Accuracy of the ISNT rule and its variants for differentiating glaucomatous from normal eyes in a population-based study

AimsTo evaluate the accuracy of the ISNT rule (I=inferior, S=superior, N=nasal, T=temporal) and its variants with neuroretinal rim width and retinal nerve fibre layer (RNFL) thickness measurements differentiating normal from glaucomatous eyes.MethodsThe diagnosis accuracy of the ISNT rule and its variants was evaluated in a population-based study. Neuroretinal rim widths were measured on monoscopic optic disc photographs with an image-processing program. RNFL thickness measurements were obtained with spectral-domain optical coherence tomography (SD-OCT).ResultsIn this study including 940 normal subjects and 93 patients with glaucoma, the sensitivity of the ISNT rule with optic disc photographs was 94.1% (95% CI 90.2 to 98.1), whereas its specificity was 49.2% (46.9 to 51.6). When using the IST rule, the sensitivity decreased to 69.9% (62.1 to 77.6) with a higher specificity, 87.0% (85.3 to 88.6). All the diagnosis indicators were somewhat lower for the different rules using RNFL thickness: the sensitivity of the ISNT rule was 79.4% (72.6 to 86.2) and its specificity was 34.1% (31.9 to 36.4). With the IST rule, the sensitivity decreased to 50.0% (41.6 to 58.4) while the specificity increased to 64.9% (62.7 to 67.2).ConclusionsThe ISNT and IST rules applied to neuroretinal rim width measurement by optic disc photographs are useful and simple tools for differentiating normal from glaucomatous eyes. The translation of these rules to RNFL thickness by SD-OCT is of limited value.

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Compensation of retinal nerve fibre layer thickness as assessed using optical coherence tomography based on anatomical confounders

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314086 ◽

2019 ◽

Vol 104 (2) ◽

pp. 282-290 ◽

Cited By ~ 7

Author(s):

Jacqueline Chua ◽

Florian Schwarzhans ◽

Duc Quang Nguyen ◽

Yih Chung Tham ◽

Josh Tjunrong Sia ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optic Disc ◽

Retinal Vessel ◽

Retinal Nerve Fibre Layer ◽

Eye Diseases ◽

Vessel Density ◽

Rnfl Thickness ◽

Nerve Fibre Layer ◽

Retinal Vessel Density ◽

Sd Oct

Background/AimsTo compensate the retinal nerve fibre layer (RNFL) thickness assessed by spectral-domain optical coherence tomography (SD-OCT) for anatomical confounders.MethodsThe Singapore Epidemiology of Eye Diseases is a population-based study, where 2698 eyes (1076 Chinese, 704 Malays and 918 Indians) with high-quality SD-OCT images from individuals without eye diseases were identified. Optic disc and macular cube scans were registered to determine the distance between fovea and optic disc centres (fovea distance) and their respective angle (fovea angle). Retinal vessels were segmented in the projection images and used to calculate the circumpapillary retinal vessel density proﬁle. Compensated RNFL thickness was generated based on optic disc (ratio, orientation and area), fovea (distance and angle), retinal vessel density, refractive error and age. Linear regression models were used to investigate the effects of clinical factors on RNFL thickness.ResultsRetinal vessel density reduced significantly with increasing age (1487±214 µm in 40–49, 1458±208 µm in 50–59, 1429±223 µm in 60–69 and 1415±233 µm in ≥70). Compensation reduced the variability of RNFL thickness, where the effect was greatest for Chinese (10.9%; p<0.001), followed by Malays (6.6%; p=0.075) and then Indians (4.3%; p=0.192). Compensation reduced the age-related RNFL decline by 55% in all participants (β=−3.32 µm vs β=−1.50 µm/10 years; p<0.001). Nearly 62% of the individuals who were initially classified as having abnormally thin RNFL (outside the 99% normal limits) were later reclassified as having normal RNFL.ConclusionsRNFL thickness compensated for anatomical parameters reduced the variability of measurements and may improve glaucoma detection, which needs to be confirmed in future studies.

