Optical coherence tomography (OCT) of the rim and peripapillary retina can aid in the diagnosis of glaucoma and its progression.
This article was reviewed by Claude F. Burgoyne, MD
Current optical coherence tomography (OCT) devices provide imaging of the rim and peripapillary retinal nerve fiber layer (RNFL) to aid the diagnosis of glaucoma. Future generations of the technology should be able to visualize the deeper structures of the optic nerve head (ONH) and reveal existing damage that currently is masked, with the goals of earlier diagnosis and intervention.
The need for the expanded capabilities of OCT is apparent upon a review of the literature. “Clinicians are highly variable in their assessments of the disc margin and rim width,” said Claude F. Burgoyne, MD, the Van Buskirk Chair for Ophthalmic Research, and director, Optic Nerve Head Research Laboratory, Devers Eye Institute, Portland, OR.
In a study published by Dr. Burgoyne and colleagues (Am J Ophthalmol 2018;192:65-76), five glaucoma specialists evaluated 214 photographs, and the authors reported the wide variability of the disc margin and rim width.
In a follow-up study (Am J Ophthalmol 2019;199:28-43), the authors used a Spectralis device (Heidelberg Engineering) to evaluate a subset comprised of 151 of the 214 photographs in which OCT images were performed on the same day and evaluated how well and consistently suspicious rim tissue could be detected by the OCT instrument.
Another study performed by Jean-Claude Mwanza, MD, and colleagues (Am J Ophthalmol 2017;184:183-4) used a Cirrus instrument (Carl Zeiss Meditec) to evaluate the cup-to-disc ratios obtained by the instrument and clinicians.
“All three studies found great disparities and inconsistencies in the estimates of the rim widths,” Dr. Burgoyne said, underscoring the need for better detection.