Optic Disc Margin Anatomy in Glaucoma Patients and Normal Controls with Spectral Domain Optical Coherence Tomography

Alexandre S C Reis, MD1,2, Glen P Sharpe, MSc1, Hongli Yang, PhD3, Marcelo T Nicolela, MD1, Claude F Burgoyne, MD3, Balwantray C Chauhan, PhD1
of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada. 2Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil. 3Devers Eye Institute, Portland, Oregon, USA
1Department

Abstract # 30028932

Financial Disclosures

Financial support:

Grants MOP11357 (BCC), and MOP200309 (MTN) from the Canadian Institutes of Health Research, Ottawa, Ontario; Capes Foundation (ASCR), Ministry of Educational of Brazil, Brasilia, Brazil; USPHS grants R01EY011610 (CFB) from the National Eye Institute, National Institutes of Health, Bethesda, Maryland; The Legacy Good Samaritan Foundation (CFB), Portland, Oregon; the Sears Trust for Biomedical Research (CFB), Mexico, Missouri; the Alcon Research Institute (CFB), Fort Worth, Texas, and; Equipment and unrestricted research support from Heidelberg Engineering (BCC, CFB), Heidelberg, Germany.

Financial/conflict of interest disclosure: B.C. Chauhan, Heidelberg Engineering (Support). C.F. Burgoyne, Heidelberg Engineering (Support).

Objectives

To identify the deep optic nerve head (ONH) structures detected with spectral domain optical coherence tomography (SD-OCT) that colocalized with the clinically visible optic disc margin. To determine the frequency of SD-OCT detected Bruchs membrane extending beyond the clinically visible optic disc margin.

Methods: Co-localization

30 patients with open-angle glaucoma and 10 healthy agematched controls.

Stereo disc photographs were co-localized to infrared (IR) image

SD-OCTs (24 high-resolution radial scans centered on the ONH). Co-localization required the outline of the central retinal vessels and their bifurcations to be matched between the IR OCT image and the photograph (D).
Colocalization of optic disc photographs to SD-OCT image. A. Fundus photograph B. IR image extracted from SD-OCT data. C. Registered photograph after colocalization. D. Two-layer image of the IR image and registered photograph.

Methods: Projection of disc margin on Bscans

Registered photograph with optic disc margin projection to the 12-clock hour Bscans (green dots indicated by white arrows) acquired in the orientations indicated by white dashed lines. The SD-OCT structure corresponding to the clinical visible optic disc margin and the presence of a Bruchs membrane overhang was noted.

Methods: SD-OCT structure coresponding to the disc margin

Bruchs membrane Choroid

Disc margin

Disc margin

Disc margin

Sclera

Border Tissue

Schematic representation and SD-OCT scans. Black dots and white arrows in the B-scans indicate the SD-OCT structure corresponding to the optic disc margin.
A.Bruchs membrane opening corresponding to the clinically visible optic disc margin, in this case with BM overhang beyond the border tissue. Bruchs membrane/border tissue corresponding to the optic disc margin. Border tissue alone corresponding to the optic disc margin.

Results: SD-OCT structure corresponding to disc margin

Polar plots showing the frequency of the SD-OCT structure corresponding to the optic disc margin by clock hour. The distance from the origin at each clock hour represents the frequency of each SD-OCT structure analyzed by clock hour. At most locations the SD-OCT structure most frequently identified as the disc margin was some aspect of Bruchs membrane and border tissue,

Results: Frequency of Bruchs membrane overhang

Polar plots showing the frequency of Bruchs membrane overhang by clock hour. The external areas (light green) show the frequency of Bruchs membrane overhang by clock hour. The internal areas (dark green) show the frequency of Bruchs membrane opening corresponding to the optic disc margin in those subjects with Bruchs membrane overhang.
Bruchs membrane overhang was regionally present in the majority of glaucoma patients and controls, however, in most cases it was not visible as the disc margin.

Case Example

Optic disc photograph (A) and registered infrared image (B). Magnification of the rectangular area (broken white lines, inset in A) showing the clinical disc margin (green dots) and Bruchs membrane (BM) opening (red dots). Equidistant line B-scans (x, y and z shown in C, D and E respectively). Only x and z are shown in A and B for BM is continuous in x and y (shown in C and D) indicating that these locations are outside the clarity). neural canal opening. BM shows a break in z (shown in E) verifying its location within the neural canal opening. A cross-section of a cilio-retinal artery (cra) appears beneath BM in x and y (shown in C and D) and curves around BM overhang in z (shown in E). Since the cra beneath BM is visible in the photograph, it indicates that the temporal region of BM overhang is clinically transparent and invisible.

Conclusions

What the clinician perceives as the optic disc margin in an individual eye is rarely a single structure; most frequently it is some aspect of Bruchs membrane and border tissue and less frequently, the Bruchs membrane opening of border tissue alone. The fact that the SD-OCT detected Bruchs membrane overhang beyond border tissue, which was clinically invisible as the disc margin in most eyes suggests that neuroretinal rim area measurements clinically or with confocal scanning laser tomography may not be accurate.