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. 1999 Mar;83(3):299–304. doi: 10.1136/bjo.83.3.299

Preperimetric glaucoma diagnosis by confocal scanning laser tomography of the optic disc

C Mardin 1, F Horn 1, J Jonas 1, W Budde 1
PMCID: PMC1722981  PMID: 10365037

Abstract

AIM—To evaluate the ability of confocal scanning laser tomography of the optic nerve head to detect glaucomatous optic nerve damage in ocular hypertensive eyes without visual field defects.
METHODS—The study included 50 normal subjects, 61 glaucoma patients with glaucomatous changes in the optic disc and visual field, and 102 "preperimetric" patients with increased intraocular pressure, normal visual fields, and glaucomatous appearance of the optic disc as evaluated on colour stereo optic disc photographs. For all individuals, confocal scanning laser tomographs of the optic nerve head were taken using the Heidelberg retina tomograph (HRT; software 2.01).
RESULTS—Almost all investigated HRT variables varied significantly (p<0.05) between the normal eyes and preperimetric glaucoma eyes with pronounced overlap between the two study groups. Corresponding to the overlap, sensitivity and specificity values were relatively low when HRT variables were taken to differentiate between normal and preperimetric glaucoma eyes. At a given specificity of 95% highest sensitivities were found for the variables "rim area in the superior disc sector" (24.8%), "nerve fibre layer thickness in the inferior disc sector" (26.5%), and "rim volume in the superior disc sector" (25.5%). A multivariate approach increased sensitivity to 42.2% at a given specificity of 95%. For the glaucoma group highest sensitivity values were reached by rim volume in the superior disc sector (73.8%) and rim area (72.1%); the multivariate approach reached 83.6%.
CONCLUSIONS—Owing to pronounced overlapping between the groups, confocal scanning laser tomography of the optic nerve head has relatively low diagnostic power to differentiate between normal eyes and preperimetric glaucoma eyes. One of the reasons may be the biological interindividual variability of quantitative optic disc variables.

 Keywords: glaucoma; confocal scanning laser tomography; optic disc

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Figure 1  .

Figure 1  

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Box plots showing the distribution of neuroretinal rim area in three groups: controls, preperimetric open angle glaucoma (prePOAG), and perimetric open angle glaucoma (POAG).

Figure 2  .

Figure 2  

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Box plots showing the distribution of neuroretinal rim volume above the reference level in three groups: controls, preperimetric open angle glaucoma (prePOAG), and perimetric open angle glaucoma (POAG).    

Figure 3  .

Figure 3  

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Box plots showing the distribution of retinal nerve fibre (RNF) layer thickness in three groups: controls, preperimetric open angle glaucoma (prePOAG), and perimetric open angle glaucoma (POAG).

Figure 4  .

