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Measurement of the hypotenuse of the vertical optic nerve head cup with spectral-domain optical coherence tomography for the structural diagnosis of glaucoma

Authors Lavinsky F, Benfica CZ, Castoldi N, Cruz do Carmo Chaves AE, Mello PAA

Received 28 September 2017

Accepted for publication 28 November 2017

Published 23 January 2018 Volume 2018:12 Pages 215—225

DOI https://doi.org/10.2147/OPTH.S152772

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Fabio Lavinsky,1,2 Camila Zanella Benfica,2 Nédio Castoldi,2 Anne Elise Cruz do Carmo Chaves,2 Paulo Augusto de Arruda Mello1

1Department of Ophthalmology, Paulista School of Medicine, São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; 2Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

Purpose: To evaluate the hypotenuse of the vertical optic nerve head cup (HVOC), measured using the length and depth of the cup obtained with enhanced depth imaging spectral-domain optic coherence tomography (SD-OCT), as a biomarker for glaucoma diagnosis.
Methods: This was a prospective cross-sectional study of patients with glaucoma and controls. SD-OCT was performed in all participants to assess average circumpapillary retinal nerve fiber layer (RNFL) thickness. A vertical B-scan of the optic nerve head (ONH) was obtained for HVOC measurement. The length and depth of the optic nerve cup formed the sides of a right triangle that were used to calculate the HVOC. Participants also underwent standard automated perimetry.
Results: One hundred and fifty-six eyes were divided into three groups: mean deviation (MD) <-7 dB (60 eyes); MD ≥-7 dB (74 eyes); and healthy subjects (22 eyes). The mean (SD) HVOC in these groups was 1,419.8 (347.2) µm, 1,234.6 (258.8) µm, and 685.79 (315.4) µm (P<0.01), respectively. In the secondary structure–function analysis, only discs with a vertical diameter of 1.51–2.00 mm were included (120 eyes). The HVOCs were divided into four percentile groups, with the following means: 940, 1,128, 1,390, and 1,662 µm. There was a significant difference in MD between percentile groups 1 and 3 (P<0.03), 1 and 4 (P<0.001), 2 and 3 (P<0.02), and 2 and 4 (P<0.001). RNFL thickness differed among all percentile groups (P<0.001).
Conclusion: HVOC may provide an additional morphometric biomarker for the structural evaluation of ONH remodeling in glaucoma.

Keywords: glaucoma diagnosis, optic nerve head, visual fields, ocular imaging

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