title: Confocal Adaptive Optics Imaging of Peripapillary Nerve Fiber Bundles: Implications for Glaucomatous Damage Seen on Circumpapillary OCT Scans.
abstract: OBJECTIVE
  To improve our understanding of glaucomatous damage as seen on circumpapillary disc scans obtained with frequency-domain optical coherence tomography (fdOCT), fdOCT scans were compared to images of the peripapillary retinal nerve fiber (RNF) bundles obtained with an adaptive optics-scanning light ophthalmoscope (AO-SLO).
  
  
  METHODS
  The AO-SLO images and fdOCT scans were obtained on 6 eyes of 6 patients with deep arcuate defects (5 points ≤-15 db) on 10-2 visual fields. The AO-SLO images were montaged and aligned with the fdOCT images to compare the RNF bundles seen with AO-SLO to the RNF layer thickness measured with fdOCT.
  
  
  RESULTS
  All 6 eyes had an abnormally thin (1% confidence limit) RNF layer (RNFL) on fdOCT and abnormal (hyporeflective) regions of RNF bundles on AO-SLO in corresponding regions. However, regions of abnormal, but equal, RNFL thickness on fdOCT scans varied in appearance on AO-SLO images. These regions could be largely devoid of RNF bundles (5 eyes), have abnormal-appearing bundles of lower contrast (6 eyes), or have isolated areas with a few relatively normal-appearing bundles (2 eyes). There also were local variations in reflectivity of the fdOCT RNFL that corresponded to the variations in AO-SLO RNF bundle appearance.
  
  
  CONCLUSIONS
  Relatively similar 10-2 defects with similar fdOCT RNFL thickness profiles can have very different degrees of RNF bundle damage as seen on fdOCT and AO-SLO.
  
  
  CONCLUSIONS
  While the results point to limitations of fdOCT RNFL thickness as typically analyzed, they also illustrate the potential for improving fdOCT by attending to variations in local intensity.
authors.affiliation: Departments of Psychology and Ophthalmology, Columbia University, New York, New York, USA.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Hood
authors.affiliation: Department of Psychology, Columbia University, New York, New York, USA.
authors.forename: Monica F
authors.initials: MF
authors.lastname: Chen
authors.affiliation: Department of Psychology, Columbia University, New York, New York, USA.
authors.forename: Dongwon
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Psychology, Columbia University, New York, New York, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Epstein
authors.affiliation: New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Alhadeff
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA, and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Rosen
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA, and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.affiliation: Departments of Ophthalmology and Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Dubra
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA, and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Toco Y P
authors.initials: TY
authors.lastname: Chui
keywords: adaptive optics; glaucoma; optic disc; optical coherence tomography; retinal nerve fiber layer