Azusa Akashi

Comparative Assessment for the Ability of Cirrus, RTVue, and 3D-OCT to Diagnose Glaucoma

PURPOSE We compared the ability of circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macular parameters obtained by three spectral-domain optical coherence tomography (SD-OCT) instruments to detect glaucoma. METHODS We enrolled 87 normal eyes and 145 glaucomatous eyes (75 early glaucomatous eyes (EGs), mean deviation > -6 dB). Each participant was imaged using Cirrus, RTVue, and 3D-OCT to evaluate the average and quadrant cpRNFL thicknesses. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer plus inner plexiform layer (GCL/IPL), and mRNFL + GCL/IPL (ganglion cell complex [GCC]) thicknesses were analyzed. The areas under the receiver operating characteristic curves (AUCs) were compared among the instruments. RESULTS These instruments revealed similar AUCs for the average cpRNFL and GCC thicknesses in EGs, and total all-stage glaucomatous eyes (TGs). RTVue showed better performance in the nasal cpRNFL thickness than Cirrus and 3D-OCT, and better performance in the temporal cpRNFL thickness than 3D-OCT in TGs. RTVue had a higher AUC for the superior GCC thickness compared to Cirrus and 3D-OCT in EGs, and TGs. Cirrus had higher AUCs for GCL/IPL parameters in TGs, and lower AUCs for the mRNFL parameters in EGs and TGs compared to 3D-OCT. CONCLUSIONS The average cpRNFL and GCC thicknesses measured using these OCT instruments exhibited similar abilities in the diagnosis of glaucoma, and RTVue exhibited better diagnostic abilities than Cirrus and 3D-OCT for nasal cpRNFL, and superior GCC thicknesses. The diagnostic performance of Cirrus and 3D-OCT was different for GCL/IPL and mRNFL parameters. (http://www.umin.ac.jp/ctr number, UMIN000006900.)

The ability of macular parameters and circumpapillary retinal nerve fiber layer by three SD-OCT instruments to diagnose highly myopic glaucoma.

PURPOSE To compare the ability of circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macular parameters obtained by three spectral-domain optical coherence tomography (SD-OCT) instruments to detect highly myopic glaucoma. METHODS In this study, 84 glaucomatous eyes, 53 normal eyes with high myopia, and 86 normal eyes (not highly myopic) were enrolled. Each participant was imaged using Cirrus, RTVue, and 3D OCT to evaluate the average and quadrant cpRNFL thicknesses. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCL/IPL), and mRNFL + GCL/IPL (GCC) thicknesses were analyzed. The areas under the receiver operating characteristic curves (AUCs) were compared between the instruments. In addition, the best parameters for the AUC were compared between the cpRNFL parameters and macular parameters in each instrument. RESULTS These analyses revealed similar AUCs for the average cpRNFL and GCC thicknesses between the instruments. RTVue displayed a significantly higher AUC in the nasal cpRNFL thickness than both Cirrus (P = 0.0004) and 3D OCT (P = 0.0006). 3D OCT showed higher AUCs than Cirrus in the mRNFL parameters. There were no significant differences between the best cpRNFL parameters and macular parameters in each instrument. CONCLUSIONS The average cpRNFL and GCC thicknesses that were measured using these OCT instruments exhibited similar abilities for diagnosing highly myopic glaucoma, and RTVue exhibited better diagnostic abilities than Cirrus and 3D OCT for nasal cpRNFL. 3D OCT had better ability than Cirrus in the mRNFL. Both cpRNFL and GCC in each instrument were comparable, and their measurements offered good ability for diagnosing glaucoma with high myopia. (http://www.umin.ac.jp/ctr/index/htm9, UMIN000006900.).

The detection of macular analysis by SD-OCT for optic chiasmal compression neuropathy and nasotemporal overlap.