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Retinal nerve fibre layer thickness measured with SD-OCT in a population-based study of French elderly subjects: the Alienor study

Acta Ophthalmologica ◽

10.1111/aos.12658 ◽

2015 ◽

Vol 93 (6) ◽

pp. 539-545 ◽

Cited By ~ 16

Author(s):

Marie-Bénédicte Rougier ◽

Jean-François Korobelnik ◽

Florence Malet ◽

Cédric Schweitzer ◽

Marie-Noëlle Delyfer ◽

...

Keyword(s):

Layer Thickness ◽

Nerve Fibre ◽

Population Based ◽

Retinal Nerve Fibre Layer ◽

Elderly Subjects ◽

Population Based Study ◽

Fibre Layer ◽

Nerve Fibre Layer ◽

Sd Oct

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Normative Values of Retinal Nerve Fibre Layer Thickness and Optic Nerve Head Parameters and Their Association with Visual Function in an African Population

Journal of Ophthalmology ◽

10.1155/2020/7150673 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Stephen Ocansey ◽

Emmanuel Kwasi Abu ◽

Andrew Owusu-Ansah ◽

Shadrack Mensah ◽

John Oduro-Boateng ◽

...

Keyword(s):

Optic Nerve ◽

Layer Thickness ◽

Optic Disc ◽

Optic Nerve Head ◽

Normal Subjects ◽

Retinal Nerve Fibre Layer ◽

Normative Values ◽

Age Group ◽

Rnfl Thickness ◽

Nerve Fibre Layer

Purpose. To determine normative values of retinal nerve fibre layer thickness (RNFL) and optic nerve head (ONH) parameters and their association with routine clinical tests such as refractive error (RE), stereoacuity (SA), and contrast sensitivity (CS) in an African population. Methods. In a cross-sectional observational study, 100 normal subjects aged 20 to 78 years were evaluated using the Cirrus HD-OCT 5000 and matched with 200 glaucoma patients. Results. Average (±SD) RNFL thickness for normal subjects was found to be 102.37 ± 7.45 (range, 82–119 microns) compared with 90.74 ± 14.50 found for glaucoma subjects. Females had higher average RNFL values (104.84 ± 6.90) compared with males (99.80 ± 7.18). Significant associations were calculated between quadrant RNFL thickness and SA, SE, and CS (all p<0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm2 ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40–59 age group (2.01 ± 0.41) and then 20–39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p<0.01), and RE was significantly associated with DA and average CDR (all p<0.05). Conclusion. RNFL thickness in healthy black Ghanaian population was significantly higher than that reported in other races. The values and associations reported in this study can inform clinical decision on the normal variation in RNFL and optic disc parameters.

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Repeatability of Bruch’s Membrane Opening-minimum Rim Width in Age-related Macular Degeneration and Diabetic Macular Edema

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.11.1490 ◽

2021 ◽

Vol 62 (11) ◽

pp. 1490-1501

Author(s):

Bum Jun Kim ◽

Woo Hyuk Lee ◽

Ki Yup Nam ◽

Ji Hye Kim ◽

Tae Seen Kang ◽

...

Keyword(s):

Macular Degeneration ◽

Macular Edema ◽

Optic Disc ◽

Diabetic Macular Edema ◽

Age Related Macular Degeneration ◽

Disc Membrane ◽

Rnfl Thickness ◽

Age Related ◽

Bruch’S Membrane Opening ◽

Sd Oct

Purpose: To evaluate the repeatability of retinal nerve fiber layer (RNFL) thickness and Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements by spectral-domain optical coherence tomography (SD-OCT) in wet age-related macular degeneration (wAMD) and diabetic macular edema (DME).Methods: This was a prospective study. The RNFL thickness and BMO-MRW parameters for each sector and global average were measured twice by SD-OCT. Repeatability was evaluated using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). If the optic disc membrane was confirmed, it was analyzed by dividing it into three groups based on severity.Results: A total of 99 eyes (48 with wAMD, 51 with DME) were included in the analysis. The ICCs of the global RNFL thickness and global BMO-MRW measurements were 0.996 and 0.997, respectively, in wAMD and 0.994 and 0.996, respectively, in DME eyes. The CV values of global RNFL thickness and BMO-MRW were 0.60% and 0.73%, respectively, in wAMD eyes and 1.10% and 1.21%, respectively, in DME eyes. The disc membrane on the optic nerve head significantly affected global BMO-MRW repeatability (B = 0.814, p < 0.001).Conclusions: Both RNFL thickness and BMO-MRW measurements showed good repeatability in eyes with wAMD and DME. The severity of the optic disc membrane significantly affected the repeatability of BMO-MRW measurements in eyes with wAMD and DME. Therefore, physicians should examine the BMO-MRW in eyes with severe optic disc membrane.

