Thin minimal rim width at Bruch’s membrane opening is associated with glaucomatous paracentral visual field loss
Received 16 August 2017
Accepted for publication 2 November 2017
Published 8 December 2017 Volume 2017:11 Pages 2157—2167
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Elise V Taniguchi,1–3 Eleftherios I Paschalis,1,2 Dejiao Li,1,4 Kouros Nouri-Mahdavi,5 Stacey C Brauner,1 Scott H Greenstein,1 Angela V Turalba,1 Janey L Wiggs,1 Louis R Pasquale,1,6 Lucy Q Shen1
1Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, 2Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear – Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; 4Department of Ophthalmology, Beijing China-Japan Friendship Hospital, Beijing, People’s Republic of China; 5Department of Ophthalmology, David Geffen School of Medicine and Stein Eye Institute, Los Angeles, CA, USA; 6Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Purpose: To compare optic nerve head (ONH) measurements in glaucomatous eyes with paracentral visual field (VF) loss to eyes with peripheral VF loss and controls.
Methods: Open-angle glaucoma (OAG) patients with early paracentral VF loss or isolated peripheral VF loss as well as control subjects underwent ONH imaging with swept-source optical coherence tomography (OCT) and retinal nerve fiber layer (RNFL) imaging with spectral-domain OCT. Minimum rim width at Bruch’s membrane opening (BMO-MRW), lamina cribrosa depth (LCD), and RNFL thickness were compared among the glaucoma and control groups with one-way analysis of variance, Kruskal–Wallis test, and multiple regression analysis.
Results: Twenty-nine eyes from 29 OAG patients (15 early paracentral and 14 isolated peripheral VF loss) and 20 eyes of 20 control subjects were included. The early paracentral and isolated peripheral VF loss groups had similar VF mean deviation (MD) (–5.3±2.7 dB and –3.7±3.0 dB, p=0.15, respectively). Global BMO-MRW was lower in OAG eyes than in controls (193.8±40.0 vs 322.7±62.2 µm, p<0.001), but similar between eyes with early paracentral VF loss and those with isolated peripheral VF loss (187.6±43.4 vs 200.6±36.3 µm; p>0.99). In contrast, the minimal BMO-MRW was lower in eyes with early paracentral loss (69.0±33.6 µm) than in eyes with isolated peripheral loss (107.7±40.2 µm; p=0.03) or control eyes (200.1±40.8 µm; p<0.001). Average and thinnest RNFL thickness did not differ between OAG groups (p=0.61 and 0.19, respectively). Horizontal and vertical LCD did not differ among the OAG groups and controls (p=0.80 and 0.82, respectively). Multivariable linear regression analysis among OAG cases confirmed the association between lower minimal BMO-MRW and early paracentral VF loss (β=–38.3 µm; 95% confidence interval, –69.8 to –6.8 µm; p=0.02) after adjusting for age, gender, MD, and disc size.
Conclusion: Thin minimal BMO-MRW may represent a new structural biomarker associated with early glaucomatous paracentral VF loss.
Keywords: paracentral loss, BMO-MRW, open angle glaucoma, optic nerve damage, swept-source OCT
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