Brandon Smith

Variation of the Axial Location of Bruch's Membrane Opening With Age, Choroidal Thickness, and Race

PURPOSE This study explores variation in the axial location of Bruchs membrane opening (BMO) to determine if this reference plane varies with age and race. METHODS There were 168 spectral-domain optical coherence tomography (SDOCT) optic nerve head volumes that were obtained from healthy subjects and manually delineated within 24 axial slices to develop point clouds for Bruchs membrane and anterior scleral surfaces. A BMO-independent reference plane was generated based on the peripapillary sclera to measure BMO position. General estimating equations were used to determine the relationship of the axial position of BMO (BMO height) with choroidal thickness, age, and race (African Descent [AD] versus European Descent [ED]) controlling for variations in axial length. RESULTS The peripapillary choroid was thinner with increasing axial length (-14.9 μm/mm, P = 0.0096), advancing age (-1.1 μm/y, P = 0.00091), and in the ED group (20.2 μm, P = 0.019) in a multivariable model. Choroidal thickness was also strongly related to BMO height (P < 0.00001) independent of all covariates. Bruchs membrane opening position was more posterior relative to the sclera in older subjects (1.3 μm/y, P = 0.00017), independent of axial length and race. However, when choroidal thickness was included in the model, this association was lost (P = 0.225). There was no significant difference in BMO height between racial groups after adjustment for age and axial length. CONCLUSIONS Bruchs membrane opening is more posteriorly located in older individuals. These differences are largely due to differences in choroidal thickness and suggest that BMO migrates posteriorly with age due to age-related choroidal thinning. However, additional studies in longitudinal datasets are needed to validate these findings.

Peripapillary Choroidal Thickness Variation With Age and Race in Normal Eyes

PURPOSE This study examined the association between peripapillary choroidal thickness (PCT) with age and race in a group of African descent (AD) and European descent (ED) subjects with normal eyes. METHODS Optic nerve head images from enhanced depth imaging spectral-domain optical coherence tomography of 166 normal eyes from 84 subjects of AD and ED were manually delineated to identify the principal surfaces of Bruchs membrane (BM), Bruchs membrane opening (BMO), and anterior sclera (AS). Peripapillary choroidal thickness was measured between BM and AS at increasing distance away from BMO. The mean PCT was compared between AD and ED subjects and generalized estimating equation (GEE) regression analysis was used to examine the association between race and PCT overall, in each quadrant, and by distance from BMO. Models were adjusted for age, BMO area, and axial length in the regression analysis. RESULTS Overall, the mean PCT increased from 63.9 μm ± 18.1 at 0 to 250 μm to 170.3 μm ± 56.7 at 1500 to 2000 μm from BMO. Individuals of AD had a greater mean PCT than those of ED at all distances from BMO (P < 0.05 at each distance) and in each quadrant (P < 0.05 in each quadrant). Results from multivariate regression indicate that ED subjects had significantly lower PCT compared to AD overall and in all quadrants and distances from BMO. Increasing age was also significantly associated with a lower PCT in both ED and AD participants. CONCLUSIONS Peripapillary choroidal thickness varies with race and age, as individuals of AD have a thicker peripapillary choroid than those of ED. (ClinicalTrials.gov number, NCT00221923.).

Variation of Laminar Depth in Normal Eyes With Age and Race

PURPOSE To determine if laminar depth (LD) and prelaminar tissue volume (PTV) are associated with age and race in healthy human eyes. METHODS Optic nerve head images from enhanced depth imaging spectral-domain optical coherence tomography of 166 normal eyes from 84 subjects of African descent (AD) and European descent (ED) were manually delineated to identify the principal surfaces: internal limiting membrane, Bruchs membrane (BM), anterior sclera (AS), and anterior surface of the lamina cribrosa. These four surfaces defined the LD and PTV using Bruchs membrane opening (BMO) and AS for reference structures. Generalized estimating equations were used to evaluate whether the effect of age on each outcome was differential by race. RESULTS When age was analyzed as a continuous variable, the interaction term between age and race was statistically significant for mean LDBMO (P = 0.015) and mean LDAS (P = 0.0062) after adjusting for axial length and BMO area. For every 1-year increase in age, the LDAS was greater on average by 1.78 μm in AD subjects and less by 1.71 μm in ED subjects. Mean PTV was lower in the older subjects (1248 × 10(6) μm(3) AD, 881 × 10(6) μm(3) ED) compared to the younger subjects (1316 × 10(6) μm(3) AD, 1102 × 10(6) μm(3) ED) in both groups. CONCLUSIONS With increasing age, the LD changes differently across racial groups in normal subjects. The LD in ED subjects showed a significantly decreasing slope suggesting that the lamina moves anteriorly with age in this group.