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Intrasession Reproducibility of RNFL Thickness Measurements Using SD-OCT in Eyes With Keratoconus

Ophthalmic Surgery Lasers and Imaging ◽

10.3928/15428877-20121001-04 ◽

2012 ◽

Vol 43 (6) ◽

pp. S83-S89 ◽

Cited By ~ 5

Author(s):

Michele Reibaldi ◽

Maurizio G. Uva ◽

Teresio Avitabile ◽

Mario D. Toro ◽

Marco Zagari ◽

...

Keyword(s):

Rnfl Thickness ◽

Thickness Measurements ◽

Sd Oct

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Comparison of a commercial spectral-domain OCT and swept-source OCT based on an angiography scan for measuring circumpapillary retinal nerve fibre layer thickness

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314706 ◽

2019 ◽

Vol 104 (7) ◽

pp. 974-979 ◽

Cited By ~ 2

Author(s):

Bingyao Tan ◽

Jacqueline Chua ◽

Thiyagrajan Harish ◽

Amanda Lau ◽

Alfred Tau Liang Gan ◽

...

Keyword(s):

Nerve Fibre ◽

Excellent Agreement ◽

Retinal Nerve Fibre Layer ◽

Spectral Domain ◽

Wide Field ◽

Swept Source ◽

Rnfl Thickness ◽

Fibre Layer ◽

Nerve Fibre Layer ◽

Sd Oct

Background/aimsTo assess the agreement in measuring retinal nerve fibre layer (RNFL) thickness between spectral-domain (SD; Cirrus HD, Carl Zeiss Meditec, USA) optical coherence tomography (OCT) and swept-source (SS; Plex Elite 9000, Carl Zeiss Meditec) OCT using an OCT angiography (OCTA) scanning protocol.Methods57 participants (12 glaucomatous, 8 ocular hypertensive and 74 normal eyes) were scanned with two OCT instruments by a single experienced operator on the same day. Circumpapillary RNFL thicknesses were automatically segmented for SD-OCT and manually segmented for SS-OCTA scans. Agreement of global RNFL thickness, as well as average thickness in four quadrants was assessed using intraclass correlation coefficients (ICCs).ResultsThere was excellent agreement in the inferior and superior quadrants and the global (all ICC >0.90), followed by good agreement in the temporal (ICC=0.79) and nasal (ICC=0.73) quadrants. The ICC values were similar in the subgroups except within the ocular hypertension group, where the nasal quadrant was less agreeable (ICC=0.31). SS-OCTA-derived RNFL thickness was on average 3 µm thicker than SD-OCT, particularly in the nasal (69.7±11.5 µm vs 66.3±9.3 µm; p<0.001) and temporal (75.6±13.7 µm vs 67.9±12.3 µm; p<0.001) quadrants.ConclusionsRNFL measurements taken with SS-OCTA have good-to-excellent agreement with SD-OCT, which suggests that the RNFL thickness can be sufficiently extracted from wide-field OCTA scans.

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Optic disc size in a population based study in northern China: the Beijing Eye Study

British Journal of Ophthalmology ◽

10.1136/bjo.2005.081521 ◽

2006 ◽

Vol 90 (3) ◽

pp. 353-356 ◽

Cited By ~ 78

Author(s):

Y Wang

Keyword(s):

Optic Disc ◽

Northern China ◽

Population Based ◽

Population Based Study ◽

Beijing Eye Study ◽

Optic Disc Size ◽

Disc Size

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Utility of Bruch membrane opening-based optic nerve head parameters in myopic subjects

European Journal of Ophthalmology ◽

10.5301/ejo.5001022 ◽

2017 ◽

Vol 28 (1) ◽

pp. 42-46 ◽

Cited By ~ 7

Author(s):

Marina Sastre-Ibañez ◽

Jose M. Martinez-de-la-Casa ◽

Gema Rebolleda ◽

Pilar Cifuentes-Canorea ◽

Maria Nieves-Moreno ◽

...

