Serial Changes in Lamina Cribrosa Depth and Neuroretinal Parameters in Glaucoma: Impact of Choroidal Thickness.
Vianna Jayme R, Lanoe Victoria R, Quach Jack, Sharpe Glen P, Hutchison Donna M, Belliveau Anne C, Shuba Lesya M, Nicolela Marcelo T, Chauhan Balwantray C
AI Summary
This study found that measuring lamina cribrosa depth from the anterior sclera, not Bruch's membrane, reduces choroidal thickness influence. Lamina depth changes occur as frequently as neuroretinal changes in glaucoma.
Abstract
Purpose
To determine whether: (1) change in lamina cribrosa depth occurs more frequently than change in neuroretinal parameters in glaucoma, and (2) Bruch's membrane or anterior sclera should be used as a reference plane when measuring laminar depth.
Design
Prospective observational study.
Participants
One hundred fifty-five glaucoma patients and 35 healthy controls.
Methods
Anterior laminar depth from a Bruch's membrane (LD-BM) or anterior sclera (LD-AS) reference plane were measured with optical coherence tomography. Two neuroretinal parameters, minimum rim width and retinal nerve fiber layer thickness, in addition to peripapillary choroidal thickness were measured. Factors related to laminar depth were determined with mixed-effects modeling. Cutoffs for significant change in each parameter were estimated from variability in healthy controls over 1 year. The occurrences of significant change in laminar depth and neuroretinal parameters were compared with survival models. Because normal aging has a clear effect on neuroretinal parameters, but not on laminar depth, changes in neuroretinal parameters were adjusted for age-related reduction.
Main outcome measures
Longitudinal changes in laminar depth and neuroretinal parameters.
Results
Glaucoma patients were followed up for a mean of 3.90 years (range, 2.03-5.44 years). The LD-BM was influenced significantly more by choroidal thickness (1.14 μm/μm; 95% confidence interval, 1.07-1.21) than was the LD-AS (0.15 μm/μm; 95% confidence interval, 0.08-0.22). Posterior movement of the lamina (LD-BM increase or LD-AS increase) occurred with the same frequencies as thinning in neuroretinal parameters. Anterior movement of the lamina was detected more frequently with the Bruch's membrane (LD-BM decrease) compared with the anterior sclera (LD-AS decrease) reference plane (hazard ratio, 3.23; P < 0.01). Significant choroidal thinning occurred in most patients (25/28 [89%]) in whom anterior movement of the lamina occurred with the Bruch's membrane, but not the anterior sclera, reference plane (LD-BM decrease without LD-AS decrease). Patients had a wide range of individual rates of change of choroidal thickness, from -20.00 to 17.09 μm/year (mean, -1.62 μm/year).
Conclusions
Lamina cribrosa depth should be measured from an anterior sclera reference plane to reduce the influence of choroidal thickness changes. In glaucoma patients, lamina cribrosa depth changes are detected with similar frequency as neuroretinal parameter changes.
MeSH Terms
Shields Classification
Key Concepts5
In glaucoma patients, lamina cribrosa depth changes are detected with similar frequency as neuroretinal parameter changes.
Lamina cribrosa depth should be measured from an anterior sclera reference plane to reduce the influence of choroidal thickness changes.
The lamina cribrosa depth from a Bruch's membrane (LD-BM) reference plane was influenced significantly more by choroidal thickness (1.14 μm/μm; 95% confidence interval, 1.07-1.21) than was the lamina cribrosa depth from an anterior sclera (LD-AS) reference plane (0.15 μm/μm; 95% confidence interval, 0.08-0.22) in glaucoma patients.
Anterior movement of the lamina cribrosa was detected more frequently with the Bruch's membrane (LD-BM decrease) compared with the anterior sclera (LD-AS decrease) reference plane in glaucoma patients (hazard ratio, 3.23; P < 0.01).
Significant choroidal thinning occurred in most glaucoma patients (25/28 [89%]) in whom anterior movement of the lamina cribrosa occurred with the Bruch's membrane, but not the anterior sclera, reference plane (LD-BM decrease without LD-AS decrease).
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