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. 2023 Mar 1;12(3):11.
doi: 10.1167/tvst.12.3.11.

Discriminating Between Compressive Optic Neuropathy With Glaucoma-Like Cupping and Glaucomatous Optic Neuropathy Using OCT and OCTA

Kun Lei  1 , Yuanzhen Qu  1 , Yang Tang  1 , Wen Lu  1 , Heng Zhao  2 , Meizi Wang  1 , Liu Yang  1 , Xuxiang Zhang  1
Affiliations

Discriminating Between Compressive Optic Neuropathy With Glaucoma-Like Cupping and Glaucomatous Optic Neuropathy Using OCT and OCTA

Kun Lei et al. Transl Vis Sci Technol. .

Abstract

Purpose: To discriminate between compressive optic neuropathy with glaucoma-like cupping (GL-CON) and glaucomatous optic neuropathy (GON) by comparing the peripapillary retinal nerve fiber layer (pRNFL) thickness and retinal microvasculature using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

Methods: In this retrospective cross-sectional study, OCT scans were performed on 28 eyes of GL-CON, 34 eyes of GON, and 41control eyes to determine the pRNFL thickness, ganglion cell complex thickness, and cup/disc ratio. OCTA scans were conducted for 12 eyes of GL-CON, 15 eyes of GON, and 15 control eyes to measure the vessel density of the peripapillary and macular areas. Analysis of covariance was used to perform the comparisons, and the area under the curve was calculated.

Results: The GON eyes had a significantly thinner pRNFL in the inferior quadrant and greater vertical cup/disc ratio than the GL-CON eyes. In the radial peripapillary capillary segment, the vessel density of the GON in the inferior sectors was significantly lower than in the GL-CON. The superficial macular vessel density in the whole-image, peritemporal, perinasal, and peri-inferior sectors was significantly smaller in the GON group than in the GL-CON group. The best parameter for discriminating between GL-CON and GON was the superficial macular vessel density in the peritemporal sector.

Conclusions: GL-CON eyes showed a characteristic pattern of pRNFL and retinal microvascular changes.

Translational relevance: GL-CON can be effectively distinguished from GON by detecting the alterations in the pRNFL and retinal microvasculature using OCT and OCTA.

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Conflict of interest statement

Disclosure: K. Lei, None; Y. Qu, None; Y. Tang, None; W. Lu, None; H. Zhao, None; M. Wang, None; L. Yang, None; X. Zhang, None

Figures

Figure 1.
Figure 1.
Peripapillary (4.5 × 4.5 mm) and macular (6.0 × 6.0 mm) region was scanned for vessel density measurement. (A) The radial peripapillary capillary area was divided automatically into eight sectors: nasal superior (NS), nasal inferior (NI), inferior nasal (IN), inferior temporal (IT), temporal inferior (TI), temporal superior (TS), superior temporal (ST), and superior nasal (SN). (B) The software defined the parafoveal region as an annulus with an outer diameter of 3.0 mm and an inner diameter of 1.0 mm, and the perifovea region as an annulus with an outer diameter of 6.0 mm and inner diameter of 3.0 mm. Both regions were divided automatically into four subfields: parafovea superior (para-S), parafovea inferior (para-I), parafovea nasal (para-N), and parafovea temporal (para-T), as well as perifovea superior (peri-S), perifovea inferior (peri-I), perifovea nasal (peri-N), and perifovea temporal (peri-T).
Figure 2.
Figure 2.
Comparison of percentage retinal nerve fiber layer thickness (RNFLT) (A) and RPC vessel density (B) in the GL-CON and GON groups for data normalized relative to the average in the healthy control group. Significant difference in RNFLT was identified in the inferior quadrant between GL-CON and GON (P = 0.005). Significant difference in vessel density of RPC was identified in the IN and IT sectors between GL-CON and GON (P = 0.007, P = 0.001, respectively). PP, peripapillary.
Figure 3.
Figure 3.
ROC of inferior pRNFL and vessel density in perifovea temporal in the differential diagnosis of GL-CON versus GON.
Figure 4.
Figure 4.
Relative reduction of the mean sectorial values of vessel density in the macular superficial retinal capillary plexus in the GL-CON and GON groups compared with the healthy controls. *Significant differences (P < 0.05) when compared with the healthy controls. #Sectors with significant differences (P < 0.05) between the GL-CON and GON groups.
Figure 5.
Figure 5.
Images from three right eyes of representative samples among groups (patient A: GL-CON; patient B: GON; control C). The top row shows diffused retinal nerve fiber layer thickness thinning with the inferior area relatively preserved in patient A (A1), and the same pattern of vessel density reduction was observed in radial peripapillary capillary segment (A2). The reduction of vessel density of the superficial retinal capillary plexus in patient B (B3) is more obvious than that in patient A (A3), while the difference between the two patients in the deep retinal capillary plexus is not apparent (A4 and B4). The optic disc photograph shows the disc of patient A (A5) is mimicking the disc of GON (B5). The visual field of patient A demonstrates atypical temporal hemianopia with some of the nasal part involved (A6), while a superior defect is revealed in the visual field of patient B (B6). C1 to C4 are the images of the control.
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