Three-dimensional neuroretinal rim thickness and visual fields in glaucoma: A broken-stick model

Wendy W. Liu; Michael McClurkin; Edem Tsikata; Pui Chuen Hui; Tobias Elze; Ali R.C. Celebi; Ziad Khoueir; Ramon Lee; Eric Shieh; Huseyin Simavli; Christian Que; Rong Guo; Johannes De Boer; Teresa C. Chen

doi:10.1097/IJG.0000000000001604

Three-dimensional neuroretinal rim thickness and visual fields in glaucoma: A broken-stick model

Wendy W. Liu
, Michael McClurkin
, Edem Tsikata
, Pui Chuen Hui
, Tobias Elze
, Ali R.C. Celebi
, Ziad Khoueir
, Ramon Lee
, Eric Shieh
, Huseyin Simavli
, Christian Que
, Rong Guo
, Johannes De Boer
, Teresa C. Chen^*

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Precis: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable.

Purpose: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable.

Methods: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. "Broken-stick" regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs.

Results: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates.

Conclusions: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.

Original language	English
Pages (from-to)	952-963
Number of pages	12
Journal	Journal of Glaucoma
Volume	29
Issue number	10
DOIs	https://doi.org/10.1097/IJG.0000000000001604
Publication status	Published - Oct 2020

Funding

Disclosure: T.C.C.: Massachusetts Lions Eye Research Fund; American Glaucoma Society Mid-Career Award; National Institutes of Health UL1 RR 025758; Fidelity Charitable Fund; Department of Defense Small Business Innovation Research DHP 15-01615-016. J.F.B.: Center for Biomedical Optical Tomography Research and Translation Scientific Advisory Board Chair (Harvard Medical School); Licenses to NIDEK Inc., Terumo Corporation, Ninepoint Medical, and Heidelberg Engineering. T.E.: Massachusetts Lions Eye Research Fund; BrightFocus Foundation; Grimshaw-Gudewicz Foundation; Research to Prevent Blindness; Alice Adler Fellowship; National Institutes of Health R21EY030142, R21EY030631, R01EY030575, NEI Core Grant P30EY003790. US Provisional Applications No. 62/637,181; 62/641,785; 62/804,903; US Patent PCT/US2014/052414. The remaining authors declare no conflict of interest. This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Insti-tutes of Health.

Funders	Funder number
Fidelity Charitable Fund	DHP 15-01615-016
Grimshaw-Gudewicz Foundation
National Institutes of Health
National Eye Institute	R21EY030631, P30EY003790, R01EY030575, R21EY030142
Research to Prevent Blindness
National Center for Advancing Translational Sciences	UL 1TR002541
BrightFocus Foundation
Harvard University
Harvard Catalyst
Massachusetts Lions Eye Research Fund
American Glaucoma Society	RR 025758

Keywords

minimum distance band
optic nerve
spectral-domain optical coherence tomography

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10.1097/IJG.0000000000001604

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@article{7d9ef23260214cbb8e842c6eb864c8f5,

title = "Three-dimensional neuroretinal rim thickness and visual fields in glaucoma: A broken-stick model",

abstract = "Precis: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable.Purpose: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable.Methods: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. {"}Broken-stick{"} regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs.Results: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31\% of global MDB thickness, and 36.8\% and 43.6\% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates.Conclusions: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.",

keywords = "minimum distance band, optic nerve, spectral-domain optical coherence tomography",

author = "Liu, \{Wendy W.\} and Michael McClurkin and Edem Tsikata and Hui, \{Pui Chuen\} and Tobias Elze and Celebi, \{Ali R.C.\} and Ziad Khoueir and Ramon Lee and Eric Shieh and Huseyin Simavli and Christian Que and Rong Guo and \{De Boer\}, Johannes and Chen, \{Teresa C.\}",

year = "2020",

month = oct,

doi = "10.1097/IJG.0000000000001604",

language = "English",

volume = "29",

pages = "952--963",

journal = "Journal of Glaucoma",

issn = "1057-0829",

publisher = "Lippincott Williams and Wilkins",

number = "10",

}

TY - JOUR

T1 - Three-dimensional neuroretinal rim thickness and visual fields in glaucoma: A broken-stick model

AU - Liu, Wendy W.

AU - McClurkin, Michael

AU - Tsikata, Edem

AU - Hui, Pui Chuen

AU - Elze, Tobias

AU - Celebi, Ali R.C.

AU - Khoueir, Ziad

AU - Lee, Ramon

AU - Shieh, Eric

AU - Simavli, Huseyin

AU - Que, Christian

AU - Guo, Rong

AU - De Boer, Johannes

AU - Chen, Teresa C.

PY - 2020/10

Y1 - 2020/10

N2 - Precis: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable.Purpose: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable.Methods: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. "Broken-stick" regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs.Results: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates.Conclusions: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.

AB - Precis: In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable.Purpose: To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable.Methods: In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. "Broken-stick" regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs.Results: Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates.Conclusions: When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.

KW - minimum distance band

KW - optic nerve

KW - spectral-domain optical coherence tomography

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UR - https://www.scopus.com/pages/publications/85091916999#tab=citedBy

U2 - 10.1097/IJG.0000000000001604

DO - 10.1097/IJG.0000000000001604

M3 - Article

C2 - 32925518

AN - SCOPUS:85091916999

SN - 1057-0829

VL - 29

SP - 952

EP - 963

JO - Journal of Glaucoma

JF - Journal of Glaucoma

IS - 10

ER -

Three-dimensional neuroretinal rim thickness and visual fields in glaucoma: A broken-stick model

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