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1.  Lack of Association between Glaucoma and Macular Choroidal Thickness Measured with Enhanced Depth-Imaging Optical Coherence Tomography 
Enhanced depth-imaging optical coherence tomography was used to measure choroidal thickness in subjects with normal vision, primary-open angle glaucoma, and normal tension glaucoma. No difference was found in choroidal thickness, suggesting a lack of relationship between choroidal thickness and glaucoma.
Purpose.
To compare choroidal thickness measurements among normal eyes, eyes with normal tension glaucoma (NTG), and those with primary open-angle glaucoma (POAG), and to correlate choroidal thickness with demographic and clinical ocular parameters.
Methods.
Choroidal thickness was measured with enhanced depth-imaging (EDI) optical coherence tomography (OCT) in one eye of 38 normal, 20 NTG, and 56 POAG subjects and compared among groups. The mean age was 69.3 ± 13.6 years (60.1 ± 13.4 years for normal subjects and 73.8 ± 11.3 years for glaucoma subjects; P < 0.001). Measurements were made at the fovea and in the temporal and nasal choroid every 0.5 mm up to 3 mm away from the fovea. Univariate and multivariate linear regression analyses were performed to assess the association between choroidal thickness and demographic and ocular parameters.
Results.
There were no differences in foveal, temporal, or nasal choroidal thickness between normal, NTG, and POAG subjects (all P > 0.05) after adjusting for age, axial length, and intraocular pressure. Similarly, glaucoma severity groups did not differ from each other in all choroidal thickness measurements (all P > 0.05). Age (β = −1.78; P < 0.001) was the most significant factor associated with subfoveal choroidal thickness in the entire group, followed by axial length (β = −11.8; P = 0.002).
Conclusions.
Choroidal thickness does not differ among normal, NTG, and POAG subjects, suggesting a lack of relationship between choroidal thickness and glaucoma based on EDI OCT measurements.
doi:10.1167/iovs.10-6600
PMCID: PMC3109036  PMID: 21357398
2.  Clinicopathologic Correlation of Disc and Peripapillary Region Using SD-OCT 
Purpose
To describe a technique for evaluating peripapillary and optic nerve head (ONH) anatomy using spectral domain optical coherence tomography (SD-OCT) raster scanning in humans and compare quantifiable parameters between diagnosis categories.
Methods
Ninety-five eyes of 51 consecutive patients were evaluated in this retrospective cross-sectional pilot study. Cirrus 5-line raster SD-OCTs with a resolution of 5 to 15 μm obtained through the ONH were included. A single observer manually measured neural canal opening (NCO), prelaminar canal depth (PLCD), peripapillary choroidal thickness (PPCT), and canal nerve fiber layer (CNFL) in normals, ocular hypertension, primary open-angle glaucoma (POAG), low-pressure glaucoma (LPG), secondary glaucoma, and early atrophic age-related macular degeneration. Clinical information, including central corneal thickness (CCT), was obtained via medical record review. Mean anatomical values within diagnosis categories were compared using one-way analysis of variance and multivariate analysis. Bivariate analysis was used to investigate relationships between continuous variables, and significant (p < 0.05) relationships were incorporated into the final statistical model.
Results
Horizontal NCO was significantly greater in eyes with LPG than that in normals (p = 0.021). The PPCT was thinner in age-related macular degeneration (p = 0.001) and glaucoma (p = 0.004) compared with that in controls (normals). Mean CNFL was thinner in POAG (p < 0.001) and LPG (p = 0.053) compared with that in normals. Vertical NCO was inversely correlated to CCT (p = 0.013). Multivariate analysis indicated a positive correlation between PLCD and PPCT (p = 0.008) and an inverse correlation between CNFL and PLCD (p < 0.001). Controlling for PPCT, PLCD and CCTwere inversely correlated (p < 0.001).
Conclusions
The SD-OCT raster scanning may be used to quantify ONH anatomy in humans. The NCO differences between POAG and LPG may indicate a distinct structural vulnerability in LPG. In addition, CNFL, PPCT, and PLCD may be important parameters to consider in glaucoma. The PLCD correlates with PPCT and should be considered in new models of glaucoma pathogenesis.
doi:10.1097/OPX.0b013e318278fc15
PMCID: PMC3775484  PMID: 23232801
Fourier domain OCT; spectral domain OCT; SD-OCT; low-pressure glaucoma; optic disc size; prelaminar canal depth; peripapillary choroidal thickness
3.  Analysis of Normal Peripapillary Choroidal Thickness via Spectral Domain Optical Coherence Tomography 
Ophthalmology  2011;118(10):2001-2007.
PURPOSE
To analyze the normal peripapillary choroidal thickness utilizing a commercial spectral domain optical coherence tomography (OCT) device and determine the inter-grader reproducibility of this method.
DESIGN
Retrospective, non-comparative, non-interventional case series.
PARTICIPANTS
Thirty-six eyes of 36 normal patients seen at the New England Eye Center between April and September 2010.
METHODS
All patients underwent high-definition scanning with the Cirrus HD-OCT. Two raster scans were obtained per eye, a horizontal and a vertical scan, both of which were centered at the optic nerve. Two independent graders individually measured the choroidal thickness. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid-scleral junction at 500 μm intervals away from the optic nerve in the superior, inferior, nasal and temporal quadrants. Statistical analysis was conducted to compare mean choroidal thicknesses. Inter-grader reproducibility was assessed by intraclass correlation coefficient and Pearson’s correlation coefficient. Average choroidal thickness in each quadrant was compared to retinal nerve fiber layer (RNFL) thickness in their respective quadrants.
MAIN OUTCOME MEASURES
Peripapillary choroidal thickness, intraclass coefficient, Pearson’s correlation coefficient.