Figure 4  

Figure 4  

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ROC (receiver operated characteristic) curves generated for multivariate analysis (broken line) and optic disc variables measured by confocal laser scanning tomography in the preperimetric and perimetric glaucoma group. (A) Variables of the rim: rim area superior (more broken line), rim volume superior (solid line), RNF inferior (dotted line). (B) Variables of the cup: cup volume superior (broken line), cup area superior (solid line), cup shape measure (dotted line).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Airaksinen P. J., Drance S. M., Douglas G. R., Schulzer M., Wijsman K. Visual field and retinal nerve fiber layer comparisons in glaucoma. Arch Ophthalmol. 1985 Feb;103(2):205–207. doi: 10.1001/archopht.1985.01050020057019. [DOI] [PubMed] [Google Scholar]
  2. Balazsi A. G., Drance S. M., Schulzer M., Douglas G. R. Neuroretinal rim area in suspected glaucoma and early chronic open-angle glaucoma. Correlation with parameters of visual function. Arch Ophthalmol. 1984 Jul;102(7):1011–1014. doi: 10.1001/archopht.1984.01040030813022. [DOI] [PubMed] [Google Scholar]
  3. Bathija R., Zangwill L., Berry C. C., Sample P. A., Weinreb R. N. Detection of early glaucomatous structural damage with confocal scanning laser tomography. J Glaucoma. 1998 Apr;7(2):121–127. [PubMed] [Google Scholar]
  4. Burk R. O., Rohrschneider K., Takamoto T., Völcker H. E., Schwartz B. Laser scanning tomography and stereophotogrammetry in three-dimensional optic disc analysis. Graefes Arch Clin Exp Ophthalmol. 1993 Apr;231(4):193–198. doi: 10.1007/BF00918840. [DOI] [PubMed] [Google Scholar]
  5. Caprioli J., Miller J. M., Sears M. Quantitative evaluation of the optic nerve head in patients with unilateral visual field loss from primary open-angle glaucoma. Ophthalmology. 1987 Nov;94(11):1484–1487. doi: 10.1016/s0161-6420(87)33264-6. [DOI] [PubMed] [Google Scholar]
  6. Dichtl A., Jonas J. B., Mardin C. Y. Comparison between tomographic scanning evaluation and photographic measurement of the neuroretinal rim. Am J Ophthalmol. 1996 May;121(5):494–501. doi: 10.1016/s0002-9394(14)75423-6. [DOI] [PubMed] [Google Scholar]
  7. Dreher A. W., Tso P. C., Weinreb R. N. Reproducibility of topographic measurements of the normal and glaucomatous optic nerve head with the laser tomographic scanner. Am J Ophthalmol. 1991 Feb 15;111(2):221–229. doi: 10.1016/s0002-9394(14)72263-9. [DOI] [PubMed] [Google Scholar]
  8. Glovinsky Y., Quigley H. A., Drum B., Bissett R. A., Jampel H. D. A whole-field scotopic retinal sensitivity test for the detection of early glaucoma damage. Arch Ophthalmol. 1992 Apr;110(4):486–490. doi: 10.1001/archopht.1992.01080160064031. [DOI] [PubMed] [Google Scholar]
  9. Hatch W. V., Flanagan J. G., Etchells E. E., Williams-Lyn D. E., Trope G. E. Laser scanning tomography of the optic nerve head in ocular hypertension and glaucoma. Br J Ophthalmol. 1997 Oct;81(10):871–876. doi: 10.1136/bjo.81.10.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Horn F. K., Jonas J. B., Korth M., Jünemann A., Gründler A. The full-field flicker test in early diagnosis of chronic open-angle glaucoma. Am J Ophthalmol. 1997 Mar;123(3):313–319. doi: 10.1016/s0002-9394(14)70126-6. [DOI] [PubMed] [Google Scholar]
  11. Javitt J. C. A modified slit lamp for examination of wheelchair-bound patients. Arch Ophthalmol. 1989 Mar;107(3):453–454. doi: 10.1001/archopht.1989.01070010463046. [DOI] [PubMed] [Google Scholar]
  12. Jonas J. B., Dichtl A. Optic disc morphology in myopic primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 1997 Oct;235(10):627–633. doi: 10.1007/BF00946938. [DOI] [PubMed] [Google Scholar]
  13. Jonas J. B., Fernández M. C., Naumann G. O. Glaucomatous parapapillary atrophy. Occurrence and correlations. Arch Ophthalmol. 1992 Feb;110(2):214–222. doi: 10.1001/archopht.1992.01080140070030. [DOI] [PubMed] [Google Scholar]
  14. Jonas J. B., Gusek G. C., Naumann G. O. Optic disc morphometry in chronic primary open-angle glaucoma. I. Morphometric intrapapillary characteristics. Graefes Arch Clin Exp Ophthalmol. 1988;226(6):522–530. doi: 10.1007/BF02169199. [DOI] [PubMed] [Google Scholar]
