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. 2017 Oct 1;58(12):5015-5021.
doi: 10.1167/iovs.17-22596.

Progressive Deformation of the Optic Nerve Head and Peripapillary Structures by Graded Horizontal Duction

Soh Youn Suh  1 , Alan Le  1   2 , Andrew Shin  1 , Joseph Park  1   3 , Joseph L Demer  1   2   3   4   5   6
Affiliations

Progressive Deformation of the Optic Nerve Head and Peripapillary Structures by Graded Horizontal Duction

Soh Youn Suh et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: We investigated the effect of graded range of horizontal duction on the shape of the peripapillary Bruch's membrane (ppBM) and optic nerve head (ONH).

Methods: In 50 eyes of 25 normal subjects, the ONH and peripapillary retina were imaged by optical coherence tomography (OCT) in central gaze and incremental angles of add- and abduction. Displacements of the Bruch's membrane opening (BMO), optic cup (OC), and change in ONH angle in eccentric gazes were compared to those of central gaze, in add- and abduction.

Results: With increasing duction, the nasal edge of the BMO (nBMO) shifted progressively anteriorly in adduction and posteriorly in abduction, while the temporal edge of the BMO (tBMO) shifted posteriorly in adduction and anteriorly in abduction. The summed absolute nBMO and tBMO displacements in 30° and 35° adduction significantly exceeded those in comparable abduction angles (P < 0.005 for both). The ONH progressively tilted temporally in adduction and nasally in abduction; absolute ONH tilt in adduction was significantly greater than that in abduction for 30° and 35° ductions (P < 0.005 for both). BMO displacement and ONH tilt in adduction exhibited bilinear behavior, with greater effects for both at angles exceeding 26°. The OC shifted significantly farther anteriorly in abduction than adduction at every angle from 10° to 35°.

Conclusions: Horizontal duction deforms the ONH and ppBM, but more in adduction than in abduction, and increasingly so for angles greater than 26°. This behavior is consistent with optic nerve sheath tethering for adduction exceeding 26°.

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Figures

Figure 1
Figure 1
En face (A) and cross-sectional (B) OCT images of the ONH and peripapillary retina. The middle scan passing through the ONH center and foveola in (A) and shown in (B) was analyzed quantitatively. The aspect ratio in (B) is vertically exaggerated for illustrative purposes.
Figure 2
Figure 2
Superimposed OCT images of a right eye in central gaze (red reference image in all cases), 35° adduction (green, left column), and 35° abduction (green, right column). Top row: Ten mm-wide OCT scans. Red (central gaze) and green lines (eccentric gaze) connect nBMO and tBMO. Bottom row: Magnified views of rectangular area in top panels. Left column: In adduction, tBMO shifts posteriorly (a), nBMO shifts anteriorly (b), and ONH tilts temporally (c). Vertical distance from the BMO connecting line to the bottom of the OC was measured in central gaze (*) and in adduction (d) to determine the OC displacement. Right column: In abduction, tBMO shifts anteriorly (a), nBMO shifts posteriorly (b), and ONH tilts nasally (c). Note that the absolute BMO displacements and ONH tilt angles are greater in 35° adduction than in 35° abduction.
Figure 3
Figure 3
Mean displacements of nBMO and tBMO in add- and abduction. The summed absolute nBMO and tBMO displacements were significantly greater in adduction than in abduction at 30° and 35°. The intersection of the two best bilinear fits (dotted lines) to summed BMO displacements in adduction was at 25.7° (black arrow).
Figure 4
Figure 4
Mean ONH tilt in add- and abduction. The absolute tilt at 30° and 35° adduction was significantly greater than in comparable abduction. Bilinear regression of ONH tilt angle in adduction (dotted lines) indicated a transition point of 25.4° (black arrow).
Figure 5
Figure 5
OC displacements in add- and abduction. Although displacements of OC varied widely among individuals, on average the OC shifted anteriorly in abduction, and showed little change in adduction.
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