RESULTS
The peripapillary choroid in the inferior quadrant was significantly thinner compared to all other quadrants (p< 0.001). None of the other quadrants were significantly different from each other in terms of thickness. The inferior peripapillary choroid was significantly thinner compared to all other quadrants at all distances measured away from the optic nerve (p< 0.001). Generally, the peripapillary choroid increases in thickness the farther it was away from the optic nerve and eventually approaching a plateau. Intraclass correlation coefficient ranged from 0.62 to 0.93 and Pearson’s correlation coefficient ranged from 0.74 to 0.95 (p< 0.001). Neither RNFL thickness nor average age was significantly correlated with average choroidal thickness.
CONCLUSIONS
Manual segmentation of the peripapillary choroidal thickness is reproducible between graders suggesting that this method is accurate. The inferior peripapillary choroid was significantly thinner than all other quadrants (p< 0.001).
doi:10.1016/j.ophtha.2011.02.049
PMCID: PMC3184379  PMID: 21703691
4.  Comparison of Retinal Nerve Fiber Layer Thickness between Stratus and Spectralis OCT 
Purpose
To compare the peripapillary retinal nerve fiber layer (RNFL) thickness of normal patients and those with various glaucoma diseases by time domain (Stratus) and spectral domain (Spectralis) optical coherence tomography (OCT).
Methods
The RNFL thickness as measured by the Stratus and Spectral OCT was compared (paired t-test). The relationship and agreement of RNFL thickness between the two OCT modalities were evaluated by Pearson correlation, Bland-Altman plot, and area under the receiver operating characteristic curve.
Results
Two-hundred seventeen eyes of 217 patients, including twenty-four normal eyes, ninety-one glaucoma suspects, seventy-six normal tension glaucoma cases, and twenty-six primary open angle glaucoma cases (POAG) were analyzed. The peripapillary RNFL thicknesses as measured by Stratus OCT were significantly greater than those measured by Spectralis OCT. However, in quadrant comparisons, the temporal RNFL thickness obtained using Stratus OCT were significantly less than those obtained using Spectralis OCT. Correlations between RNFL parameters were strong (Pearson correlation coefficient for mean RNFL thickness = 0.88); a high degree of correlation was found in the POAG group. Bland-Altman plotting demonstrated that agreement in the temporal quadrant was greater than any other quadrant.
Conclusions
Both OCT systems were highly correlated and demonstrated strong agreement. However, absolute measurements of peripapillary RNFL thickness differed between Stratus OCT and Spectralis OCT. Thus, measurements with these instruments should not be considered interchangeable. The temporal quadrant was the only sector where RNFL thickness as measured by Spectralis OCT was greater than by Stratus OCT; this demonstrated greater agreement than other sectors.
doi:10.3341/kjo.2011.25.3.166
PMCID: PMC3102819  PMID: 21655041
Retinal nerve fiber layer thickness; Spectral domain optical coherence tomography; Time domain optical coherence tomography
5.  Comparison of Retinal Nerve Fiber Layer Measurements Using Time Domain and Spectral Domain Optical Coherent Tomography 
Ophthalmology  2009;116(7):1271-1277.
Purpose
To determine the agreement between peripapillary retinal nerve fiber layer (RNFL) thickness measurements from Stratus time domain optical coherence tomography (OCT) and Cirrus spectral domain OCT (Carl Zeiss Meditec, Dublin, CA) in normal subjects and glaucoma patients.
Design
Evaluation of diagnostic test or technology.
Participants
One hundred thirty eyes from 130 normal subjects and glaucoma patients were analyzed. The subjects were divided into Normal (n=29), Glaucoma Suspect (n=12), Mild Glaucoma (n=41), Moderate Glaucoma (n=18), and Severe Glaucoma (n=30) by visual field criteria.
Methods
Peripapillary RNFL thickness was measured with Stratus Fast RNFL and Cirrus 200 x 200 Optic Disc Scan on the same day in one eye of each subject to determine agreement. Two operators used the same instruments for all scans.
Main Outcome Measures
Student paired t-testing, Pearson’s correlation coefficient, and Bland-Altman analysis of RNFL thickness measurements.
Results
The average age of the glaucoma group was significantly older at 68.3±12.3 years versus 55.7±12.1 years. The average RNFL thickness (mean ± SD, in μm) for each severity group with Stratus OCT was 99.4 ± 13.2, 94.5 ± 15.0, 79.0 ± 14.5, 62.7 ± 10.2, and 51.0 ± 8.9, corresponding to normal, suspects, mild, moderate, and severe subjects, respectively. For Cirrus OCT, the corresponding measurements were 92.0 ± 10.8, 88.1 ± 13.5, 73.3 ± 11.8, 60.9 ± 8.3, and 55.3 ± 6.6. All Stratus-Cirrus differences were statistically significant by paired t-testing (p < 0.001) except for the moderate group (p = 0.11). For average RNFL, there was a highly significant linear relationship between Stratus minus Cirrus difference and RNFL thickness as well (p < 0.001). Bland-Altman plots showed that the systematic difference of Stratus measurements are smaller than Cirrus at thinner RNFL values but larger at thicker RNFL measurements.
Conclusions
RNFL thickness measurements between Stratus OCT and Cirrus OCT cannot be directly compared. Clinicians should be aware that measurements are generally higher with Stratus than Cirrus except when the RNFL is very thin as in severe glaucoma. This difference must be taken into account if comparing measurements made with a Stratus instrument to those of a Cirrus instrument.
doi:10.1016/j.ophtha.2008.12.032
PMCID: PMC2713355  PMID: 19395086
6.  Peripapillary choroidal thickness in healthy Chinese subjects 
BMC Ophthalmology  2013;13:23.
Background
To evaluate the peripapillary choroidal thickness of a healthy Chinese population, and to determine its influencing factors.
