title: The use of Bruch's membrane opening-based optical coherence tomography of the optic nerve head for glaucoma detection in microdiscs.
abstract: To assess the performance of Bruch's membrane opening (BMO)-based spectral domain optical coherence tomography (SD-OCT) of the optic nerve head for glaucoma detection in microdiscs in comparison with confocal scanning laser tomography (CSLT).
  
  
  
  Retrospective cohort study.
  
  
  
  82 eyes of 82 patients with disc size <1.63 mm2underwent SD-OCT and CSLT measurements, visual field testing and clinical examination. BMO-based minimal rim width (BMO-MRW), retinal nerve fibre layer thickness (RNFLT) in SD-OCT and rim area measured in CSLT were compared and correlated with visual field defects.
  
  
  
  51 patients with glaucoma, 11 patients with ocular hypertension (OHT) and 20 healthy controls had a mean disc area of 1.36±0.19 mm2in CSLT, and BMO area was 1.45±0.22 mm2(r=0.17; p=0.12). In patients with glaucoma, visual field mean defect was -7.5±6.7 dB. Global BMO-MRW correlated better with visual field function (Spearman's r=0.65; p<0.001) than RNFLT (r=0.58; p≤0.001) and CSLT rim area (r=0.47; p=0.004). BMO-MRW significantly deteriorated with progressive visual field loss (p<0.001). In receiver operating characteristic analysis, sensitivity of BMO-MRW was 68.6% at 95% specificity (area under curve (AUC)=0.87), similar to sensitivity of RNFLT (66.4%; AUC=0.81). Performance of CSLT rim area was significantly worse (AUC=0.70, p=0.008). In healthy controls, mean BMO-MRW was 344.3±64.1 µm, mean RNFLT 78.0±11.3 µm and CSLT mean rim area 1.07±0.18 mm2.
  
  
  
  In small optic discs, BMO-MRW and peripapillary RNFLT (OCT) have similar sensitivity to discriminate patients with glaucoma from normal controls; both exceed CSLT rim area in diagnostic power. In glaucomatous patients, BMO-MRW correlates strongest with visual field function.
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Enders
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Schaub
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Adler
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Nikoluk
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Hermann
authors.affiliation: Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ludwig M
authors.initials: LM
authors.lastname: Heindl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016570:Bruch Membrane / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers; D009898:Optic Disk / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012165:Retinal Ganglion Cells; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests; D014794:Visual Fields
keywords: Glaucoma; Imaging; Optic Nerve