Measurement of Deep Optic Nerve Complex Structures with Two Spectral Domain Optical Coherence Tomography Instruments

Sung Yu; Kyoo Won Lee; Tae Yoon Lee

doi:10.7469/JKOS.2015.56.03.371

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Yu, Lee, and Lee: Measurement of Deep Optic Nerve Complex Structures with Two Spectral Domain Optical Coherence Tomography Instruments

Original Article

J Korean Ophthalmol Soc 2015;56(3):371-378.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.371

Measurement of Deep Optic Nerve Complex Structures with Two Spectral Domain Optical Coherence Tomography Instruments

Sung Yu, MD, Kyoo Won Lee, MD, PhD, Tae Yoon Lee, MD

Cheil Eye Hospital, Daegu, Korea

￭ Address reprint requests to Tae Yoon Lee, MD Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 701-820, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758 E-mail: 10041419@naver.com

Received 14 August 2014 Accepted 10 October 2014 Accepted 4 February 2015

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.

초록

Purpose:

To assess the usefulness of two spectral domain optical coherence tomography (SD-OCT) instruments (Cirrus^®, Spectralis^®) for evaluating optic nerve head and peripapillary structures.

Methods:

Images of optic nerve complex were obtained from 136 eyes of 136 patients using enhanced depth imaging technique of 2 SD-OCT instruments. Optic nerve head and peripapillary structures were investigated for their visibility and morphological features in total eyes and glaucomatous eyes. Effect factors for laminar thickness measurement were evaluated and the reproducibility of the lamina cribrosa thickness measured by the 2 OCT instruments was analyzed.

Results:

Lamina cribrosa thickness was better identified using Spectralis^® OCT in total and glaucomatous eyes. Short posterior ciliary artery (in total eyes) and peripapillary choroid (in total and glaucomatous eyes) were also better identified using Spectralis^® OCT ( p < 0.001). A cup-disc ratio ≤ 0.6 was the significant effect factor for laminar thickness measurement ( p < 0.05). Interobserver reproducibility was excellent using both OCT instruments. Intraobserver reproducibility was excellent using Spectralis^® OCT and moderate using Cirrus^® OCT.

Conclusions:

Spectralis^® OCT was better for visualizing optic nerve head and peripapillary structures and showed better reproducibility than Cirrus^® OCT. Thus, the Spectralis^® may be helpful for detecting and understanding features of the optic nerve complex.

Keywords: Glaucoma, Lamina cribrosa, Peripapillary structure, Reproducibility, Spectral domain optical coherence tomography

References

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Figure 1.

Bland-Altman plot for lamina cribrosa thickness. Mean difference is 18.61 μm. The 95% limits of agreement for laminal thickness measurements are -40.90 to 80.14 μm.

Figure 2.

Optic nerve head complex of cross-sectional images revealed using Cirrus® optical coherence tomography (OCT) (A), Spectralis® OCT (B). Black arrow heads in (A) and (B) denote suspected lamina cribrosa. Lamina cribrosa thickness was 230.77 μm measured by Cirrus® OCT (A) and 297.69 μm measured by Spectralis® OCT (B). Lamina cribrosa pores of various shapes and sizes well identified. Posterior border of lamina cribrosa is relatively less identified in (A). Central retinal vessel trunk (white arrow) passing through the lamina cribrosa identified. Short posterior ciliary artery (black arrow) are shown in the sclera draining into the choroid.

Table 1.

Patient demographics and clinical information

	Total (n = 136)	Healthy eyes (n = 97)	Glaucomatous eyes (n = 39)	p-value
Sex (M/F) (n)	74/62	58/39	16/23	0.139^*
Age (years)	56.41 ± 2.98	54.05 ± 12.59	62.28 ± 12.19	0.003^†
Visual field test
MD (dB)	-2.35 ± 3.06	-1.54 ± 2.22	-4.44 ± 6.14	<0.001^†
PSD (dB)	2.37 ± 2.12	1.87 ± 1.49	3.70 ± 3.24	<0.001^†
Cup-disc ratio	0.71 ± 0.13	0.68 ± 0.14	0.81 ± 0.16	0.003^†
Spherical equivalent (diopter)	-0.96 ± 2.42	-0.98 ± 2.45	-0.75 ± 2.38	0.980^†

Values are presented as mean ± SD unless otherwise indicated.

MD = mean deviation; PSD = pattern standard deviation.

^* Pearson’s chi-square test;

^† One-way ANOVA.

Table 2.