Methods
A total of 76 healthy volunteers (76 eyes) without ophthalmic or systemic symptoms were enrolled. Choroidal scans (360-degree 3.4 mm diameter peripapillary circle scans) were obtained for all eyes using enhanced depth imaging spectral-domain optical coherence tomography. Choroid thickness was measured at the temporal, superotemporal, superior, superonasal, nasal, inferonasal, inferior, and inferotemporal segments.
Results
The average peripapillary choroidal thicknesses were 165.03 ± 40.37 μm. Inferonasal, inferior, and inferotemporal thicknesses were significantly thinner than temporal, superotemporal, superior, superonasal, nasal thicknesses (p < 0.05). No statistically significant difference was found among inferonasal, inferior, and inferotemporal thicknesses. The average peripapillary choroidal thickness decreased linearly with age (β = −1.33, 95% CI −1.98, -0.68, P < 0.001). No correlation was noted between average choroidal thickness and other factors (gender, refractive error, axial length, average retinal nerve fiber layer thickness, intraocular pressure, diastolic blood pressure, systolic blood pressure, mean blood pressure, diastolic ocular perfusion pressure, systolic ocular perfusion pressure, and mean ocular perfusion pressure).
Conclusions
The inferonasal, inferior, inferotemporal peripapillary choroidal thicknesses were significantly thinner than temporal, superotemporal, superior, superonasal, and nasal thicknesses. A thinner peripapillary choroid is associated with increasing age.
doi:10.1186/1471-2415-13-23
PMCID: PMC3685566  PMID: 23758729
Peripapillary choroidal thickness; Enhanced depth imaging optical coherence tomography; Healthy Chinese subjects
7.  Choroidal and macular thickness changes induced by cataract surgery 
Background
The aim of this study was to evaluate the effect of uneventful phacoemulsification on the morphology and thickness of the macula, the submacular choroid, and the peripapillary choroid.
Methods
In 14 eyes from 14 patients, retinal macular thickness, choroidal submacular thickness, and choroidal peripapillary thickness were measured preoperatively and at one week and one month after phacoemulsification using enhanced depth imaging spectral domain optical coherence tomography. Changes in thickness of the different ocular tissues were evaluated.
Results
There was a statistically significant increase in mean retinal macular thickness at one month. In horizontal scans, the mean increase was +8.67±6.75 μm (P<0.001), and in vertical scans, the mean increase was +8.80±7.07 μm (P=0.001). However, there were no significant changes in choroidal morphology in the submacular and peripapillary areas one month after surgery. In vertical scans, there was a nonsignificant increase in choroidal thickness (+4.21±20.2 μm; P=0.47) whilst in horizontal scans a nonsignificant decrease was recorded (−9.11±39.59 μm; P=0.41). In peripapillary scans, a nonsignificant increase in mean choroidal thickness was registered (+3.25±11.80 μm; P=0.36).
Conclusion
Uncomplicated phacoemulsification induces nonpathologic increases in retinal macular thickness probably due to the inflammatory insult of the surgery; however these changes are not accompanied by significant changes in choroidal thickness. In the posterior segment, the morphologic response to the inflammatory insult of phacoemulsification is mainly observed at the retinal level, and seems to be independent of choroidal thickness changes.
doi:10.2147/OPTH.S53989
PMCID: PMC3869938  PMID: 24368877
phacoemulsification; macular thickness; choroidal thickness; prostaglandins
8.  2-D Pattern of Nerve Fiber Bundles in Glaucoma Emerging from Spectral-Domain Optical Coherence Tomography 
Through a structure-structure correlation analysis of focal macular and peripapillary SD-OCT regions in 57 subjects with glaucoma (or glaucoma suspicion), a color-coded map closely resembling the nerve fiber bundle pattern of retinal ganglion cells emerged.
Purpose.
To correlate the thicknesses of focal regions of the macular ganglion cell layer with those of the peripapillary nerve fiber layer using spectral-domain optical coherence tomography (SD-OCT) in glaucoma subjects.
Methods.
Macula and optic nerve head SD-OCT volumes were obtained in 57 eyes of 57 subjects with open-angle glaucoma or glaucoma suspicion. Using a custom automated computer algorithm, the thickness of 66 macular ganglion cell layer regions and the thickness of 12 peripapillary nerve fiber layer regions were measured from registered SD-OCT volumes. The mean thickness of each ganglion cell layer region was correlated to the mean thickness of each peripapillary nerve fiber layer region across subjects. Each ganglion cell layer region was labeled with the peripapillary nerve fiber layer region with the highest correlation using a color-coded map.
Results.
The resulting color-coded correlation map closely resembled the nerve fiber bundle (NFB) pattern of retinal ganglion cells. The mean r2 value across all local macular-peripapillary correlations was 0.49 (± 0.11). When separately analyzing the 30 glaucoma subjects from the 27 glaucoma-suspect subjects, the mean r2 value across all local macular-peripapillary correlations was significantly larger in the glaucoma group (0.56 ± 0.13 vs. 0.37 ± 0.11; P < 0.001).
Conclusions.
A two-dimensional (2-D) spatial NFB map of the retina can be developed using structure-structure relationships from SD-OCT. Such SD-OCT-based NFB maps may enhance glaucoma detection and contribute to monitoring change in the future.
doi:10.1167/iovs.11-8349
PMCID: PMC3292380  PMID: 22222272
9.  Ability of Cirrus™ HD-OCT Optic Nerve Head Parameters to Discriminate Normal from Glaucomatous Eyes 
Ophthalmology  2010;118(2):241-248.e1.
Purpose
To determine the ability of optic nerve head (ONH) parameters measured with spectral domain Cirrus™ HD-OCT to discriminate between normal and glaucomatous eyes and to compare them to the discriminating ability of peripapillary retinal nerve fiber layer (RNFL) thickness measurements performed with Cirrus™ HD-OCT.
