Diagnostic Accuracies of Bruch Membrane Opening-minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Glaucoma

Hee Kim So; Heung Park Keun; MD Ji Woong Lee,

doi:10.3341/jkos.2017.58.7.836

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So, Keun, and Ji Woong Lee,: Diagnostic Accuracies of Bruch Membrane Opening-minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Glaucoma

Original Article

J Korean Ophthalmol Soc 2017;58(7):836-845.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.836

Diagnostic Accuracies of Bruch Membrane Opening-minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Glaucoma

Hee Kim So, M.D.¹, Heung Park Keun, M.D.¹, MD Ji Woong Lee,, PhD^1,^2,

¹Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Address reprint requests to Ji Woong Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7326, Fax: 82-51-242-7341 E-mail: glaucoma@pnu.ac.kr

* This work was supported by clinical research grant from Pusan National University Hospital in 2017.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 6 April 201717 June 2017 Accepted 30 June 2017

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 compare the diagnostic capability of Bruch membrane opening-minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness for the detection of primary open angle glaucoma.

Methods

Spectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 peripapillary B-scans centered on the Bruch membrane opening (BMO) was performed. Two SD-OCT parameters were computed globally and sectorally: (1) BMO- MRW, the minimum distance between BMO and internal limiting membrane; and (2) peripapillary retinal nerve fiber layer (RNFL) thickness. The diagnostic performance of BMO-MRW and RNFL thickness were compared with receiver operating characteristic (ROC) analysis globally and sectorally. Areas under the ROC (AUC) were calculated and compared.

Results

One hundred fourteen eyes (52 healthy, 62 glaucomatous) of 114 participants were included. In global analyses, the performance of BMO-MRW was similar to that of RNFL thickness (AUC 0.95 [95% confidence interval {CI}, 0.91-0.99], and 0.95 [95% CI, 0.91-0.99], respectively, p=0.93). In sectoral analyses, the pair-wise comparison among the ROC curves showed no statistical difference for all sectors except for the superotemporal, superonasal, and nasal sectors, which had significantly larger AUCs in BMO-MRW compared to RNFL thickness (p=0.03, p<0.001, and p=0.03, respectively). The parameter with the largest AUC was the inferotemporal sector for both BMO-MRW and RNFL thickness (AUC 0.98 [95% CI, 0.96-1.00], and 0.98 [95% CI, 0.96-1.00], respectively, p=0.99).

Conclusions

Global BMO-MRW performed as well as global RNFL thickness for detection of glaucoma. In superotemporal, su-peronasal and nasal sectors, regional BMO-MRW performed better than regional RNFL thickness.

Keywords: Bruch membrane opening-minimum rim width, Diagnostic capability, Peripapillary retinal nerve fiber layer thickness, Spectral-domain optical coherence tomography

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Figure 1.

Neuroretinal rim parameters measured with Spectralis optical coherence tomography. B-scan illustrating Bruch mem-brane opening (BMO), and Bruch membrane opening-minimum rim width (BMO-MRW), the minimum distance from BMO to the internal limiting membrane (ILM).

Figure 2.

The receiver operating characteristic (ROC) curves. ROC curves illustrating the diagnostic performance of global Bruch membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT).

Figure 3.

The receiver operating characteristic curves illustrating the diagnostic performance of sectoral Bruch membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT). (A) Superonasal. (B) Nasal. (C) Inferonasal. (D) Superotemporal. (E) Temporal. (F) Inferotemporal.

Table 1.

Demographic and ocular characteristics of the included eyes

	Normal group (n = 52 eyes)	Glaucoma patients (n= 62 eyes)	p-value
Age (years)	54.96 ± 13.69	60.88 ± 11.30	0.013^*
Intraocular pressure (mmHg)	14.54 ± 2.91	14.81 ± 3.27	0.648^*
Central corneal thickness (µm)	545.56 ± 39.04	540.78 ± 38.54	0.526^*
Axial length (mm)	23.79 ± 1.29	23.97 ± 1.50	0.889^†
Spherical equivalent (diopter)	-0.96 ± 2.42	-1.04 ± 2.70	0.984^†
Gender (n) (male/female)	24/28	34/28	0.356^‡
Eye laterality (n) (right/left)	25/27	26/36	0.511^‡
Lens (n) (phakic/pseudophakic)	48/4	57/5	0.941^‡
Visual field
Mean deviation (dB)	-0.76 ±1.74	-7.64 ± 5.23	<0.001^†
Pattern standard deviation (dB)	1.63 ± 0.45	7.33 ± 3.74	<0.001^†
Visual Field Index (%)	99.1 ± 1.27	80.02 ± 16.49	<0.001^†
Comorbidity (n)
Hypertension	7	17	0.069^‡
Diabetes	9	7	0.357^‡
Tilt ratio	1.11 ± 0.09	1.11 ± 0.11	0.986^*
Degree of rotation (°)	2.35 ± 8.51	3.74 ± 9.03	0.404^‡
β-Zone PPA (n, %)	11 (21.15)	41 (66.13)	<0.001^‡

Values are presented as mean ± SD unless otherwise indicated. PPA = parapapillary atrophy.

