Résumé
Purpose: To review and interpret the anatomy of the optic nerve head (ONH) detected with spectral-domain optical coherence tomography (SD OCT) pertaining to the clinical examination of the optic disc and to propose that a paradigm change for clinical assessment of the ONH is necessary. Design: Perspective. Methods: Presently, the clinician evaluates neuroretinal rim health according to the appearance of the optic disc, the clinically visible surface of the ONH. Recent anatomic findings with SD OCT have challenged the basis and accuracy of current rim evaluation. We demonstrate why incorporation of SD OCT imaging of the ONH into the clinical examination of the disc is required. Results: Disc margin-based rim evaluation lacks a solid anatomic basis and results in variably inaccurate measurements for 2 reasons. First, the clinically visible disc margin is an unreliable outer border of rim tissue because of clinically and photographically invisible extensions of Bruch's membrane. Second, rim tissue orientation is not considered in width measurements. We propose alternative anatomically and geometrically accurate SD OCT-based approaches for rim assessment that have enhanced detection of glaucoma. We also argue for new data acquisition and analysis strategies with SD OCT that account for the large interindividual variability in the angle between the fovea and ONH. Conclusions: We propose a 4-point paradigm change for clinical assessment of the ONH that is anchored to the eye-specific anatomy and geometry of the ONH and fovea. Our approach is designed to enhance the accuracy and consistency of rim width, as well as of peripapillary and macular intraretinal thickness measurements.
| Langue d'origine | English |
|---|---|
| Pages (de-à) | 218-227.e2 |
| Journal | American Journal of Ophthalmology |
| Volume | 156 |
| Numéro de publication | 2 |
| DOI | |
| Statut de publication | Published - août 2013 |
Note bibliographique
Funding Information:All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and the following were reported. Dr Chauhan is a consultant for and receives lectures fees from Allergan, receives equipment support and lecture fees from Carl Zeiss Meditec, and receives unrestricted research and equipment support from Heidelberg Engineering. Dr Burgoyne is a consultant to and receives lectures fees from Merck, Sharpe, and Dohme; receives unrestricted research and equipment support from Heidelberg Engineering ; and is a nonpaid consultant to and receives equipment support from Reichert . Dr Chauhan is supported by Grant MOP11357 from the Canadian Institutes of Health Research , Ottawa, Ontario, Canada. Dr Burgoyne is supported by Grants RO1EY011610 and RO1EY021281 from the National Eye Institute, National Institutes of Health , Bethesda, Maryland. Involved in Design of study (B.C.C., C.F.B.); Conduct of study (B.C.C., C.F.B.); Analysis and interpretation of data (B.C.C., C.F.B.); and Preparation, review, and approval of manuscript (B.C.C., C.F.B.). The authors thank Drs Marcelo Nicolela, Neil O'Leary, Alexandre Reis, Faisal AlMobarak, Brad Fortune, Nicholas Strouthidis, and Hongli Yang for their contribution and discussions leading to the various research projects and ideas represented in this article; Drs. Shaban Demirel, Stuart Gardiner, and Brad Fortune of the Portland Progression Project for providing the data in Figure 4 ; Glen Sharpe and Donna Hutchison for data collection and processing; and Juan Reynaud for software support.
ASJC Scopus Subject Areas
- Ophthalmology