Keyword(s):

Cross Sectional Study ◽

Refractive Errors ◽

Sectional Study ◽

Analysis Software ◽

Fiber Layer ◽

Cross Sectional ◽

Neuroretinal Rim ◽

Rnfl Thickness ◽

Ring Analysis ◽

Sd Oct

Purpose: To evaluate whether the new rim analysis software with spectral-domain optical coherence tomography (SD-OCT) shows advantages over the retinal nerve fiber layer (RNFL) thickness in patients with moderate myopia. Methods: In this prospective cross-sectional study, we studied 65 healthy subjects, 37 with spherical refractive errors in the range of -3 to -6 D (moderate, G1) and 28 with less than -3 D (low/non-myopic, G0). All patients were examined with Heidelberg Spectralis SD-OCT, including Glaucoma Premium Module Edition (GPME) software. With GPME, we analyzed the neuroretinal rim (Bruch membrane opening-minimum rim width [BMO-MRW]) and RNFL. Results: The average age of subjects was 30.2 ± 9.3 years for G0 and 29.9 ± 7.1 years for G1 (p = 0.903). Mean sphere was −0.5 ± 0.3 D (-1.25 to 0 D) G0 and -3.9 ± 0.3 D (-6.00 to -3 D) G1 (p<0.001). The RNFL thickness comparison between G0 and G1 showed a significantly lower thickness in G1 (p = 0.018). The BMO-MRW measurements were similar in both groups (p = 0.331). With the BMO-MRW examination, the number of sectors classified as pathologic per subject in G1 were significantly lower compared to RNFL analysis (p = 0.023). Conclusions: Ring analysis based on BMO-MRW measurements shows a lower rate of false-positives compared to RNFL thickness when studying healthy moderate myopic eyes and it would be advisable to take this into consideration when analyzing these patients.

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Kinetic and static perimetry after 16 years and additional OCT-A analysis in eyes with long-lasting optic disc drusen

PLoS ONE ◽

10.1371/journal.pone.0247399 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247399

Author(s):

Edyta Koman-Wierdak ◽

Katarzyna Nowomiejska ◽

Agnieszka Brzozowska ◽

Dominika Nowakowska ◽

Mario Damiano Toro ◽

...

Keyword(s):

Optic Disc ◽

Superficial Layer ◽

Retinal Nerve Fibre Layer ◽

Macular Thickness ◽

Vessel Density ◽

Control Group ◽

Automated Perimetry ◽

Kinetic Perimetry ◽

Rnfl Thickness ◽

Optic Disc Drusen

The aim of the study is to evaluate the progression of visual field (VF) defects over 16 years of observation and to assess abnormalities in vessels and retinal nerve fibre layer (RNFL) thickness in patients with optic disc drusen (ODD). Both static automated perimetry (SAP) and semi-automated kinetic perimetry (SKP) were performed in 16 eyes of 8 patients (mean age 54 years) with ODD among 26 eyes of 13 patients examined 16 years before. The area of I2e, I4e, III4e, and V4e isopters was measured in deg2. The MD and PSD parameters were estimated using SAP. Optical coherence tomography angiography (OCT-A) was additionally performed in 16 ODD eyes and 16 eyes of 8 healthy subjects to estimate the RNFL thickness and vessel density of the optic nerve disc and the macula. The differences in all isopter areas of SKP and SAP parameters after 16 years were not significant. The analysis of OCT-A showed a significant reduction of the vessel density and RNFL of the peripapillary area in each segment in patients with ODD, compared with the control group. The highest reduction of RNFL was observed in the superior segment of the optic disc area (92.56μm vs 126.63μm) also the macular thickness was decreased in ODD patients, compared with the control group. In the macula, there was a significant vascular defect in the whole superficial layer and in the parafoveal deep layer. A strong significant correlation of the parafoveal deep plexus with MD and PSD parameters was detected. In conclusion, VF loss due to ODD after 16 years of the follow-up was not significant both in SKP and SAP. ODD caused a reduced vessel density and RNFL, as well as macular thickness in OCT-A. SAP parameters were influenced by parafoveal deep plexus.

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