PURPOSE To assess the diagnostic performance of the macular parameters detected by spectral-domain optical coherence tomography (SD-OCT) in band atrophy (BA) eyes. METHODS Forty-nine BA eyes with permanent temporal hemianopia and 89 normal eyes were enrolled. Any patients who had nasal visual field loss were excluded. Each participant was imaged by three-dimensional (3D) OCT-2000, and 10 × 10 grids in the macula were automatically allocated. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL)+ (GCL+inner plexiform layer [IPL]), and GCL++ (RNFL+GCL+IPL) in both nasal and temporal hemiretina was calculated and compared between the BA and normal eyes. The areas under the receiver operating characteristic curves (AUCs) in these parameters were compared between the nasal hemiretina and the temporal hemiretina. RESULTS All the parameters in the BA eyes were significantly thinner than those in the normal eyes. The AUCs for the mRNFL, GCL+, and GCL++ thickness in the nasal hemiretina were 0.890, 0.988, and 0.981, respectively. The parameters in the nasal hemiretina showed significantly higher AUCs than those parameters in the temporal hemiretina. In the temporal hemiretina, the damaged grids in the mRNFL were located in the arcuate areas in each hemifield. CONCLUSIONS The inner macular parameters in the nasal hemiretina exhibited high diagnostic abilities to detect BA. The GCL+ was more affected than mRNFL. The characteristic pattern of mRNFL and GCL+ thinning was implicated in the anatomical architecture regarding the nasotemporal overlap of the crossed and uncrossed fibers around the fovea. (www.umin.ac.jp/ctr number, UMIN000006900.).

Effects of Axial Length and Age on Circumpapillary Retinal Nerve Fiber Layer and Inner Macular Parameters Measured by 3 Types of SD-OCT Instruments.

Purposes:To evaluate the effects of axial length and age on the circumpapillary retinal nerve fiber layer (cpRNFL) and the inner macular parameters measured using 3 spectral-domain optical coherence tomography (OCT) instruments. Methods:A total of 102 normal eyes (1 eye per subject) were imaged using Cirrus, RTVue, and 3D-OCT. The cpRNFL and the macular retinal nerve fiber layer (mRNFL), the ganglion cell layer+inner plexiform layer (GCLIPL), and the mRNFL+GCLIPL ganglion cell complex, GCC thicknesses were analyzed. The correlations between these values and the axial length or age were evaluated using a partial correlation analysis. These correlations were corrected using the axial length–related magnification effect. Results:All but the nasal quadrant cpRNFL thicknesses and GCC thicknesses obtained using the 3 OCT instruments were significantly correlated with age. The average cpRNFL thickness and GCC thickness measured using the Cirrus and RTVue, but not by the 3D-OCT, had a negative correlation with the axial length. The temporal quadrant cpRNFL thickness measured using the 3 instruments was positively correlated with the axial length. The magnification correction made the most correlations positive. Conclusions:The average cpRNFL and GCC thicknesses measured using these 3 instruments decreased with age. The axial length affected the cpRNFL and GCC thicknesses as measured using the Cirrus and RTVue; this effect likely depended on the fundus area of analyses.

The Ability of SD-OCT to Differentiate Early Glaucoma With High Myopia From Highly Myopic Controls and Nonhighly Myopic Controls

PURPOSE Optical coherence tomography (OCT) instruments do not embed a normative database from highly myopic normal (HMN) eyes. The abilities of three OCT instruments to detect early glaucoma with high myopia were compared using the two controls with or without high myopia. METHODS A total of 52 early glaucomatous eyes (mean deviation > -6.0 dB) with high myopia (spherical equivalent ≤ -6.0 diopters [HMG]), 54 HMN eyes, and 90 nonhighly myopic normal (NHMN) eyes were enrolled. Each participant was imaged using Cirrus, RTVue, and Topcon 3D OCT to evaluate the thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL), the macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCL/IPL), and mRNFL + GCL/IPL (GCC). The covariate-adjusted areas under the receiver operating characteristic curves (AUCs) for detecting HMG were compared among the instruments and between the two normal groups (HMN or NHMN). RESULTS Highly myopic normal eyes showed higher AUCs for the temporal quadrant cpRNFL thickness but lower AUCs for the superior and inferior RNFL thicknesses compared with NHMN. We found the AUCs for the GCC thickness showed no significant difference between the two control groups, but the GCL/IPL and mRNFL thicknesses had differences. CONCLUSIONS The abilities of the three OCT instruments to detect early glaucomatous eyes with high myopia were different if the normal eyes were associated with high myopia or not. A normative database that includes data from patients with high myopia should be established for accurate diagnosis of glaucoma with high myopia. (www.umin.ac.jp/ctr number, UMIN000006900.).

