Macular morphology in patients with optic nerve head drusen and optic disc edema.

In this study we investigated macular morphology, including individual retinal layers, in patients with optic nerve head drusen (ONHD) and optic disc edema (ODE) compared with healthy participants, using high-resolution spectral domain optical coherence tomography (OCT). Prospective, cross-sectional, observational study. A total of 67 patients with ONHD, 36 patients with ODE, and 57 healthy participants. High-resolution spectral domain OCT (Copernicus [OPTOPOL Technology S.A., Zawiercie, Poland] 3-μm resolution, 7 × 7 × 2-mm volumetric scans) was used to image macula morphology. Average retinal nerve fiber layer (RNFL) thickness was measured using a semiautomated method with manual correction of the internal limiting membrane, RNFL, and retinal pigment epithelium (RPE). Retinal and RNFL thicknesses were measured and analyzed in 3 circular zones (Early Treatment Diabetic Retinopathy Study protocol). Individual retinal layers at the macula were quantified by analyzing tomograms using ImageJ (http://rsbweb.nih.gov/ij/; Accessed June 1, 2013). Average retinal and individual retinal layer thickness in patients with ODE or ONHD, and healthy controls. Patients with ONHD had thicker retinae in the inner annulus compared with patients with ODE and controls (significant in the temporal segment compared with those with ODE [P = 0.013] and in the superior segment compared with controls [P = 0.05]). Patients with ONHD had a significantly thinner inner plexiform layer (IPL) (P = 0.02), nerve fiber layer (P = 0.05), and RPE (P = 0.0001), and thicker ganglion cell layer (P = 0.003) and outer plexiform layer (OPL) (P < 0.001) compared with controls. Patients with ODE demonstrated the thickest retina and RNFL in the outer annulus (significant in the inferior segment compared with controls, P = 0.02 for both) with significant thickening in the IPL (P = 0.004), OPL (P < 0.003), and outer segment layer (P ≤ 0.02), and severe ganglion cell loss (P = 0.004) and RPE (P = 0.0001) thinning compared with healthy volunteers. Our study shows that optic nerve diseases are associated with selective changes in different retinal layers in patients with ODE and ONHD. These findings may be of diagnostic value and could be taken into consideration in assessing patients and studying the pathogenesis of these conditions.

Pilat AV ，Proudlock FA ，Kumar P ，Lee H ，Papageorgiou E ，Gottlob I ... -  《-》

Differentiation of optic nerve head drusen and optic disc edema with spectral-domain optical coherence tomography.

To evaluate the efficacy of spectral-domain optical coherence tomography (SD-OCT) in differentiating optic disc edema (ODE) and optic nerve head drusen (ONHD) and to reveal the differential points. Comparative case series. Forty-five patients with ONHD, 15 patients with ODE, and 32 normal controls. Spectral-domain optical coherence tomography was performed with scans on the optic nerve head and measurements of retinal nerve fiber layer thickness. Qualitative findings of optic nerve head scans and retinal nerve fiber layer thickness profiles on SD-OCT. Optic nerve head drusen was visualized as a focal, hyperreflective, subretinal mass with a discrete margin on SD-OCT. The retinal nerve fiber layer was deformed and showed pseudoedema and high reflectance. The outer nuclear layer smoothly covered the drusen, which led to a hyporeflective, boot-shaped area adjacent to the drusen. In ODE, peripapillary retinal nerve fiber layers were significantly thicker in all sections than ONHD (average thickness of ODE: 174.1±53.5 μm vs ONHD: 119.2±20.2 μm vs control: 103.4±19.1 μm, P<0.001). Retinal nerve fiber thickness in the nasal section provides a good differential marker for ODE from ONHD (area under receiver operating characteristic curve = 0.866). With the use of SD-OCT, noninvasive and accurate differentiation of ONHD and ODE is possible.

Lee KM ，Woo SJ ，Hwang JM 《-》

Differentiating optic disc edema from optic nerve head drusen on optical coherence tomography.

Johnson LN ，Diehl ML ，Hamm CW ，Sommerville DN ，Petroski GF ... -  《-》

Sensitivity and specificity of time-domain and spectral-domain optical coherence tomography in differentiating optic nerve head drusen and optic disc oedema.

