Elsevier

Ophthalmology

Volume 122, Issue 9, September 2015, Pages 1786-1794
Ophthalmology

Original article
Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population: A Multicenter Study

https://doi.org/10.1016/j.ophtha.2015.06.001Get rights and content

Purpose

Conventional optic disc margin-based neuroretinal rim measurements lack a solid anatomic and geometrical basis. An optical coherence tomography (OCT) index, Bruch's membrane opening minimum rim width (BMO-MRW), addresses these deficiencies and has higher diagnostic accuracy for glaucoma. We characterized BMO-MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) in a normal population.

Design

Multicenter cross-sectional study.

Participants

Normal white subjects.

Methods

An approximately equal number of subjects in each decade group (20–90 years of age) was enrolled in 5 centers. Subjects had normal ocular and visual field examination results. We obtained OCT images of the optic nerve head (24 radial scans) and peripapillary retina (1 circular scan). The angle between the fovea and BMO center (FoBMO angle), relative to the horizontal axis of the image frame, was first determined and all scans were acquired and analyzed relative to this eye-specific FoBMO axis. Variation in BMO-MRW and RNFLT was analyzed with respect to age, sector, and BMO shape.

Main Outcome Measures

Age-related decline and between-subject variability in BMO-MRW and RNFLT.

Results

There were 246 eyes of 246 subjects with a median age of 52.9 years (range, 19.8–87.3 years). The median FoBMO angle was −6.7° (range, 2.5° to −17.5°). The BMO was predominantly vertically oval with a median area of 1.74 mm2 (range, 1.05–3.40 mm2). Neither FoBMO angle nor BMO area was associated with age or axial length. Both global mean BMO-MRW and RNFLT declined with age at a rate of −1.34 μm/year and −0.21 μm/year, equivalent to 4.0% and 2.1% loss per decade of life, respectively. Sectorially, the most rapid decrease occurred inferiorly and the least temporally; however, the age association was always stronger with BMO-MRW than with RNFLT. There was a modest relationship between mean global BMO-MRW and RNFLT (r = 0.35), whereas sectorially the relationship ranged from moderate (r = 0.45, inferotemporal) to nonexistent (r = 0.01, temporal).

Conclusions

There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO-MRW and RNFLT in their relationship with age and between each other. Adjusting BMO-MRW and RNFLT for age and sector is important in ensuring optimal diagnostics for glaucoma.

Section snippets

Participants

Study participants of self-identified white descent were recruited in 5 centers: 1 in Canada, 2 in the United States, and 2 in Germany. The study was approved by the ethics review board at each institution. In accordance with the Declaration of Helsinki, all subjects gave informed consent to participate.

A verbal screening for participation was conducted first. A medical history then was obtained, followed by an ocular health assessment that included visual acuity measurement with a standard

Results

There were 259 subjects enrolled and tested, of whom 13 (5.0%) were excluded because of poor OCT image quality. Among the remaining 246 subjects, there were approximately 35 to 40 subjects in each decade group, except the group 80 to 89 years of age, which included 14 subjects. The median age was 52.9 years (range, 19.8–87.3 years).

The FoBMO angle varied widely (Fig 3), with a median of −6.7° (range, 2.5° to −17.5°), relative to the horizontal axis of the image frame. The FoBMO angle was

Discussion

Phenotyping the normal ONH and RNFL and constructing accurate normative databases helps the clinician in diagnosing glaucoma. The current study is important because it characterizes for the first time, to the best of our knowledge, indices based on BMO in a normal population acquired and analyzed with respect to the eye-specific orientation of the fovea relative to the ONH.

We confirmed the notable variation in the position of the fovea compared with the ONH16 or BMO center.15 In the current

References (48)

  • N.M. Jansonius et al.

    A mathematical model for describing the retinal nerve fiber bundle trajectories in the human eye: average course, variability, and influence of refraction, optic disc size and optic disc position

    Exp Eye Res

    (2012)
  • C.A. Girkin et al.

    Variation in optic nerve and macular structure with age and race with spectral-domain optical coherence tomography

    Ophthalmology

    (2011)
  • H.L. Rao et al.

    Comparison of the diagnostic capability of the Heidelberg Retina Tomographs 2 and 3 for glaucoma in the Indian population

    Ophthalmology

    (2010)
  • N.G. Strouthidis et al.

    Comparison of clinical and spectral domain optical coherence tomography optic disc margin anatomy

    Invest Ophthalmol Vis Sci

    (2009)
  • V.J. Srinivasan et al.

    Ultrahigh-speed optical coherence tomography for three-dimensional and en face imaging of the retina and optic nerve head

    Invest Ophthalmol Vis Sci

    (2008)
  • N.G. Strouthidis et al.

    A comparison of optic nerve head morphology viewed by spectral domain optical coherence tomography and by serial histology

    Invest Ophthalmol Vis Sci

    (2010)
  • A.S. Reis et al.

    Influence of clinically invisible, but optical coherence tomography detected, optic disc margin anatomy on neuroretinal rim evaluation

    Invest Ophthalmol Vis Sci

    (2012)
  • B. Povazay et al.

    Minimum distance mapping using three-dimensional optical coherence tomography for glaucoma diagnosis

    J Biomed Optics

    (2007)
  • T.C. Chen

    Spectral domain optical coherence tomography in glaucoma: qualitative and quantitative analysis of the optic nerve head and retinal nerve fiber layer: an AOS thesis

    Trans Am Ophthalmol Soc

    (2009)
  • N.G. Strouthidis et al.

    Longitudinal change detected by spectral domain optical coherence tomography in the optic nerve head and peripapillary retina in experimental glaucoma

    Invest Ophthalmol Vis Sci

    (2011)
  • K. Mizumoto et al.

    Correlation between optic nerve head structural parameters and glaucomatous visual field indices

    Clin Ophthalmol

    (2014)
  • F. Pollet-Villard et al.

    Structure-function relationships with spectral-domain optical coherence tomography retinal nerve fiber layer and optic nerve head measurements

    Invest Ophthalmol Vis Sci

    (2014)
  • S.K. Gardiner et al.

    A method to estimate the amount of neuroretinal rim tissue in glaucoma: comparison with current methods for measuring rim area

    Am J Ophthalmol

    (2014)
  • V.M. Danthurebandara et al.

    Enhanced structure-function relationship in glaucoma with an anatomically and geometrically accurate neuroretinal rim measurement

    Invest Ophthalmol Vis Sci

    (2015)
  • Cited by (0)

    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s):

    B.C.C.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    S.D.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    C.A.G.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    C.Y.M.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    A.F.S.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    C.F.B.: Financial support - Heidelberg Engineering GmbH, Heidelberg, Germany

    Supported by the Canadian Institutes of Health Research, Ottawa, Ontario (grant no.: MOP11357 [B.C.C.]), National Eye Institute, National Institutes of Health, Bethesda, MD (grant no. EY021281 [C.F.B.]); and the Center for Disease Control, Atlanta, GA (C.A.G.).

    Author Contributions:

    Conception and design: Chauhan, Burgoyne

    Analysis and interpretation: Chauhan, Danthurebandara, Burgoyne

    Data collection: Chauhan, Sharpe, Demirel, Girkin, Mardin, Scheuerle,

    Obtained funding: Chauhan

    Overall responsibility: Chauhan

    View full text