Thin minimal rim width at Bruch’s membrane opening is associated with glaucomatous paracentral visual field loss

Elise V Taniguchi1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA;2 Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear – Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA;3 Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil

Eleftherios I Paschalis1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA;2 Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear – Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA

Dejiao Li1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA;4 Department of Ophthalmology, Beijing China-Japan Friendship Hospital, Beijing, People’s Republic of China

Kouros Nouri-Mahdavi5 Department of Ophthalmology, David Geffen School of Medicine and Stein Eye Institute, Los Angeles, CA, USA

Stacey C Brauner1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA

Scott H Greenstein1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA

Angela V Turalba1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA

Janey L Wiggs1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA

Louis R Pasquale1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA;6 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Lucy Q Shen1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MACorrespondence[email protected]

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Abstract

Purpose

To compare optic nerve head (ONH) measurements in glaucomatous eyes with paracentral visual field (VF) loss to eyes with peripheral VF loss and controls.

Methods

Open-angle glaucoma (OAG) patients with early paracentral VF loss or isolated peripheral VF loss as well as control subjects underwent ONH imaging with swept-source optical coherence tomography (OCT) and retinal nerve fiber layer (RNFL) imaging with spectral-domain OCT. Minimum rim width at Bruch’s membrane opening (BMO-MRW), lamina cribrosa depth (LCD), and RNFL thickness were compared among the glaucoma and control groups with one-way analysis of variance, Kruskal–Wallis test, and multiple regression analysis.

Results

Twenty-nine eyes from 29 OAG patients (15 early paracentral and 14 isolated peripheral VF loss) and 20 eyes of 20 control subjects were included. The early paracentral and isolated peripheral VF loss groups had similar VF mean deviation (MD) (−5.3±2.7 dB and −3.7±3.0 dB, p=0.15, respectively). Global BMO-MRW was lower in OAG eyes than in controls (193.8±40.0 vs 322.7±62.2 μm, p<0.001), but similar between eyes with early paracentral VF loss and those with isolated peripheral VF loss (187.6±43.4 vs 200.6±36.3 μm; p>0.99). In contrast, the minimal BMO-MRW was lower in eyes with early paracentral loss (69.0±33.6 μm) than in eyes with isolated peripheral loss (107.7±40.2 μm; p=0.03) or control eyes (200.1±40.8 μm; p<0.001). Average and thinnest RNFL thickness did not differ between OAG groups (p=0.61 and 0.19, respectively). Horizontal and vertical LCD did not differ among the OAG groups and controls (p=0.80 and 0.82, respectively). Multivariable linear regression analysis among OAG cases confirmed the association between lower minimal BMO-MRW and early paracentral VF loss (β=−38.3 μm; 95% confidence interval, −69.8 to −6.8 μm; p=0.02) after adjusting for age, gender, MD, and disc size.

Conclusion

Thin minimal BMO-MRW may represent a new structural biomarker associated with early glaucomatous paracentral VF loss.

Keywords:

Supplementary materials

Figure S1 Diagram showing scans included in each sector for calculating sector BMO-MRW in a right eye.

Notes: N: 10, 11, 12, 1, 2, 3, 4; SN: 5, 6, 7; ST: 8, 9, 10; T: 11, 12, 1, 2, 3; IT: 4, 5, 6; IN: 7, 8, 9. Similarly, the corresponding scans were used for calculating sector BMO-MRW in left eyes.

Abbreviations: BMO-MRW, minimum rim width at Bruch’s membrane opening; N, nasal; SN, superonasal; ST, superotemporal; T, temporal; IT, inferotemporal; IN, inferonasal.

Figure S1 Diagram showing scans included in each sector for calculating sector BMO-MRW in a right eye.Notes: N: 10, 11, 12, 1, 2, 3, 4; SN: 5, 6, 7; ST: 8, 9, 10; T: 11, 12, 1, 2, 3; IT: 4, 5, 6; IN: 7, 8, 9. Similarly, the corresponding scans were used for calculating sector BMO-MRW in left eyes.Abbreviations: BMO-MRW, minimum rim width at Bruch’s membrane opening; N, nasal; SN, superonasal; ST, superotemporal; T, temporal; IT, inferotemporal; IN, inferonasal.

Figure S2 Example of a left eye with early paracentral loss.

Notes: The corresponding visual field test is shown in left side. The minimal BMO-MRW is 34.8 μm and the minimal sector BMO-MRW, as an average over three adjacent scans, is thicker at 92.4 μm. (A) Minimal BMO-MRW (34.8 μm) is in the inferotemporal sector (red arrow) on scan 6. (B) BMO-MRW in the inferotemporal sector (red arrowheads) is 109.3 μm on scan 5. (C) BMO-MRW in the inferotemporal sector (red arrowheads) is 133.0 μm on scan 4.

Abbreviation: BMO-MRW, minimum rim width at Bruch’s membrane opening.

Figure S2 Example of a left eye with early paracentral loss.Notes: The corresponding visual field test is shown in Figure 1 left side. The minimal BMO-MRW is 34.8 μm and the minimal sector BMO-MRW, as an average over three adjacent scans, is thicker at 92.4 μm. (A) Minimal BMO-MRW (34.8 μm) is in the inferotemporal sector (red arrow) on scan 6. (B) BMO-MRW in the inferotemporal sector (red arrowheads) is 109.3 μm on scan 5. (C) BMO-MRW in the inferotemporal sector (red arrowheads) is 133.0 μm on scan 4.Abbreviation: BMO-MRW, minimum rim width at Bruch’s membrane opening.

Acknowledgments

The authors thank Dr John Miller, Dr Neha Sangal, and Marissa Shoji for data collection; Taibo Li and Haobing Wang for assisting with measurements of optic nerve head parameters; Dr Tobias Elze for calculating linearized visual field mean deviation values; Massachusetts Eye and Ear Fluorescein Laboratory Photographers for performing the imaging protocols described in this paper; and Massachusetts Eye and Ear study coordinators.

This work was supported by the Harvard Glaucoma Center of Excellence and the Miller Research Funds at the Massachusetts Eye and Ear. Some of the results of this paper were presented at the Association for Research in Vision and Ophthalmology as a conference talk with interim findings. The poster’s abstract was published in “ARVO Annual Meeting Abstract” in Invest Ophthalmol Vis Sci: http://iovs.arvojournals.org/issues.aspx?issueid=934157&journalid=177#issueid=934157.

Disclosure

Louis R Pasquale is supported by a Harvard Medical School Distinguished Scholar Award. Lucy Q Shen is supported by the Eleanor and Miles Shore Fellowship, Harvard Medical School. The authors report no other conflicts of interest in this work.