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Comparative Study
. 1999 Mar;106(3):570-9.
doi: 10.1016/s0161-6420(99)90118-5.

Evaluation of focal defects of the nerve fiber layer using optical coherence tomography

L Pieroth  1 , J S Schuman, E Hertzmark, M R Hee, J R Wilkins, J Coker, C Mattox, R Pedut-Kloizman, C A Puliafito, J G Fujimoto, E Swanson
Affiliations
Comparative Study

Evaluation of focal defects of the nerve fiber layer using optical coherence tomography

L Pieroth et al. Ophthalmology. 1999 Mar.

Abstract

Objective: To analyze glaucomatous eyes with known focal defects of the nerve fiber layer (NFL), relating optical coherence tomography (OCT) findings to clinical examination, NFL and stereoscopic optic nerve head (ONH) photography, and Humphrey 24-2 visual fields.

Design: Cross-sectional prevalence study.

Participants: The authors followed 19 patients in the study group and 14 patients in the control group.

Intervention: Imaging with OCT was performed circumferentially around the ONH with a circle diameter of 3.4 mm using an internal fixation technique. One hundred OCT scan points taken within 2.5 seconds were analyzed.

Main outcome measures: Measurements of NFL thickness using OCT were performed.

Results: In most eyes with focal NFL defects, OCTs showed significant thinning of the NFL in areas closely corresponding to focal defects visible on clinical examination, to red-free photographs, and to defects on the Humphrey visual fields. Optical coherence tomography enabled the detection of focal defects in the NFL with a sensitivity of 65% and a specificity of 81%.

Conclusion: Analysis of NFL thickness in eyes with focal defects showed good structural and functional correlation with clinical parameters. Optical coherence tomography contributes to the identification of focal defects in the NFL that occur in early stages of glaucoma.

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Figures

Figure 1
Figure 1
Schematic diagram of the 100 optical coherence tomography points taken within 2.5 seconds.
Figure 2
Figure 2
Optical coherence tomography graph illustrating the mean peripapillary nerve fiber layer (NFL) thickness (±1.96*standard deviation) of all control eyes (open squares) compared to all eyes with inferotemporal NFL defects (filled circles). Note that the overall shapes of the two curves are similar. SD = standard deviation.
Figure 3
Figure 3
Optical coherence tomography graph illustrating the mean standardized peripapillary nerve fiber layer (NFL) thickness (±2.33*standard deviation) of all control eyes (open squares) compared to all eyes with inferotemporal NFL defects (filled circles). Note that the mean standardized values at the optical coherence tomography points for the study eyes are almost the same as those for the control eyes, except for the inferotemporal region. SD = standard deviation.
Figure 4
Figure 4. Control 18
A, stereoscopic optic nerve head photography of a control eye. B, red-free nerve fiber layer (NFL) photograph of the control eye. C, full Humphrey 24–2 visual field. D, circular optical coherence tomography (OCT) scan shows normal NFL thickness values in all four quadrants. E, OCT graph depicting 100 OCT points taken within 2.5 seconds. MD = mean deviation; CPSD = corrected pattern standard deviation.
Figure 5
Figure 5. Case 17
A, stereoscopic optic nerve head photograph of the right eye with moderate cupping of the optic disc and a localized arcuate nerve fiber layer (NFL) defect inferotemporally. B, red-free NFL photograph shows the localized arcuate NFL defect inferotemporally (arrows). Note that a blood vessel demarcates the focal NFL defect inferiorly. C, Humphrey 24–2 visual field shows a superior cecocentral scotoma. D, circular optical coherence tomograph (OCT) shows significant thinning of the NFL, especially in the inferotemporal region. E, OCT graph shows focal thinning in the inferotemporal NFL.
Figure 6
Figure 6. Case 15
A, stereoscopic optic nerve head photograph of the right eye in a subject with a localized arcuate nerve fiber layer (NFL) defect inferotemporally (arrows). B, red-free NFL photograph shows the localized arcuate NFL defect inferotemporally (arrows). C, Humphrey 24–2 visual field shows a superior paracentral defect corresponding with the inferotemporal defect. D, circular optical coherence tomograph (OCT) shows significant thinning of the NFL, especially in the inferotemporal region. E, OCT graph shows focal thinning in the inferotemporal NFL.
Figure 7
Figure 7. Case 11
A, stereoscopic optic nerve head photograph of the left eye in a subject with a localized arcuate nerve fiber layer (NFL) defect superotemporally (arrows). B, red-free NFL photograph shows the localized arcuate NFL defect superotemporally (arrows). Note that a blood vessel demarcates the focal NFL defect superiorly. C, Humphrey 24–2 visual field shows an inferior arcuate defect. D, circular optical coherence tomograph (OCT) shows focal thinning of the NFL (arrow). E, OCT graph shows thinning in the superotemporal NFL.
Figure 8
Figure 8. Case 22
A, stereoscopic optic nerve head photograph of the left eye in a subject with a localized arcuate nerve fiber layer (NFL) defect inferotemporally (arrows). B, red-free NFL photograph shows the localized arcuate NFL defect inferotemporally (arrows). Note that blood vessels demarcate the focal NFL defect superiorly and inferiorly. C, Humphrey 24–2 visual field shows a paracentral defect. D, circular optical coherence tomograph (OCT) fails to show focal thinning of the NFL inferotemporally (arrow). E, OCT graph fails to show excess thinning in the inferotemporal NFL.
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