Design
Evaluation of diagnostic test or technology.
Participants
Seventy-three subjects with glaucoma and one hundred and forty-six age-matched normal subjects.
Methods
Peripapillary ONH parameters and RNFL thickness were measured in one randomly selected eye of each participant within a 200×200 pixel A-scan acquired with Cirrus™ HD-OCT centered on the ONH.
Main Outcome Measures
ONH topographic parameters, peripapillary RNFL thickness, and the area under receiver operating characteristic curves (AUCs).
Results
For distinguishing normal from glaucomatous eyes, regardless of disease stage, the six best parameters (expressed as AUC) were vertical rim thickness (VRT, 0.963), rim area (RA, 0.962), RNFL thickness at clock-hour 7 (0.957), RNFL thickness of the inferior quadrant (0.953), vertical cup-to-disc ratio (VCDR, 0.951) and average RNFL thickness (0.950). The AUC for distinguishing between normal and eyes with mild glaucoma was greatest for RNFL thickness of clock-hour 7 (0.918), VRT (0.914), RA (0.912), RNFL thickness of inferior quadrant (0.895), average RNFL thickness (0.893) and VCDR (0.890). There were no statistically significant differences between AUCs for the best ONH parameters and RNFL thickness measurements (p > 0.05).
Conclusions
Cirrus™ HD-OCT ONH parameters are able to discriminate between eyes that are normal from those with glaucoma or even mild glaucoma. There is no difference in the ability of ONH parameters and RNFL thickness measurement, as measured with Cirrus™ OCT, to distinguish between normal and glaucomatous eyes.
doi:10.1016/j.ophtha.2010.06.036
PMCID: PMC3017237  PMID: 20920824
10.  Diabetic Retinopathy and Peripapillary Retinal Thickness 
Purpose
To assess the diagnostic efficacy of macular and peripapillary retinal thickness measurements for the staging of diabetic retinopathy (DR) and the prediction of disease progression.
Methods
In this prospective study, 149 diabetic patients (149 eyes) and 50 non-diabetic control subjects were included. Baseline optical coherence tomography was employed to measure retinal thickness in the macula (horizontal, vertical, and central) and the peripapillary zone (superior, inferior, nasal, and concentric to the optic disc). Seven baseline parameters were correlated with the DR stages identified by fluorescein angiography. Baseline retinal thickness was compared between groups of patients requiring panretinal photocoagulation (PRP) within 6 months (PRP group) and patients not requiring PRP (No-PRP group).
Results
Macular and peripapillary retinal thicknesses in diabetic subjects were significantly greater than that in normal controls (p<0.05). All retinal thickness parameters, and particularly peripapillary circular scans, tended to increase with increasing DR severity (p<0.05). The baseline thicknesses of the peripapillary circular scans were greater in the PRP group than in the no-PRP group (p<0.05).
Conclusions
Peripapillary retinal thickness may prove to be a useful criterion for DR severity and may also serve as an indicator of disease progression.
doi:10.3341/kjo.2010.24.1.16
PMCID: PMC2817818  PMID: 20157409
Diabetic retinopathy; Laser photocoagulation; Retina; Mass screening
11.  Choroidal Thickness Measured by Spectral Domain Optical Coherence Tomography: Factors Affecting Thickness in Glaucoma Patients 
Ophthalmology  2011;118(8):1571-1579.
Purpose
To measure choroidal thickness and to determine parameters associated with it.
Design
Cross-sectional study.
Participants
Seventy-four glaucoma patients and glaucoma suspects.
Methods
Spectral domain optical coherence tomography (SDOCT) scans were obtained to estimate average choroidal thickness in a group of glaucoma suspects and glaucoma patients. Average thickness was calculated from enhanced depth SDOCT images and manually analyzed with Image J software. Open angle glaucoma, open angle glaucoma suspect, primary angle closure glaucoma, primary angle closure, and primary angle closure suspect were defined by published criteria. Glaucoma suspects had normal visual fields bilaterally. Glaucoma was defined by specific criteria for optic disc damage and visual field loss in at least one eye. The most affected eye was analyzed for comparisons across individuals, while right/left and upper half/lower half comparisons were made to compare thickness against degree of visual field damage.
Main Outcome Measured
Average macular and peripapillary choroidal thickness measured using SDOCT.
Results
The choroidal-scleral interface (CSI) was visualized in 86% and 96% of the macular and peripapillary scans, respectively. In multivariable linear regression analysis, the macular choroid was significantly thinner in association with 4 features: longer eyes (22 µm per mm longer [95% confidence Interval (CI): −33, −11]), older individuals (31 µm thinner per decade older [95% CI: −44 −17]), lower diastolic ocular perfusion pressure (26 µm thinner per 10 mmHg lower [95% CI: 8, 44]), and thicker central corneas (6 µm per 10 µm thicker cornea [95% CI: −10, 0]). The choroid was not significantly thinner in glaucoma patients than in suspects (14 µm [95% CI: −54, 26], p=0.5). Peripapillary choroidal thickness was not significantly different between glaucomaand suspect patients. Thickness was not associated with damage severity as estimated by visual field mean deviation or nerve fiber layer thickness, including comparisons of right to left eye or upper to lower values.
Conclusion
Age, axial length, central corneal thickness, and diastolic ocular perfusion pressure are significantly associated with choroidal thickness in glaucoma suspects and glaucoma patients. Degree of glaucoma damage was not consistently associated with choroidal thickness.
doi:10.1016/j.ophtha.2011.01.016
PMCID: PMC3139809  PMID: 21492939
12.  Peripapillary Retinal Nerve Fiber Layer Thickness Measurement by Three-Dimensional Optical Coherence Tomography in a Normal Population 
Purpose
To determine peripapillary retinal nerve fiber layer (RNFL) thickness values by three-dimensional optical coherence tomography (3D-OCT) in a normal Iranian population and to evaluate the concordance of these measurements with those obtained by the second generation of optical coherence tomography (OCT II).