Cluster Analyses of Grid-Pattern Display in Macular Parameters Using Optical Coherence Tomography for Glaucoma Diagnosis

PURPOSE Using spectral-domain optical coherence tomography (SD-OCT), we assessed the ability of cluster analyses, based on the grid-pattern of macular parameters, to detect glaucoma. METHODS We enrolled 75 normal eyes, 64 early glaucomatous eyes (EG), and 40 preperimetric glaucomatous eyes (PPG). Each participant was imaged using 3-dimensional optical coherence tomography (3D-OCT) to examine the macular retinal nerve fiber layer (mRNFL) and the thickness of the ganglion cell layer, together with the inner plexiform layer (GCL/IPL). Diagnostic criteria based on the clustering of abnormal grids from the mRNFL and GCL/IPL measurements were applied. The sensitivity and specificity of glaucoma detection were compared between the cluster criteria (CC) and the average thickness criteria (ATC) of total and hemiretinal sectors, and the cut-off criteria were determined using receiver operating characteristic (ROC) curve analyses from our normal controls. RESULTS The specificity values of CC and ATC from mRNFL measurements were 97% and 100%, respectively. The sensitivity of CC was 94% for EG and 68% for PPG. The sensitivity of ATC was 81% for EG and 38% for PPG. The specificity values of CC and ATC from GCL/IPL measurements were 96% and 100%, respectively. The sensitivity values of CC and ATC were 92% for EG and 63% for PPG. The sensitivity of ATC was 84% for EG and 25% for PPG. When compared to ATC and ROC-based cut-off criteria, CC showed a higher diagnostic capability. CONCLUSIONS Judging abnormality based on a clustering of abnormal grids from macular OCT parameters may be a reliable approach for diagnosing early glaucoma. (http://www.umin.ac.jp/ctr/index/htm9 number, UMIN000006900.).

Aquaporin 9 expression is required for l-lactate to maintain retinal neuronal survival.

Aquaporin 9 (AQP9), an aquaglyceroporin, is not only permeable to water but also to non-charged solutes, such as lactate. Lactate can be an energy source for retinal neurons. This study aimed to evaluate the effect of the downregulation of AQP9 expression on the survival rates and reactive oxygen species accumulation in RGC-5 cells cultured in a medium containing lactate. The Live/Dead assay revealed that the cell death rate of RGC-5 cells transfected with the control siRNA (siControl) was 3.65%±0.75% in the 5-mM glucose medium. The death rate was significantly increased by five-fold in the no glucose and 10-mM d-lactate media but not in the 10-mM l-lactate medium. In comparison, the death rate of cells transfected with siRNA targeting AQP9 (siAQP9) was 8.07%±1.01% in the 5-mM glucose medium, which was significantly increased by two-fold in the other medium conditions, indicating that the downregulation of AQP9 expression eliminated the prosurvival effect of l-lactate. Few RGC-5 cells transfected with siControl showed dichlorofluorescein (DCF) fluorescence when cultured in 5-mM glucose and 10-mM l-lactate media. However, approximately 70% of those showed DCF fluorescence when cultured in the no glucose and 10-mM d-lactate media. The downregulation of AQP9 significantly increased the DCF fluorescence rate to 50.44%±6.13% in the 10-mM l-lactate medium, whereas, it did not increase the rate in the other medium conditions. These results demonstrate that AQP9 expression is required for l-lactate to maintain retinal neuronal survival.