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Purpose: To evaluate the effect of multiple covariates on the diagnostic performance of the Cirrus high-definition optical coherence tomography (HD-OCT) for glaucoma detection. Methods: A prospective case-control study was performed and included 173 recently diagnosed glaucoma patients and 63 unaffected individuals from the Macular Ganglion Cell Imaging Study. Regression analysis of receiver operating characteristic were conducted to evaluate the influence of age, spherical equivalent, axial length, optic disc size, and visual field index on the macular ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) measurements. Results: Disease severity, as measured by visual field index, had a significant effect on the diagnostic performance of all Cirrus HD-OCT parameters. Age, axial length and optic disc size were significantly associated with diagnostic accuracy of average peripapillary RNFL thickness, whereas axial length had a significant effect on the diagnostic accuracy of average GCIPL thickness. Conclusions: Diagnostic performance of the Cirrus HD-OCT may be more accurate in the advanced stages of glaucoma than at earlier stages. A smaller optic disc size was significantly associated with improved the diagnostic ability of average RNFL thickness measurements; however, GCIPL thickness may be less affected by age and optic disc size. [ABSTRACT FROM AUTHOR]

Purpose: To compare the deep optic nerve head (ONH) structure between normal-tension glaucoma (NTG) and nonarteritic anterior ischemic optic neuropathy (NAION) and also in healthy subjects as a control using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT). Methods: This prospective cross-sectional study included 21 NAION patients who had been diagnosed as NAION at least 6 months prior to study entry, and 42 NTG patients and 42 healthy controls who were matched with NAION patients in terms of age, intraocular pressure (IOP), and optic disc area. The retinal nerve fiber layer (RNFL) thickness in the affected sector was also matched between NAION and NTG patients. The ONH was imaged using SD-OCT with the EDI technique. The anterior lamina cribrosa surface depth (LCD) and average prelaminar tissue (PT) thickness were measured in a sector of interest in each eye and compared among the three groups. Results: In the sector-matched comparison, LCD was largest in NTG patients, followed by NAION patients, while PT was thinner in NTG patients than in NAION patients (all P < 0.001). NAION patients had a comparable LCD and a thinner PT relative to normal controls (P = 0.170 and < 0.001, respectively). Conclusion: The deep ONH configuration is strikingly different between NTG and NAION. The differing features provide comparative insight into the pathophysiology of the two diseases, and may be useful for differential diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the structural and clinical characteristics of peripapillary retinoschisis observed in glaucomatous eyes using spectral-domain optical coherence tomography (SD-OCT). Methods: Circumpapillary retinal nerve fiber layer (cpRNFL) and macular cross-hair SD-OCT scans and infrared fundus images of the glaucoma patients from the Investigating Glaucoma Progression Study (IGPS) and healthy volunteers were reviewed. Optic disc images obtained using enhanced depth imaging (EDI) SD-OCT were also evaluated. The structural characteristics and clinical course of the retinoschisis associated with glaucoma were investigated. Results: Twenty-five retinoschisis areas were found in 22 of the 372 patients (5.9%) included in the IGPS, and in 1 area in 1 of 187 healthy control subjects (0.5%). In the 22 glaucomatous eyes with retinoschisis, the schisis was attached to the optic disc and overlapped with the retinal nerve fiber layer (RNFL) defect. The RNFL was the layer most commonly affected by the retinoschisis, either alone or together with other deeper layers. Acquired optic disc pit was identified in 8 eyes on disc photography and/or B-scan images obtained by EDI SD-OCT. Spontaneous resolution of this condition was observed in nine eyes. No retinal detachment or macular involvement of the retinoschisis was observed in any of the eyes. Multivariate analysis showed a significant influence of a higher intraocular pressure at SD-OCT scanning on the presence of retinoschisis (Odds ratio  = 1.418, P = 0.001). Conclusions: The present study investigated 22 cases of peripapillary retinoschisis in glaucomatous eyes. The retinoschisis was attached to the optic nerve and topographically correlated with RNFL defect. It often resolved spontaneously without causing severe visual disturbance. Care should be taken not to overestimate the RNFL thickness in eyes with retinoschisis, and also not to misinterpret the resolution of retinoschisis as a rapid glaucomatous RNFL deterioration. [ABSTRACT FROM AUTHOR]

Purpose To investigate the structural and clinical characteristics of the optic disc pit (ODP) in primary open-angle glaucoma (POAG) via enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT). Design Prospective, observational case series. Participants Seventy POAG eyes clinically diagnosed with an ODP via stereo disc photography. Methods Optic discs were scanned using EDI SD-OCT. Serial horizontal and vertical B-scan images covering the optic discs were obtained from each eye. The structural characteristics of the ODP were investigated via 3-dimensional images constructed from the serial B-scans, focusing on the presence of alterations in the contour of the lamina cribrosa (LC) or prelaminar tissue (PLT), in conjunction with associated clinical characteristics. Main Outcome Measures The structural characteristics of the ODP and associated clinical characteristics. Results In the EDI SD-OCT images, the ODP was viewed as an isolated alteration of the LC (n = 14, 20.0%) or PLT (n = 16, 22.9%) or an alteration of both the LC and PLT (n = 40, 57.1%). Alterations of the LC were located at the mid-periphery near the LC insertion (n = 17) or far periphery adjacent to the LC insertion (n = 37), and the depth of alteration was deep (n = 23), involving nearly full-thickness LC, or shallow (n = 31), with partially visible LC at the base. Fifty-four eyes (77.1%) exhibited parafoveal visual field (VF) defect within 10 degrees of fixation, and in 98.1% of these eyes (53/54) it was spatially associated with the location of ODP. The parafoveal VF defect was more prevalent in eyes with LC alteration than those without (83.3% vs. 56.2%, P = 0.023) and in eyes with deep LC defect than those with shallow defect (95.7% vs. 74.2%, P = 0.036). Disc hemorrhage (32.4% vs. 0.0%, P = 0.008) and peripapillary retinoschisis (18.9 vs. 0.0%, P = 0.055) were more strongly associated with LC alterations located at the far periphery than at the mid-periphery. Conclusions Enhanced depth imaging SD-OCT facilitated visualization of the varied structure of the ODP, which presented as alteration of the LC or PLT or both. The clinical significance of differing characteristics of ODP microstructure remains to be determined. [ABSTRACT FROM AUTHOR]