Methods
In a cross-sectional observational study, 96 normal Iranian subjects 20-53 years old were enrolled. Peripapillary RNFL thickness in one randomly selected eye of each subject was measured by 3D-OCT and also by OCT II. Standard achromatic perimetry, corneal pachymetry and A-scan ultrasonographic biometry were also performed. Other study variables included age, gender, laterality (right versus left eye), refractive error, corneal diameter and disc area.
Results
Mean peripapillary RNFL thickness measured by 3D-OCT (75.50±8.38) μm was significantly less than that measured by OCT II (144.10±33.32 μm) (P<0.001). Using 3DOCT, no significant difference in peripapillary RNFL thickness was observed by gender (P=0.90) or laterality (P=0.17); RNFL thickness had no correlation with age (P=0.95), axial length (P=0.32), spherical equivalent refractive error (P=0.21), central corneal thickness (P=0.66) and disc area (P=0.31). However, a positive correlation was found between peripapillary RNFL thickness and corneal diameter (P=0.03).
Conclusion
3D-OCT seems to yield lower RNFL thickness values as compared to OCT II. It seems advisable to obtain separate baseline measurements when using different generations of OCT machines.
PMCID: PMC3507263  PMID: 23330060
Optical Coherence Tomography; Retinal Nerve Fiber Layer Thickness; Three-Dimensional Tomography
13.  Optical Coherence Tomography Disc Assessment in Optic Nerves With Peripapillary Atrophy 
BACKGROUND AND OBJECTIVE
Optical coherence tomography (OCT) is able to determine the optic disc margin automatically. The aim of this study was to investigate the accuracy of the automatic OCT optic nerve head measurements in the presence of peripapillary atrophy.
PATIENTS AND METHODS
This was a cross-sectional, retrospective study. Thirty-one subjects with peripapillary atrophy underwent optic nerve head scanning with OCT version 3. Nineteen of the eyes were classified clinically as having glaucoma, nine had suspected glaucoma, and three were normal. Automatic OCT results were compared with manual tracing results.
RESULTS
Significant differences were found between most OCT optic nerve head automated and manual disc assessment parameters; however, good agreement was found between the two methods for all parameters (intraclass correlation, 0.71 to 0.94). Areas under receiver operator characteristics curves for clinical status were similar for all parameters with both methods.
CONCLUSION
Automated OCT optic nerve head analysis may be used in the clinical setting in the presence of peripapillary atrophy; however, caution should be used when comparing individual results with population-derived optic nerve head results.
PMCID: PMC1950848  PMID: 14620759
14.  Simplified Method to Measure the Peripapillary Choroidal Thickness Using Three-dimensional Optical Coherence Tomography 
Purpose
To evaluate a simplified method to measure peripapillary choroidal thickness using commercially available, three-dimensional optical coherence tomography (3D-OCT).
Methods
3D-OCT images of normal eyes were consecutively obtained from the 3D-OCT database of Korea University Medical Center On the peripapillary images for retinal nerve fiber layer (RNFL) analysis, choroidal thickness was measured by adjusting the segmentation line for the retinal pigment epithelium to the chorioscleral junction using the modification tool built into the 3D-OCT image viewer program. Variations of choroidal thickness at 12 sectors of the peripapillary area were evaluated.
Results
We were able to measure the peripapillary choroidal thickness in 40 eyes of our 40 participants, who had a mean age of 41.2 years (range, 15 to 84 years). Choroidal thickness measurements had strong inter-observer correlation at each sector (r = 0.901 to 0.991, p < 0.001). The mean choroidal thickness was 191 ± 62 µm. Choroidal thickness was greatest at the temporal quadrant (mean ± SD, 210 ± 78 µm), followed by the superior (202 ± 66 µm), nasal (187 ± 64 µm), and inferior quadrants (152 ± 59 µm).
Conclusions
The measurement of choroidal thickness on peripapillary circle scan images for RNFL analysis using the 3D-OCT viewing program was highly reliable and efficient.
doi:10.3341/kjo.2013.27.3.172
PMCID: PMC3663059  PMID: 23730109
Choroid; Optical coherence tomography; Retina; Retinal nerve fiber layer
15.  Peripapillary Intrachoroidal Cavitations. The Beijing Eye Study 
PLoS ONE  2013;8(10):e78743.
Purpose
To assess prevalence, size and location of peripapillary intrachoroidal cavitations (PICCs) and their associations in a population-based sample. .
Methods
The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range:50-93 years). A detailed ophthalmic examination included enhanced depth imaging of the choroid by spectral-domain optical coherence tomography and fundus photography. PICCs were defined as triangular thickening of the choroid with the base at the optic disc border and a distance between Bruch´s membrane and sclera of ≥200μm. Parapapillary large choroidal vessels were excluded.
Results
Out of 94 subjects with high myopia (refractive error <-6.0 diopters or axial length >26.5mm in right eyes), OCT images were available for 89 (94.7%) participants. A PICC was detected in 15 out of these 89 highly myopic subjects (prevalence:16.9±4.0%) and in none of hyperopic, emmetropic or medium myopic subgroups each consisting of 100 randomly selected subjects. Mean PICC width was 4.2±2.3 hours (30°) of disc circumference and mean length was 1363±384μm. PICCs were located most frequently (40%) at the inferior disc border. On fundus photos, a typical yellow-orange lesion was found in 8 (53%) eyes with PICCs. In binary regression analysis, presence of PICCs was significantly associated with optic disc tilting (P=0.04) and presence of posterior staphylomata (P=0.046).
