title: Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter.
abstract: OBJECTIVE
  Neuroretinal rim assessment based on the clinical optic disc margin (DM) lacks a sound anatomic basis for 2 reasons: (1) The DM is not reliable as the outer border of rim tissue because of clinically and photographically invisible extensions of Bruch's membrane (BM) inside the DM and (2) nonaccountability of rim tissue orientation in the optic nerve head (ONH). The BM opening-minimum rim width (BMO-MRW) is a parameter that quantifies the rim from its true anatomic outer border, BMO, and accounts for its variable orientation. We report the diagnostic capability of BMO-MRW.
  
  
  METHODS
  Case control.
  
  
  METHODS
  Patients with open-angle glaucoma (n = 107) and healthy controls (n = 48).
  
  
  METHODS
  Spectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 circumpapillary B-scans, centered on the ONH, and confocal scanning laser tomography (CSLT) were performed. The internal limiting membrane (ILM) and BMO were manually segmented in each radial B-scan. Three SD-OCT parameters were computed globally and sectorally: (1) circumpapillary retinal nerve fiber layer thickness (RNFLT); (2) BMO-horizontal rim width (BMO-HRW), the distance between BMO and ILM in the BMO reference plane; and (3) BMO-MRW, the minimum distance between BMO and ILM. Moorfields Regression Analysis (MRA) with CLST was performed globally and sectorally to yield MRA1 and MRA2, where "borderline" was classified as normal and abnormal, respectively.
  
  
  METHODS
  Sensitivity, specificity, and likelihood ratios (LRs) for positive and negative test results (LR+/LR-).
  
  
  RESULTS
  The median (interquartile range) age and mean deviation of patients and controls were 69.9 (64.3-76.9) and 65.0 (58.1-74.3) years and -3.92 (-7.87 to -1.62) and 0.33 (-0.32 to 0.98) dB, respectively. Globally, BMO-MRW yielded better diagnostic performance than the other parameters. At 95% specificity, the sensitivity of RNFLT, BMO-HRW, and BMO-MRW was 70%, 51%, and 81%, respectively. The corresponding LR+/LR- was 14.0/0.3, 10.2/0.5, and 16.2/0.2. Sectorally, at 95% specificity, the sensitivity of RNFLT ranged from 31% to 59%, of BMO-HRW ranged from 35% to 64%, and of BMO-MRW ranged from 54% to 79%. Globally and in all sectors, BMO-MRW performed better than MRA1 or MRA2.
  
  
  CONCLUSIONS
  The higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared with current BMO methods is significant, indicating a new structural marker for the detection and risk profiling of glaucoma.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: bal@dal.ca.
authors.forename: Balwantray C
authors.initials: BC
authors.lastname: Chauhan
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: O'Leary
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Faisal A
authors.initials: FA
authors.lastname: AlMobarak
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Ophthalmology, University of São Paulo, São Paulo, Brazil.
authors.forename: Alexandre S C
authors.initials: ASC
authors.lastname: Reis
authors.affiliation: Devers Eye Institute, Portland, Oregon.
authors.forename: Hongli
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Glen P
authors.initials: GP
authors.lastname: Sharpe
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Hutchison
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Nicolela
authors.affiliation: Devers Eye Institute, Portland, Oregon.
authors.forename: Claude F
authors.initials: CF
authors.lastname: Burgoyne
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005189:False Positive Reactions; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D016013:Likelihood Functions; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence