title: Optic disc biomorphometry with the Heidelberg Retina Tomograph at different reference levels.
abstract: OBJECTIVE
  The Heidelberg Retina Tomograph (HRT) is a confocal scanning laser tomograph that produces high resolution optical section images of the optic disc and central retina. Measurement accuracy and reproducibility is good. Several of the stereometric variables depend on the definition of a reference plane level. The purpose of the present study was to evaluate the four different reference levels in terms of their advantages and disadvantages in clinical work.
  
  
  METHODS
  Sixty-seven randomly chosen eyes belonging to 67 subjects were included in this study. Forty of the eyes were healthy and 27 had glaucoma. The HRT with software versions 1.09 and 1.11 was used to acquire and evaluate topographic measurements of the optic disc. Image analysis was performed at four different reference levels: 320 microm fixed offset reference level (REFd) (version 1.09), an individually determined reference level (REFi), a papillo-macular reference level (REFm) and a flexible reference level (REFf) (version 1.11). ANOVA was used to determine differences in the topographic parameters between the reference levels.
  
  
  RESULTS
  In terms of the healthy eyes, all the variables using different reference levels give rather similar results. However, with advanced glaucoma the measurement values provided with REFd are clearly different to those of the other reference levels. The measurement values using REFm and REFf provide fairly similar results in all clinical groups. REFf indicates the lowest point in the segment between 350 degrees and 356 degrees along the contour line and thus provides the most stable and clinically useful reference level at present.
  
  
  CONCLUSIONS
  At present, the flexible reference level REFf gives the most reliable and adequate HRT measurement values, both in normal and in glaucomatous eyes.
authors.affiliation: Department of Ophthalmology, University of Oulu, Oulu, Finland.
authors.forename: Kyösti
authors.initials: K
authors.lastname: Vihanninjoki
authors.forename: Reinhard O W
authors.initials: RO
authors.lastname: Burk
authors.forename: Pait
authors.initials: P
authors.lastname: Teesalu
authors.forename: Anja
authors.initials: A
authors.lastname: Tuulonen
authors.forename: P Juhani
authors.initials: PJ
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D009798:Ocular Hypertension; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012016:Reference Values; D015203:Reproducibility of Results; D014054:Tomography; D014794:Visual Fields