  15. Jonas J. B., Königsreuther K. A. Optic disk appearance in ocular hypertensive eyes. Am J Ophthalmol. 1994 Jun 15;117(6):732–740. doi: 10.1016/s0002-9394(14)70316-2. [DOI] [PubMed] [Google Scholar]
  16. Jonas J. B., Nguyen N. X., Naumann G. O. Non-quantitative morphologic features in normal and glaucomatous optic discs. Acta Ophthalmol (Copenh) 1989 Aug;67(4):361–366. doi: 10.1111/j.1755-3768.1989.tb01615.x. [DOI] [PubMed] [Google Scholar]
  17. Kohn A. N., Moss A. P., Podos S. M. Relative afferent pupillary defects in glaucoma without characteristic field loss. Arch Ophthalmol. 1979 Feb;97(2):294–296. doi: 10.1001/archopht.1979.01020010146010. [DOI] [PubMed] [Google Scholar]
  18. Kruse F. E., Burk R. O., Völcker H. E., Zinser G., Harbarth U. Reproducibility of topographic measurements of the optic nerve head with laser tomographic scanning. Ophthalmology. 1989 Sep;96(9):1320–1324. doi: 10.1016/s0161-6420(89)32719-9. [DOI] [PubMed] [Google Scholar]
  19. Pederson J. E., Anderson D. R. The mode of progressive disc cupping in ocular hypertension and glaucoma. Arch Ophthalmol. 1980 Mar;98(3):490–495. doi: 10.1001/archopht.1980.01020030486010. [DOI] [PubMed] [Google Scholar]
  20. Quigley H. A., Dunkelberger G. R., Green W. R. Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol. 1989 May 15;107(5):453–464. doi: 10.1016/0002-9394(89)90488-1. [DOI] [PubMed] [Google Scholar]
  21. Rohrschneider K., Burk R. O., Völcker H. E. Reproducibility of topometric data acquisition in normal and glaucomatous optic nerve heads with the laser tomographic scanner. Graefes Arch Clin Exp Ophthalmol. 1993 Aug;231(8):457–464. doi: 10.1007/BF02044232. [DOI] [PubMed] [Google Scholar]
  22. Sample P. A., Martinez G. A., Weinreb R. N. Short-wavelength automated perimetry without lens density testing. Am J Ophthalmol. 1994 Nov 15;118(5):632–641. doi: 10.1016/s0002-9394(14)76578-x. [DOI] [PubMed] [Google Scholar]
  23. Schuman J. S., Hee M. R., Puliafito C. A., Wong C., Pedut-Kloizman T., Lin C. P., Hertzmark E., Izatt J. A., Swanson E. A., Fujimoto J. G. Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol. 1995 May;113(5):586–596. doi: 10.1001/archopht.1995.01100050054031. [DOI] [PubMed] [Google Scholar]
  24. Sommer A., Katz J., Quigley H. A., Miller N. R., Robin A. L., Richter R. C., Witt K. A. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991 Jan;109(1):77–83. doi: 10.1001/archopht.1991.01080010079037. [DOI] [PubMed] [Google Scholar]
  25. Sommer A., Pollack I., Maumenee A. E. Optic disc parameters and onset of glaucomatous field loss. I. Methods and progressive changes in disc morphology. Arch Ophthalmol. 1979 Aug;97(8):1444–1448. doi: 10.1001/archopht.1979.01020020106002. [DOI] [PubMed] [Google Scholar]
  26. Teesalu P., Vihanninjoki K., Airaksinen P. J., Tuulonen A., Lärä E. Correlation of blue-on-yellow visual fields with scanning confocal laser optic disc measurements. Invest Ophthalmol Vis Sci. 1997 Nov;38(12):2452–2459. [PubMed] [Google Scholar]
  27. Tjon-Fo-Sang M. J., de Vries J., Lemij H. G. Measurement by nerve fiber analyzer of retinal nerve fiber layer thickness in normal subjects and patients with ocular hypertension. Am J Ophthalmol. 1996 Aug;122(2):220–227. doi: 10.1016/s0002-9394(14)72013-6. [DOI] [PubMed] [Google Scholar]
  28. Tuulonen A., Lehtola J., Airaksinen P. J. Nerve fiber layer defects with normal visual fields. Do normal optic disc and normal visual field indicate absence of glaucomatous abnormality? Ophthalmology. 1993 May;100(5):587–598. doi: 10.1016/s0161-6420(93)31598-8. [DOI] [PubMed] [Google Scholar]
  29. Tyler C. W. Specific deficits of flicker sensitivity in glaucoma and ocular hypertension. Invest Ophthalmol Vis Sci. 1981 Feb;20(2):204–212. [PubMed] [Google Scholar]
  30. Uchida H., Brigatti L., Caprioli J. Detection of structural damage from glaucoma with confocal laser image analysis. Invest Ophthalmol Vis Sci. 1996 Nov;37(12):2393–2401. [PubMed] [Google Scholar]
  31. Zeyen T. G., Caprioli J. Progression of disc and field damage in early glaucoma. Arch Ophthalmol. 1993 Jan;111(1):62–65. doi: 10.1001/archopht.1993.01090010066028. [DOI] [PubMed] [Google Scholar]

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