New technologies for diagnosing and monitoring glaucomatous optic neuropathy.
BACKGROUND
Recently, instruments have been developed to provide real-time, quantitative measurements of the optic disc and retinal nerve fiber layer (RNFL) for use in glaucoma management. Our objective is to (1) provide an overview of two of these instruments, the confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph, HRT) and scanning laser polarimeter (Nerve Fiber Analyzer, NFA) and (2) compare measurements obtained with these instruments to clinical features used in the diagnosis of glaucoma.


METHODS
Twenty glaucoma patients, 4 normal subjects and 20 glaucoma subjects were included. All subjects had images obtained with the HRT and NFA, and RNFL and optic disc photography completed within 5 weeks of each other. The HRT results were compared with qualitative evaluation of stereophotographs of the optic disc, and NFA results were compared against a semi-quantitative RNFL photograph severity score.


RESULTS
Twenty-five (57%) subjects had thinning of the neuroretinal rim identified by evaluation of stereoscopic optic disc photographs. Despite overlap, HRT measurements of rim volume, rim area, and rim/disc ratio were significantly smaller in eyes with evidence of rim thinning than in eyes with no evidence of rim thinning. Moderate to severe RNFL damage was detected by evaluation of photographs in 25 (57%) of subjects. NFA RNFL thickness measures were smaller in eyes with moderate to severe RNFL damage than in relatively healthy eyes.


CONCLUSIONS
Previous studies have documented the reproducibility of these instruments and suggested analytic techniques for improving their ability to differentiate between normal and glaucoma eyes. Our results indicate that despite overlap in values, these instruments provide measurements that reflect clinically relevant features of the optic disc and RNFL. Whether these technologies can improve our ability to detect glaucomatous progression over time needs to be determined with well-designed longitudinal studies and comparison with established diagnostic techniques for evaluating glaucomatous optic neuropathy.
Zangwill
L M
LM
Glaucoma Center and Diagnostic Imaging Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093-0946, USA.
Chang
C F
CF
Williams
J M
JM
Weinreb
R N
RN
D000368:Aged; D005260:Female; D005654:Fundus Oculi; D005901:Glaucoma / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008859:Microscopy, Polarization; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009885:Ophthalmology / Q000379:methods* / Q000639:trends*; D009887:Ophthalmoscopy; D009901:Optic Nerve Diseases / Q000473:pathology*; D010781:Photography; D012016:Reference Values; D012160:Retina / Q000473:pathology