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Kang, Majid, Kim, Kwag, and Yim: Retinal Nerve Fiber Layer Thickness in Children With Glaucoma
Original Article

J Korean Ophthalmol Soc 2009;50(6):887-892.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.887

Retinal Nerve Fiber Layer Thickness in Children With Glaucoma

Kui Dong Kang, MD, MSc1, 2, Aman Shah B. Abdul Majid, B.Sc, MB, ChB2, 3, Yeon Deok Kim, MD4, Jee hyun Kwag, PhD5, Hye Bin Yim, MD, PhD6

1Department of Ophthalmology, Oxford Eye Hospital, Headington, Oxford, UK

2Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK

3Advanced Medical and DentalInstitute, Universiti Sains Malaysia, Penang, Malaysia

4Hangil Eye Hospital, Incheon, Korea

5Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK

6Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea

Address reprint requests to Hye Bin Yim, MD Department of Ophthalmology, Incheon St. Mary's Hospital #665 Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Korea Tel: 82-32-510-5525, Fax: 82-32-510-5833, E-mail: yimhb@catholic.ac.kr

Received 8 December 2008       Accepted 10 March 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To find the optimal parameter of retinal nerve fiber layer (RNFL) analysis in optical coherence tomography (OCT) for diagnosing glaucoma in children.

Methods

The study was comprised of 127 eyes of 84 patients (aged 6 to 18 years) who visited our institute between March 2006 and February 2008. Subjects were classified into normal, glaucoma suspect and glaucoma groups, and each eye was scanned using Stratus 3.0 OCT. Routine ophthalmic examinations including fundus examination, visual field test and OCT RNFL analysis were performed.

Results

There were 55 normal eyes, 27 glaucoma suspect eyes and 45 glaucomatous eyes. The average RNFL thickness was the most useful parameter to differentiate between the glaucoma and non-glaucoma groups. The next most useful parameter was inferior average thickness, followed by superior RNFL thickness. The sensitivity and specificity of the new discriminant of the formula used were 78%, and 68.6%, respectively.

Conclusions

In OCT analysis, the average RNFL thickness is the most useful parameter in the diagnosis of glaucoma in children. The new discriminant of the formula is useful in the diagnosis of pediatric glaucoma patients.

Keywords: Children, Optical coherence tomography, Retinal nerve fiber layer analysis

References

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Figure 1.
Comparison of mean value between normal, glaucoma suspect and glaucomatous eye using optical coherence tomography retinal nerve fiber layer analysis.
jkos-50-887f1.tif
Figure 2.
ROC (receiver operator characteristic) curve of the discriminant formula.
jkos-50-887f2.tif
Table 1.
Characteristics and average retinal nerve fiber layer thickness in each group (N=127)
Normal Glaucoma suspect Glaucoma p-value*
Number (eye) 55 27 45
Gender (Male/Female) 26/29 15/12 24/21
Visual Acuity 0.43±0.28 0.40±0.25 0.34±0.30 <0.001
Refraction error (D) −2.49±1.92 −2.7±2.71 −2.4±2.62 0.23
Age (year± SD) 13.1±3.1 14.3±4.5 13.7±4.1 0.17

* Statistical significance was tested by ANOVA.

Table 2.
Comparison of mean value between normal, glaucoma suspect and glaucomatous eye using optical coherence tomography retinal nerve fiber layer analysis and optic nerve head ophthalmoscopic examination
Normal Glaucoma suspect Glaucoma p-value*
OCT RNFL analysis Superior 131.26±14.09 121.3±35.7 104.59±38.72 0.002
Nasal 78.0±15.2 75.92±18.64 65.09±25.53 0.072
Inferior 134.34±12.91 122.07±33.18 107.45±46.53 0.004
Temporal 81.31±17.2 77.38±38.84 66.409±23.2 0.064
Average 105.39±9.22 99.23±28.31 79.98±28.85 <0.001
Ophthalmoscopic Cup/Disk Horizontal Ratio 0.41±0.15 0.50±0.19 0.68±0.21 <0.001
examination Cup/Disk Vertical Ratio 0.43±0.17 0.48±0.18 0.72±0.19 <0.001

* Statistical significance was tested by ANOVA.

Table 3.
Correlation of optic nerve headophthalmoscopic examination parameters, optical coherence tomography retinal nerve fiber layer analysis parameters
Ophthalmoscopic exam.
Cup/disk horizontal ratio
 Cup/disk vertical ratio
r p-value* R p-value*
OCT RNFL analysis Superior −0.198 0.123 −0.290 0.022
Nasal −0.195 0.128 −0.203 0.113
Inferior −0.228 0.075 −0.334 0.008
Temporal −0.230 0.072 −0.283 0.026
Average −0.304 0.016 −0.382 0.002

* Statistical significance was tested by Pearson's correlation test.

Table 4.
Area under the receiver operator characteristic(ROC) curve, sensitivity, specificity and cut-off values by each parameters (ROC curve and discriminant analysis)
OCT* RNFL† Analysis ROC area Sensitivity(%) Specificity(%) Cut-off value
Superior 0.679 70.7 65.7 124.5
Nasal 0.656 67.5 62.9 72.5
Inferior 0.684 78.0 60.0 123.5
Temporal 0.677 70.2 62.9 73.5
Average 0.751 71.0 66.8 100.3
New discriminant function‡ 0.722 73.7 65.7 0.0823
New discriminant function§ 0.750 78.0 68.6 0.0236

* OCT=optical coherence tomography

† RNFL=retinal nerve fiber layer

‡ New discriminant function=-4.336+0.007× Superior-0.011× Nasal+0.004× Inferior-0.02× Temporal+0.054× Average RNFL thickness

§ New discriminant function=-4.676+0.003× Superior+0.004× Inferior+0.039× Average RNFL thickness.

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