To evaluate the efficacy of time-domain optical coherence tomography (TD-OCT) and spectral-domain optical coherence tomography (SD-OCT) in differentiating between optic nerve head drusen (ONHD) and optic disc oedema (ODE). We studied 66 patients with ONHD, 31 patients with ODE, and 70 controls using TD-OCT and SD-OCT. We analysed two aspects of the tomographic findings: (i) quantitative, through measurement of the retinal nerve fibre layer (RNFL) and papillary elevation; and (ii) qualitative, through assessment of the hyporeflective space, morphology of the internal contour, focal papillary mass and RNFL increases in seven contiguous clock hours. We evaluated the sensitivity, specificity, intra-class correlation coefficient (ICC), and inter-observer agreement (κ). The quantitative analysis of the RNFL revealed an average thickness of the RNFL <124μm with TD-OCT (sensitivity=91%; specificity=94%) and <116μm with SD-OCT (sensitivity=91%; specificity=97%). The thickness of the nasal quadrant was <108μm with TD-OCT (sensitivity=89%; specificity=87%) and with SD-OCT was <92μm (sensitivity=88%; specificity=94%), however without significant differences between the nasal, superior and inferior quadrants' and average thickness. The measurement of papillary elevation was 0.85mm with TD-OCT (sensitivity=96%; specificity=84% [ICC=0.96]) and was <0.80 mm with SD-OCT (sensitivity=86%; specificity=87% [ICC=0.94]). The abrupt termination of the hyporeflective space measured with TD-OCT had sensitivity=79% and specificity=90% (κ=0.60) and with SD-OCT had sensitivity=88% and specificity=89% (κ=0.75); the irregularity of the internal contour with TD-OCT had sensitivity=80% and specificity=90% (κ=0.70) and with SD-OCT had sensitivity=88% and specificity=90% (κ=0.75); and the absence of seven contiguous clock hours had values of sensitivity=97% and specificity=77% with TD-OCT and had sensitivity=98% and specificity=77% with SD-OCT. Optical coherence tomography allowed for differentiation between ONHD and ODE, yielding similar results with TD-OCT and SD-OCT. The new quantitative parameters of papillary elevation and RNFL measurements showed greater sensitivity and specificity than the qualitative criteria.

Flores-Rodríguez P ，Gili P ，Martín-Ríos MD 《-》

High-Resolution Imaging of the Optic Nerve and Retina in Optic Nerve Hypoplasia.

To investigate the optic nerve and macular morphology in patients with optic nerve hypoplasia (ONH) using spectral-domain optical coherence tomography (SD OCT). Prospective, cross-sectional, observational study. A total of 16 participants with ONH (10 female and 6 male; mean age, 17.2 years; 6 bilateral involvement) and 32 gender-, age-, ethnicity-, and refraction-matched healthy controls. High-resolution SD OCT (Copernicus [Optopol Technology S.A., Zawiercie, Poland], 3 μm resolution) and handheld SD OCT (Bioptigen Inc [Research Triangle Park, NC], 2.6 μm resolution) devices were used to acquire horizontal scans through the center of the optic disc and macula. Horizontal optic disc/cup and rim diameters, cup depth, peripapillary retinal nerve fiber layer (RNFL), and thickness of individual retinal layers in participants with ONH and in controls. Patients with ONH had significantly smaller discs (P < 0.03 and P < 0.001 compared with unaffected eye and healthy controls, respectively), horizontal cup diameter (P < 0.02 for both), and cup depth (P < 0.02 and P < 0.01, respectively). In the macula, significantly thinner RNFL (nasally), ganglion cell layer (GCL) (nasally and temporally), inner plexiform layer (IPL) (nasally), outer nuclear layer (ONL) (nasally), and inner segment (centrally and temporally) were found in patients with ONH compared with the control group (P < 0.05 for all comparisons). Continuation of significantly thicker GCL, IPL, and outer plexiform layer in the central retinal area (i.e., foveal hypoplasia) was found in more than 80% of patients with ONH. Clinically unaffected fellow eyes of patients with ONH showed mild features of underdevelopment. Visual acuity and presence of septo-optic dysplasia were associated with changes in GCL and IPL. Sensitivity and specificity for the detection of ONH based on disc and retinal optical coherence tomography (OCT) parameters were >80%. Our study provides evidence of retinal changes in ONH. In addition to thinning of retina layers mainly involving the RNFL and GCL, signs reminiscent of foveal hypoplasia were observed in patients with ONH. Optic nerve and foveal parameters measured using OCT showed high sensitivity and specificity for detecting ONH, demonstrating their useful for clinical diagnosis.

Pilat A ，Sibley D ，McLean RJ ，Proudlock FA ，Gottlob I ... -  《-》