Displacement of the Lamina Cribrosa in Response to Acute Intraocular Pressure Elevation in Normal Individuals of African and European Descent

Purpose To assess if the in vivo mechanical displacement of the anterior laminar cribrosa surface (ALCS) as a response of an acute elevation in intraocular pressure (IOP) differs in individuals of European (ED) and African descent (AD). Methods Spectral-domain optical coherence tomography (SDOCT) scans were obtained from 24 eyes of 12 individuals of AD and 18 eyes of 9 individuals of ED at their normal baseline IOP and after 60 seconds IOP elevation using ophthalmodynamometry. Change in depth (displacement) of the LC and to the prelaminar tissue (PLT) were computed in association with the change (delta) in IOP (Δ IOP), race, age, corneal thickness, corneal rigidity (ocular response analyzer [ORA]), and axial. Results In the ED group for small IOP elevations (Δ IOP < 12 mm Hg), the ALCS initially displaced posteriorly but for larger increase of IOP an anterior displacement of the lamina followed. Inversely, in the AD group the ALCS did not show a significant posterior displacement for small Δ IOP, while for larger IOP increases the ALCS significantly displaced posteriorly. Posterior displacement of the lamina cribrosa (LC) was also significantly correlated with longer axial length, higher corneal thickness, and ORA parameters. Prelaminar tissue posteriorly displaced for any magnitude of Δ IOP, in both groups. Conclusions The African descent group demonstrated a greater acute posterior bowing of the LC after adjustment for age, axial length, Bruchs membrane opening (BMO) area, and ORA parameters. Greater PLT posterior displacement was also seen in the AD group with increasing IOP, which was tightly correlated with the displacement of the LC.

Variation in the Three-Dimensional Histomorphometry of the Normal Human Optic Nerve Head With Age and Race: Lamina Cribrosa and Peripapillary Scleral Thickness and Position

Purpose This study quantified the thickness and depth of the lamina cribrosa (LC) and peripapillary scleral thickness in high-resolution three-dimensional (3D) fluorescent reconstructions of the optic nerve head (ONH) in eyes from donors of African (AD) and European descent (ED). Methods A total of 64 eyes (45 ED, 19 AD) from 51 normal donors were obtained within 6 hours of death and fixed at 10 mm Hg of pressure. The optic nerve head was trephined from the globe and digitally reconstructed at 1.5 × 1.5 × 1.5 μm voxel resolution with an automated episcopic fluorescence technique. The load-bearing ONH connective tissue surfaces were manually delineated in 3D using custom software. Results The lamina cribrosa and peripapillary sclera were significantly thinner in AD eyes adjusting for age and sex (LC was 24 ± 11 μm thinner; P = 0.0350; scleral was 56 ± 22 μm thinner; P = 0.0097). The lamina cribrosa was significantly thinner in females (23 ± 11 μm thinner; P = 0.0425). Age was not significantly associated with any morphologic parameter in the ED group. However, increasing age was associated with an increase in scleral thickness (1.3 μm/year, P = 0.0499) and an increase in LC depth (2.3 μm/year, P = 0.0035) in the AD group. The sclera was thickest in the superior and temporal regions while the LC was thinnest superiorly. Conclusions Substantial sectorial and racial differences in LC and scleral morphology were observed, as well as increasing LC depth and scleral thickness with age in the AD group. Results suggest greater age-related remodeling of the load-bearing ONH connective tissues in eyes from AD individuals that could explain, in part, the greater predilection to glaucomatous injury seen in aged AD populations.

Measuring mean cup depth in the optic nerve head

Since the deformation of structures in the optic nerve head (ONH) is associated with glaucoma and other diseases of the optic nerve, measurement of this deformation is of current research interest. This paper considers the computation of cup depth, a measurement of the depth of the internal limiting membrane (ILM). The computation of cup depth requires a reference structure against which to measure the ILM, and the construction of two reference structures is discussed, one based on Bruchs membrane opening (BMO) and the other based on the anterior surface of the peripapillary sclera (AS). A main focus of the paper is the robust computation of mean cup depth, which requires a good sampling of a reconstruction of the ILM surface. To evaluate our algorithm, the construction of synthetic datasets is considered.