Lamina cribrosa and ONH Structures measured by Spectralis® OCT and Cirrus® OCT in all eyes (n = 136)

	Spectralis® OCT	Cirrus® OCT	p-value
Lamina cribrosa
Thickness (μm)	218.1 ± 27.7	206.6 ± 25.5	0.002^*
Anterior surface (n, %)	129 (94.9)	109 (82.6)	0.002^†
Posterior surface (n, %)	125 (91.9)	71 (55.0)	<0.001^†
Pore (n, %)	132 (97.1)	124 (93.9)	0.250^†
Deep ONH structures (n, %)
Central retinal vessel trunk	123 (90.4)	115 (87.1)	0.441^†
Central retinal artery	18 (13.2)	11 (8.3)	0.239^†
Central retinal vein	20 (14.7)	10 (7.6)	0.081^†
Short posterior ciliary artery	40 (29.4)	8 (6.1)	<0.001^†
Peripapillary choroid	135 (99.3)	129 (97.7)	0.365^†
Peripapillary sclera	129 (94.9)	91 (68.9)	<0.001^†

Values are presented as mean ± SD unless otherwise indicated.

ONH = optic nerve head; OCT = optical coherence tomography.

^* Paired t-test;

^† Pearson’s chi square test.

Table 3.

Lamina cribrosa and ONH Structures measured by Spectralis® OCT and Cirrus® OCT in eyes with glaucoma (n = 39)

	Spectralis® OCT	Cirrus® OCT	p-value
Lamina cribrosa
Thickness (μm)	215.7 ± 27.9	204.2 ± 31.8	0.235^*
Anterior surface (n, %)	39 (100)	31 (81.6)	0.005^†
Posterior surface (n, %)	37 (94.9)	15 (41.7)	<0.001^†
Pore (n, %)	37 (94.9)	35 (92.1)	0.675^†
Deep ONH structures (n, %)
Central retinal vessel trunk	39 (100)	37 (97.4)	0.494^†
Central retinal artery	7 (17.9)	4 (10.5)	0.517^†
Central retinal vein	9 (23.1)	4 (10.5)	0.224^†
Short posterior ciliary artery	9 (23.1)	4 (10.5)	0.224^†
Peripapillary choroid	38 (97.4)	37 (97.4)	1.000^†
Peripapillary sclera	34 (87.2)	16 (42.1)	<0.001^†

Values are presented as mean ± SD unless otherwise indicated.

ONH = optic nerve head; OCT = optical coherence tomography.

^* Paired t-test;

^† Pearson’s chi square test.

Table 4.

Multivariate logistic regression analysis for risk factor of lamina cribrosa thickness measurement

Risk factors	Odds ratio	95% CI	p-value
Total
Posterior surface
C/D ratio ≤ 0.6	2.127	1.217-3.717	0.008
Spherical equivalent ≤ -0.6 diopter	1.367	0.498-3.749	0.544
Cataract	0.843	0.483-1.473	0.549
Anterior surface
C/D ratio ≤ 0.6	9.167	3.715-22.621	0.000
Spherical equivalent ≤ -0.6 diopter	0.000	0.000	0.998
Cataract	0.516	0.220-1.213	0.129
Spectralis® OCT
Posterior surface
C/D ratio ≤ 0.6	8.387	2.098-33.537	0.003
Spherical equivalent ≤ -0.6 diopter	5.165	0.871-30.636	0.071
Cataract	0.737	0.191-2.850	0.658
Anterior surface
C/D ratio ≤ 0.6	0.000	0.000	0.996
Spherical equivalent ≤ -0.6 diopter	0.000	0.000	0.999
Cataract	0.480	0.081-2.838	0.418
Cirrus® OCT
Posterior surface
C/D ratio ≤ 0.6	1.681	0.802-3.523	0.169
Spherical equivalent ≤ -0.6 diopter	0.665	0.173-2.555	0.552
Cataract	0.839	0.415-1.696	0.625
Anterior surface
C/D ratio ≤ 0.6	7.351	2.673-20.220	0.000
Spherical equivalent ≤ -0.6 diopter	0.000	0.000	0.999
Cataract	0.498	0.180-1.377	0.179

CI = confidential interval; C/D ratio = cup-to-disc ratio; OCT = optical coherence tomography.

Table 5.

Reproducibility of the lamina cribrosa thickness measured by Spectralis® OCT and Cirrus® OCT

ICC	Spectralis® OCT (95% CI)	Cirrus® OCT (95% CI)
Intraobserver
Observer 1	0.868 (0.744-0.932)	0.595 (-0.629~0.899)
Observer 2	0.758 (0.541-0.861)	0.540 (-0.723~0.789)
Interobserver	0.913 (0.876-0.940)	0.812 (0.693-0.885)

ICC = intraclass correlation coefficient; OCT = optical coherence tomography; CI = confidential interval.

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