Evaluation of two‐dimensional Bruch's membrane opening minimum rim area for glaucoma diagnostics in a large patient cohort

• Published in: Acta ophthalmologica (Oxford, England) Vol. 97; no. 1; pp. 60 - 67
• Main Authors: Enders, Philip, Adler, Werner, Kiessling, David, Weber, Vincent, Schaub, Friederike, Hermann, Manuel M., Dietlein, Thomas, Cursiefen, Claus, Heindl, Ludwig M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2019
• Subjects: Bruch Membrane - pathology; Bruch's membrane opening minimum rim area; Cross-Sectional Studies; Eye; Female; Glaucoma; Glaucoma - diagnosis; Glaucoma - epidemiology; Glaucoma - physiopathology; glaucoma detection; Humans; Intraocular Pressure - physiology; Male; Middle Aged; Optic Disk - pathology; Optic nerve; optic nerve head morphometry; Optical Coherence Tomography; Reproducibility of Results; Retina; Retinal Ganglion Cells - pathology; Retrospective Studies; ROC Curve; SD‐OCT for glaucoma; Severity of Illness Index; Tomography; Tomography, Optical Coherence - methods; Visual field; Visual Fields; Visual perception; glaucoma detection; SD-OCT for glaucoma; Bruch's membrane opening minimum rim area; optic nerve head morphometry
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.13698

Purpose
To characterize the two‐dimensional parameter Bruch's membrane opening minimum rim area (BMO‐MRA) in spectral domain optical coherence tomography (SD‐OCT) of the optic nerve head (ONH) compared to minimum rim width (BMO‐MRW) and retinal nerve fibre layer (RNFL) thickness in a large patient cohort.
Methods
Case–control, cross‐sectional study of 705 eyes of 445 participants. A total of 449 eyes with glaucoma, 67 eyes with ocular hypertension and 189 healthy controls, underwent SD‐OCT and confocal laser scanning tomography (CSLT), visual field testing and clinical examination. Morphometric ONH parameters, visual field function and diagnostic power were compared. Main outcome measures were SD‐OCT‐derived BMO‐MRA, BMO‐MRW, RNFL thickness and CSLT‐derived rim area (DM‐RA).
Results
Mean ONH area was 2.11 ± 0.57 mm2; mean BMO area was 1.89 ± 0.45 mm2. Correlation of mean deviation in visual field to morphometric parameters was ρ = 0.70, (p < 0.001) for RNFL thickness, ρ = 0.68 (p < 0.001) for BMO‐MRA, ρ = 0.66 (p < 0.001) for BMO‐MRW. These correlations were not significantly different (p > 0.05), while DM‐RA correlated significantly worse (ρ = 0.55; p < 0.001). In receiver operating characteristics, the calculated area under the curve (AUC) and sensitivity at 90% specificity to differentiate glaucoma were 0.87% and 70.1% for BMO‐MRA, 0.86% and 68.1% for RNFL thickness, 0.84% and 66.0% for BMO‐MRW, 0.82% and 51.3% for DM‐RA.
Conclusions
In a heterogenous clinical cohort of glaucoma patients, all analysed SD‐OCT parameters excel DM‐RA of CSLT. The two‐dimensional parameter BMO‐MRA shows comparable levels of diagnostic power to detect glaucoma compared to established parameters BMO‐MRW and RNFL thickness. Given higher comparability between ONH sizes, BMO‐MRA might become an additional standard tool in SD‐OCT imaging for glaucoma.