Conclusions
Prevalence of PICCs in the adult Chinese population was 16.9±4.0% in the highly myopic group, with no PICCs detected in non-highly myopic eyes. PICCs were located most frequently at the inferior optic disc border. Only half of the PICCs detected on OCT images showed a yellow-orange lesion on fundus photos. Presence of PICC was significantly associated only with an increased optic disc tilting and presence of posterior staphylomata, while it was not associated with axial length, refractive error or other ocular or systemic parameters.
doi:10.1371/journal.pone.0078743
PMCID: PMC3840228  PMID: 24302981
16.  Regional Correlation Among Ganglion Cell Complex, Nerve Fiber Layer, and Visual Field Loss in Glaucoma 
Purpose.
To analyze the relationship among macular ganglion cell complex (GCC) thickness, peripapillary nerve fiber layer (NFL) thickness, and visual field (VF) defects in patients with glaucoma.
Methods.
A Fourier-domain optical coherence tomography (FD-OCT) system was used to map the macula and peripapillary regions of the retina in 56 eyes of 38 patients with perimetric glaucoma. The macular GCC and peripapillary NFL thicknesses were mapped and standard automated perimetry (SAP) was performed. Loss of GCC and NFL were correlated with the VF map on both a point-by-point and regional basis.
Results.
Correlation between GCC thickness and peripapillary NFL thickness produced a detailed correspondence map that demonstrates the arcuate course of the NFL in the macula. Corresponding regions within the GCC, NFL, and VF maps demonstrate significant correlation, once parafoveal retinal ganglion cell (RGC) displacement is taken into account.
Conclusions.
There are significant point-specific and regional correlations between GCC loss, NFL loss, and deficits on SAP. Using these different data sources together may improve our understanding of glaucomatous damage and aid in the management of patients with glaucoma.
There is significant region-specific correlation between macular ganglion cell complex thickness and two commonly utilized measures of glaucomatous damage, peripapillary nerve fiber layer thickness and visual field deficits. These parameters may be complementary in managing patients with glaucoma.
doi:10.1167/iovs.12-11388
PMCID: PMC3691052  PMID: 23716631
optical coherence tomography; visual field; retinal nerve fiber layer; ganglion cell complex
17.  Peripapillary fundus perimetry in eyes with glaucoma 
The British Journal of Ophthalmology  2006;90(11):1398-1403.
Aims
To evaluate, with fundus perimetry, the peripapillary differential light threshold (DLT) in eyes with glaucoma and ocular hypertension (OHT), and compare it with peripapillary retinal nerve fibre layer (RNFL) thickness.
Methods
35 glaucomatous, 29 OHT and 24 control eyes were included. Peripapillary DLT at 1° from the optic nerve head was quantified with fundus perimetry; peripapillary RNFL thickness was measured over the same area by optical coherence tomography.
Results
Mean (SD) peripapillary DLT was 19.2 (1.7), 17.6 (4.2) and 10.1 (6.9) dB in control, OHT and glaucomatous eyes, respectively (p<0.001). Mean (SD) RNFL thickness was 98.4 (35.3), 83.9 (35.1) and 55.8 (28.2) μm, respectively (p<0.001). Mean peripapillary DLT showed higher sensitivity and specificity in differentiating the three groups compared with RNFL thickness.
Conclusion
Progressive, significant reduction of peripapillary DLT was documented in OHT and glaucomatous eyes compared with controls (p<0.001). DLT reduction parallels RNFL reduction.
doi:10.1136/bjo.2006.092973
PMCID: PMC1857496  PMID: 16809380
18.  Automated Quantification of Volumetric Optic Disc Swelling in Papilledema Using Spectral-Domain Optical Coherence Tomography 
Purpose.
To develop an automated method for the quantification of volumetric optic disc swelling in papilledema subjects using spectral-domain optical coherence tomography (SD-OCT) and to determine the extent that such volumetric measurements correlate with Frisén scale grades (from fundus photographs) and two-dimensional (2-D) peripapillary retinal nerve fiber layer (RNFL) and total retinal (TR) thickness measurements from SD-OCT.
Methods.
A custom image-analysis algorithm was developed to obtain peripapillary circular RNFL thickness, TR thickness, and TR volume measurements from SD-OCT volumes of subjects with papilledema. In addition, peripapillary RNFL thickness measures from the commercially available Zeiss SD-OCT machine were obtained. Expert Frisén scale grades were independently obtained from corresponding fundus photographs.
Results.
In 71 SD-OCT scans, the mean (± standard deviation) resulting TR volumes for Frisén scale 0 to scale 4 were 11.36 ± 0.56, 12.53 ± 1.21, 14.42 ± 2.11, 17.48 ± 2.63, and 21.81 ± 3.16 mm3, respectively. The Spearman's rank correlation coefficient was 0.737. Using 55 eyes with valid Zeiss RNFL measurements, Pearson's correlation coefficient (r) between the TR volume and the custom algorithm's TR thickness, the custom algorithm's RNFL thickness, and Zeiss' RNFL thickness was 0.980, 0.929, and 0.946, respectively. Between Zeiss' RNFL and the custom algorithm's RNFL, and the study's TR thickness, r was 0.901 and 0.961, respectively.
Conclusions.
Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches.
Volumetric optic disc swelling is quantified using a custom image-analysis algorithm from subjects with papilledema. The resulting mean volumes are roughly linearly related to corresponding expert-defined Frisén scale grades.
doi:10.1167/iovs.12-9438
PMCID: PMC3392074  PMID: 22599584
19.  Attenuated Age-Related Thinning of Peripapillary Retinal Nerve Fiber Layer in Long Eyes 
Purpose
To assess the impact of axial length on the age-related peripapillary retinal nerve fiber layer (RNFL) thinning.
