Diagnostic criteria for detection of retinal nerve fibre layer thickness and neuroretinal rim width abnormalities in glaucoma

Feihui Zheng, Marco Yu, Christopher Kai-Shun Leung, Feihui Zheng, Marco Yu, Christopher Kai-Shun Leung

Abstract

Background/aims: Although measurements of the Bruch's membrane opening minimum rim width (BMO-MRW) and retinal nerve fibre layer thickness (RNFLT) with optical coherence tomography (OCT) have been widely adopted in the diagnostic evaluation of glaucoma, there is no consensus on the diagnostic criteria to define BMO-MRW and RNFLT abnormalities. This study investigated the sensitivities and specificities of different diagnostic criteria based on the OCT classification reports for detection of glaucoma.

Methods: 340 eyes of 137 patients with glaucoma and 87 healthy individuals, all with axial length ≤26mm, had global and sectoral BMO-MRW and RNFLT measured with Spectralis OCT (Heidelberg Engineering). Six diagnostic criteria were examined: global measurement below the fifth or the first percentile; ≥1 sector measurement below the fifth or the first percentile; superotemporal and/or inferotemporal measurement below the fifth or the first percentile. The sensitivities and specificities of BMO-MRW/RNFLT assessment for detection of glaucoma (eyes with visual field (VF) defects) were compared.

Results: Among the six criteria examined, superotemporal and/or inferotemporal measurement below the fifth percentile showed the highest sensitivities and specificities for glaucoma detection. Abnormal superotemporal and/or inferotemporal RNFLT attained a higher sensitivity than abnormal superotemporal and/or inferotemporal BMO-MRW to detect mild glaucoma (mean VF MD: -3.32±1.59 dB) (97.9% and 88.4%, respectively, p=0.006), and glaucoma (mean VF MD: -9.36±8.31 dB) (98.4% and 93.6%, respectively, p=0.006), at the same specificity (96.1%).

Conclusions: Superotemporal and/or inferotemporal RNFLT/MRW below the fifth percentile yield the best diagnostic performance for glaucoma detection with RNFLT attains higher sensitivities than MRW at the same specificity in eyes without high myopia.

Keywords: diagnostic tests/investigation; glaucoma; imaging.

Conflict of interest statement

Competing interests: CK-SL: speaker honorarium—Carl Zeiss Meditec, Heidelberg Engineering; research support—Carl Zeiss Meditec, Heidelberg Engineering.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Case examples illustrating diagnostic classification analysis of the retinal nerve fibre layer thickness (RNFLT) can detect glaucomatous damage missed by Bruch’s membrane opening-minimum rim width (BMO-MRW). A 51-year-old patient with glaucoma with left inferonasal visual field defects and RNFLT below the first percentile at the superotemporal sector (A), and a 71-year-old patient with glaucoma with right inferonasal visual field defects and RNFLT below the first percentile at the superotemporal sector (B) had global and sectoral BMO-MRW measurements within normal limits. MD, mean deviation; PSD, pattern SD; VFI, visual field index. IN, inferonasal; IT, inferotemporal; N, nasal; SN, superonasal; ST, superotemporal; T, temporal.

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