funding Information: Funding/Support: This work was supported by US National Institutes of Health / National Eye Institute , United States (NIH/NEI) grants R01-EY02128 and CIHR- PJT-159564 ; the Legacy Good Samaritan Foundation; and Heidelberg Engineering, GmbH, Heidelberg, Germany (to C.F.B.) Publisher Copyright: © 2020 Elsevier Inc.

PY - 2020/9

Y1 - 2020/9

N2 - Purpose: To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design: Cross-sectional, multicenter study. Methods: A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results: Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions: In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.

AB - Purpose: To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design: Cross-sectional, multicenter study. Methods: A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results: Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions: In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.

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JF - American Journal of Ophthalmology

ER -

Peripapillary Scleral Bowing Increases with Age and Is Inversely Associated with Peripapillary Choroidal Thickness in Healthy Eyes

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