Methods
This cross-sectional observational comparative case series included 172 eyes from 172 healthy Korean subjects. Peripapillary RNFL thickness was measured using an Optic Disc Cube 200 × 200 scan of spectral domain Cirrus HD OCT and the axial length was measured using IOL Master Advanced Technology. In age groups based on decade, the normal ranges of peripapillary RNFL thickness for average, quadrant, and clock-hour sectors were determined with 95% confidence intervals. After dividing the eyes into two groups according to axial length (cut-off, 24.50 mm), the degrees of age-related RNFL thinning were compared.
Results
Among the eyes included in the study, 53 (30.81%) were considered to be long eyes (axial length, 25.04 ± 0.48 µm) and 119 (69.19%) were short-to-normal length eyes (axial length, 23.57 ± 0.60 µm). The decrease in average RNFL thickness with age was less in long eyes (negative slope, -0.12 µm/yr) than in short-to-normal length eyes (negative slope, -0.32 µm/yr) (p < 0.001).
Conclusions
Age-related thinning of peripapillary RNFL thickness is attenuated in long eyes compared to short-to-normal length eyes.
doi:10.3341/kjo.2011.25.4.248
PMCID: PMC3149135  PMID: 21860571
Axial length; Glaucoma; Optical coherence tomography; Retinal ganglion cell
20.  Peripapillary Retinal Nerve Fiber Layer Thinning in Patients With Autosomal Recessive Cone-Rod Dystrophy 
American journal of ophthalmology  2009;148(2):260-265.e1.
PURPOSE
To evaluate peripapillary retinalnerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT) in patients with autosomal recessive cone-rod dystrophy (CRD).
DESIGN
Cross-sectional study.
METHODS
Eleven patients (22 eyes) with CRD were studied, including 4 patients with identified ABCA4 gene mutations. Peripapillary RNFL thickness was measured in 16 segments from 4 quadrants. The analyses were based on age- and disc size-adjusted normative data. An abnormal thinning was considered when RNFL thickness measurements were under the 5th percentile in at least 2 out of 4 segments in a quadrant. Mean RNFL thickness was quantitatively compared to normative data obtained from 134 subjects.
RESULTS
Eight patients (73%) had peripapillary RNFL thinning in at least one quadrant of at least one eye, including 3 out of 4 patients with known ABCA4 gene mutations. Peripapillary RNFL thinning in the temporal quadrant was most commonly seen in 11 (79%) of 14 eyes with thinning in at least one quadrant. Significant thinning of the overall peripapillary RNFL was observed in CRD patients compared to that of controls (p=0.0002). Subgroup analysis showed that 8 (89%) of 9 patients who were older than 40 years had thinning in at least one quadrant of at least one eye.
CONCLUSIONS
Peripapillary RNFL thinning was commonly observed in our patients with autosomal recessive CRD. The results confirm that the inner retinal structures can be affected in outer retinal disease. Careful evaluation of the inner retina may be important in determining the success rate of potential treatments for predominantly outer retinal diseases.
doi:10.1016/j.ajo.2009.03.001
PMCID: PMC2976650  PMID: 19406377
21.  Choroidal haemodynamics in glaucoma 
AIM—Quantification of haemodynamics of the peripapillary choroid in and the assessment of possible differences between normal subjects (N), ocular hypertensive (OHT), primary open angle (POAG), and normal pressure glaucoma (NPG) patients.
METHODS—Video fluorescein angiograms (Rodenstock SLO 101) were made in 22 N subjects, 12 OHT, 48 POAG, and 46 NPG patients. The angiographically derived dye build up curves were described by means of an exponential model. One of the model parameters is the time constant τ theoretically reflecting local blood refreshment time; the blood refreshment time τ is the time needed to replace the blood volume in the choriocapillaris, inversely proportional to the local choroidal blood flow. Other variables are maximal fluorescence (Fdt) and time of first fluorescence (t0). Mean variable values were calculated for disc area and circular areas around the disc.
RESULTS—Fdt of the disc was significantly lower in the POAG and NPG patients. There was no statistical difference in t0 between the study groups. The choroidal blood refreshment time was significantly longer in NPG patients and to a lesser extent in the POAG patients compared with the normal controls. The slowest choroidal blood refreshment can be found in the NPG group. The median choroidal blood refreshment times (25th-75th percentile) in the controls, OHT, POAG, and NPG patients were 4.1 (3.7-4.5), 4.4 (3.7-6.4), 5.8 (4.3-6.8), and 7.1 (5.5-9.3) seconds respectively.
CONCLUSIONS—With the help of parametrisation of dye curves, using a one compartmental model, choroidal haemodynamics can be quantified. The blood refreshment time of the peripapillary choriocapillaris was found to be significantly prolonged especially in NPG patients; this may indicate slower choroidal haemodynamics in NPG patients.


PMCID: PMC1722313  PMID: 9422924
22.  Comparison of OCT and HRT Findings Among Normal, Normal Tension Glaucoma, and High Tension Glaucoma 
Purpose
To evaluate the relationship between optic disc and retinal nerve fiber layer (RNFL) measurements obtained with the optical coherence tomography (OCT) and the Heidelberg retina topography (HRT) in normal, normal tension glaucoma (NTG), and high tension glaucoma (HTG).
Methods
Normal, NTG and HTG subjects who met inclusion and exclusion criteria were evaluated retrospectively. One hundred seventy eyes of 170 patients (30 normal, 40 NTG, and 100 HTG) were enrolled. Complete ophthalmologic examination, HRT, OCT, and automated perimetry were evaluated.
