Characterization of Prelaminar Wedge-Shaped Defects in Primary Open-Angle Glaucoma

ABSTRACT

Purpose

To determine the clinical relevance of prelaminar wedge defects (PLWDs) detected by swept-source optical coherence tomography (SS-OCT) in primary open-angle glaucoma (POAG).

Materials and Methods

In this retrospective case–control study, PLWDs were defined as triangular-shaped defects at the surface of the optic nerve prelaminar tissue, not adjacent to blood vessels, present on cross-sectional SS-OCT scans. Two observers masked to diagnosis independently reviewed scans to detect PLWDs and lamina cribrosa defects. History of disc hemorrhage, occurring within 2 years prior to imaging, was obtained from chart review. One eye per subject was randomly selected. Two-sided t-tests, analysis of variance with Bonferroni correction, and multivariable logistic regression analysis were performed to explore demographic and clinical features associated with PLWDs.

Results

40 POAG and 23 control eyes were included. PLWDS were found in 27.5% of POAG (n = 11) and 4.3% of controls (n = 1, p = .04). Eyes with repeat SS-OCT imaging (7 POAG and 0 controls) had persistent PLWDs. More POAG eyes with PLWDs had a history of disc hemorrhage (45.5%) than POAG eyes without PLWDs (3.4%, p = .004). On multivariable analysis, compared to POAG without PLWDs, POAG with PLWDs had increased odds of observed disc hemorrhage (OR = 21.6, 95% CI, 2.2–589.0, p = .02) after adjusting for age, gender, visual field mean deviation and maximum intraocular pressure (IOP). POAG with PLWDs had more lamina cribrosa defects (45.5%) than POAG without PLWDs (3.4%, p = .01) but did not differ significantly from controls (8.7%, p = .07). Compared to all patients without PLWDs, patients with PLWDs had increased odds of having lamina cribrosa defects (OR = 44.8; 95% CI, 6.3–703.6, p < .001) after adjusting for age, gender, and maximum IOP.

Conclusions

PLWDs were more frequently found in POAG than control eyes and were associated with a history of disc hemorrhage and lamina cribrosa defects. PLWDs may be a useful imaging biomarker of glaucomatous damage.

KEYWORDS:

• Prelaminar tissue
• primary open-angle glaucoma
• swept-source OCT
• prelaminar wedge defects
• lamina cribrosa defects
• disc hemorrhage

Acknowledgments

The authors thank the Massachusetts Eye and Ear Fluorescein Lab Photographers for assistance with the imaging, and the Massachusetts Eye and Ear study coordinators for patient recruitment.

Meeting presentation

American Glaucoma Society Annual Meeting, San Francisco, March, 2018.

Disclosure statement

Dr. Lucy Shen receives research support from Topcon. In work that is not relevant to this research, Dr. Louis Pasquale is a consultant to Bausch + Lomb, Inc., Verily, Emerald Biosciences and on the Advisory Board of Eyenovia, Inc. Dr. Angela Turalba is a consultant for Beaver-Visitec International.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Glaucoma Center of Excellence and Miller Research Funds at the Massachusetts Eye and Ear, Eleanor and Miles Shore Fellowship, Harvard Medical School, Boston MA, and NIH K99 EY028631 (M.W.). The sponsors and funding organizations had no role in the design or conduct of this research.