^* Student's t-test.

^† Mann-Whitney U-test.

^‡ Chi-squared test.

Table 2.

Comparison of global and regional Bruch membrane opening-minimum rim and retinal nerve fiber layer thickness measure-ments in the healthy and glaucomatous eyes

OCT parameters	Normal group	Glaucoma patients	p-value
BMO-MRW
BMO area	2.14 ± 0.46	2.18 ± 0.39	0.627^*
Global	258.42 ± 49.84	159.11 ± 44.02	<0.001^*
Temporal	187.4 ± 45.06	129.12 ± 43.32	<0.001^*
Superotemporal	261.86 ± 51.43	156.32 ± 63.13	<0.001^*
Inferotemporal	287.77 ± 55.7	126.24 ± 57.93	<0.001^†
Nasal	271.23 ± 62.91	179.32 ± 52.82	<0.001^†
Superonasal	303.23 ± 55.08	194.03 ± 66.81	<0.001^*
Inferonasal	305.29 ± 59.96	171.72 ± 58.78	<0.001^†
RNFL thickness
Global	97.62 ± 9.68	68.11 ± 15.09	<0.001^*
Temporal	74.64 ± 12.49	55.81 ± 15.02	<0.001^*
Superotemporal	128.56 ± 20.16	87.53 ± 31.24	<0.001^†
Inferotemporal	151.19 ± 16.74	69.69 ± 30.34	<0.001^†
Nasal	74.08 ± 13.09	62.26 ± 14.66	<0.001^*
Superonasal	120.75 ± 22.79	88.79 ± 26.41	<0.001^*
Inferonasal	107.62 ± 20.2	70.63 ± 20.2	<0.001^*

Values are presented as mean ± SD unless otherwise indicated. OCT = optical coherence tomography; BMO-MRW = Bruch membrane opening-minimum rim width; BMO = Bruch membrane opening; RNFL = retinal nerve fiber layer.

^* Student's t-test.

^† Mann-Whitney U-test.

Table 3.

Areas under receiver operating characteristic curves (95% confidence interval) for Bruch membrane opening-minimum rim width and retinal nerve fiber layer thickness

Parameter	BMO-MRW	RNFL thickness	p-value^*
Global	0.951 (0.911-0.991)	0.953 (0.914-0.992)	0.932
Temporal	0.832 (0.759-0.906)	0.866 (0.797-0.935)	0.371
Superotemporal	0.914 (0.861-0.967)	0.852 (0.785-0.920)	0.033
Inferotemporal	0.981 (0.959-1.000)	0.981 (0.960-1.000)	0.991
Nasal	0.889 (0.829-0.949)	0.720 (0.627-0.813)	<0.001
Superonasal	0.897 (0.840-0.954)	0.815 (0.738-0.893)	0.032
Inferonasal	0.950 (0.908-0.992)	0.908 (0.855-0.961)	0.178

BMO-MRW = Bruch membrane opening-minimum rim width; RNFL = retinal nerve fiber layer.

^* p-value obtained from the pairwise comparison between 2 parameters.

Table 4.

Sensitivities and specificities set at 80% and 95% according to Bruch membrane opening-minimum rim width and retina nerve fiber layer thickness

	BMO-MRW		RNFL thickness
	Specificity at 80%	Specificity at 95%	Specificity at 80%	Specificity at 95%
Global	93.55	77.42	91.94	84.84
Temporal	72.58	40.32	80.32	52.58
Superotemporal	85.48	77.42	73.87	50.00
Inferotemporal	98.39	90.32	96.99	91.94
Nasal	80.65	45.16	45.32	29.35
Superonasal	82.26	62.90	69.03	36.77
Inferonasal	93.55	87.10	85.48	61.29

Values are presented as percentage (%). BMO-MRW = Bruch membrane opening-minimum rim width; RNFL = retinal nerve fiber layer.

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