Results
Disc area, cup area and cup/disc area ratio measured with HRT were significantly different between NTG and HTG (all p<0.05). Mean RNFL thickness measured by OCT with ascanning diameter of 3.4 mm was larger in NTG than HTG (84.97±24.20 µm vs. 73.53±27.17 µm, p=0.037). Four quadrant RNFL thickness measurements were not significantly different between NTG and HTG (all p>0.05). Mean deviation and corrected pattern standard deviation measured by automated perimetry was significantly correlated with mean and inferior RNFL thickness in both NTG and HTG (Pearson's r, p<0.05). Mean RNFL thickness/disc area ratio was significantly larger in HTG than NTG (35.21±18.92 vs. 31.30±10.91, p=0.004).
Conclusions
These findings suggest that optic disc and RNFL damage pattern in NTG may be different from those of HTG.
doi:10.3341/kjo.2008.22.4.236
PMCID: PMC2629909  PMID: 19096240
High tension glaucoma; Normal tension glaucoma; Retinal nerve fiber layer
23.  Peripapillary retinal blood flow in normal tension glaucoma 
AIMS—To determine if normal tension glaucoma (NTG) patients differ from age matched controls in blood flow to the peripapillary retina, as measured with confocal scanning laser Doppler flowmetry (cSLDF; "Heidelberg retinal flowmetry").
METHODS—12 NTG patients and 12 age matched controls were compared using (a) 10 × 10 pixel boxes (the instrument default sample size), taken from the nasal and temporal peripapillary retina, (b) the average from two of these boxes, and (c) every qualifying pixel within the peripapillary retina.
RESULTS—Patients and controls did not differ in blood flow measured using the default sample from a single 10 × 10 pixel box, placed in either the temporal or nasal peripapillary retina, or expressed as the average from these two boxes. However, in histograms using every pixel from the peripapillary retina, NTG patients displayed significantly higher percentages of minimal flow pixels (defined as less than one arbitrary unit of flow: 30% v 19%, p <0.01), and significantly lower flow in the 25th, 50th, and 75th percentile flow pixel (each p <0.05) than did age matched controls.
CONCLUSION—NTG is characterised by reduced blood flow in the peripapillary retina, a result suggesting that blood flow deficits accompany, and perhaps may contribute to, disease development in these patients.

 Keywords: glaucoma; retina; blood flow; laser Doppler flowmeter
PMCID: PMC1722989  PMID: 10434872
24.  Ability of spectral domain optical coherence tomography peripapillary retinal nerve fiber layer thickness measurements to identify early glaucoma 
Indian Journal of Ophthalmology  2011;59(6):455-459.
Purpose:
To evaluate the ability of spectral domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness (RNFLT) parameters to distinguish normal eyes from those with early glaucoma in Asian Indian eyes.
Design:
Observational cross-sectional study.
Materials and Methods:
One hundred and seventy eight eyes (83 glaucoma patients and 95 age matched healthy subjects) of subjects more than 40 years of age were included in the study. All subjects underwent RNFLT measurement with spectral OCT/ scanning laser ophthalmoscope (SLO) after dilatation. Sensitivity, specificity and area under the receiving operating characteristic curve (AROC) were calculated for various OCT peripapillary RNFL parameters.
Results:
The mean RNFLT in healthy subjects and patients with early glaucoma were 105.7 ± 5.1 μm and 90.7 ± 7.5 μm, respectively. The largest AROC was found for 12 o’clock- hour (0.98), average (0.96) and superior quadrant RNFLT (0.9). When target specificity was set at ≥ 90% and ≥ 80%, the parameters with highest sensitivity were 12 o’clock -hour (91.6%), average RNFLT (85.3%) and 12 o’ clock- hour (96.8 %), average RNFLT (94.7%) respectively.
Conclusion:
Our study showed good ability of spectral OCT/ SLO to differentiate normal eyes from patients with early glaucoma and hence it may serve as an useful adjunct for early diagnosis of glaucoma.
doi:10.4103/0301-4738.86312
PMCID: PMC3214415  PMID: 22011489
Early glaucoma; retinal nerve fiber layer thickness; spectral optical coherence tomography / scanning laser ophthalmoscope
25.  Correlation between peripapillary retinal nerve fiber layer thickness and fundus autofluorescence in primary open-angle glaucoma 
Purpose
To investigate the relationship between retinal nerve fiber layer (RNFL) thickness and retinal pigment epithelium alterations in patients with advanced glaucomatous visual field defects.
Methods
A consecutive, prospective series of 82 study eyes with primary open-angle glaucoma and advanced glaucomatous visual field defects were included in this study. All study participants underwent a full ophthalmic examination followed by visual field testing with standard automated perimetry as well as spectral-domain optical coherence tomography (SD-OCT) for peripapillary RNFL thickness and Optos wide-field fundus autofluorescence (FAF) images. A pattern grid with corresponding locations between functional visual field sectors and structural peripapillary RNFL thickness was aligned to the FAF images at corresponding location. Mean FAF intensity (range: 0 = black and 255 = white) of each evaluated sector (superotemporal, temporal, inferotemporal, inferonasal, nasal, superonasal) was correlated with the corresponding peripapillary RNFL thickness obtained with SD-OCT.
Results
Correlation analyses between sectoral RNFL thickness and standardized FAF intensity in the corresponding topographic retina segments revealed partly significant correlations with correlation coefficients ranging between 0.004 and 0.376 and were statistically significant in the temporal inferior central field (r = 0.324, P = 0.036) and the nasal field (r = 0.376, P = 0.014).
Conclusion
Retinal pigment epithelium abnormalities correlate with corresponding peripapillary RNFL damage, especially in the temporal inferior sector of patients with advanced glaucomatous visual field defects. A further evaluation of FAF as a potential predictive parameter for glaucomatous damage is necessary.
doi:10.2147/OPTH.S49112
PMCID: PMC3788816  PMID: 24092967
glaucoma; fundus autofluorescence; FAF; retinal nerve fiber layer; RNFL; optical coherence tomography; OCT; imaging

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