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Evaluating link between rim area, retinal nerve fiber layer thickness may help identify glaucoma

Am J Ophthalmol. 2011;151(2):277-286.

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Comparing the correlation between optic disc rim area and retinal nerve fiber layer thickness may distinguish eyes with open-angle glaucoma from those with nonarteritic anterior ischemic optic neuropathy, a study found.

The prospective cross-sectional study analyzed the rim area and retinal nerve fiber layer thickness (rim-RNFL) correlation in global and 12-clock-hour parameters. Rim area was determined through Heidelberg Retina Tomograph II (Heidelberg Engineering), and retinal nerve fiber thickness was determined through Cirrus optical coherence tomography (Carl Zeiss Meditec).

The study included 113 eyes with open-angle glaucoma (OAG) and 22 eyes with nonglaucomatous nonarteritic anterior ischemic optic neuropathy (NAION).

A significant linear rim-RNFL correlation was shown in global and clock-hour sectors, except the 3, 4 and 9 o'clock sectors, for eyes with OAG.

"All eyes with NAION were outside the 95% [prediction interval] of the rim-RNFL correlation of OAG in at least 1 clock-hour sector in terms of clock-hour parameters, as compared with 63.6% of eyes in terms of global parameters," the study authors said.

A rim-RNFL correlation outside the 95% prediction interval of OAG for corresponding clock-hour sectors was observed for all NAION eyes with 7 or 11 o'clock involvement.

"The study shows for the first time that NAION eyes are well differentiated from OAG eyes by the 95% [prediction interval] of the linear regression of OAG on a clock-hour basis," the authors said.

Studies have suggested that retinal nerve fiber thickness defects may be more efficacious in diagnosing glaucoma than optic disc analysis, but nonglaucomatous diseases such as NAION may cause such defects. The study authors said that evaluating the rim-RNFL correlation could help to prevent false diagnoses because a significant correlation is observed in eyes with glaucoma but not in eyes with most nonglaucomatous conditions.