Korean J Ophthalmol.  2014 Jun;28(3):234-240. 10.3341/kjo.2014.28.3.234.

Relationship between the Lamina Cribrosa, Outer Retina, and Choroidal Thickness as Assessed Using Spectral Domain Optical Coherence Tomography

• Chung HS
• Sung KR
• Lee KS
• Lee JR
• Kim S

• KMID: 2133322
• DOI: http://doi.org/10.3341/kjo.2014.28.3.234

Abstract

PURPOSE
To evaluate the characteristics and relationship between peripapillary choroidal thickness (pCT), lamina cribrosa thickness (LCT), and peripapillary outer retinal layer thickness (pORT) as determined using spectral domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI).
METHODS
In total, 255 participants were included (87 healthy subjects, 87 glaucoma suspects (GS), and 81 glaucoma cases). The pORT, defined as the thickness between the posterior outer plexiform layer and the retinal pigment epithelium (RPE) interface, and the pCT, between the outer margin of the RPE and the choroidal-scleral interface, were manually measured using EDI scanning of the circumpapillary retinal nerve fiber layer (RNFL). LCT was determined by EDI scanning of the optic nerve head (ONH). Baseline characteristics, including axial length (AXL) and the SD-OCT measurements of the participants, were compared among the three groups. The correlation between putative factors and pCT was determined using univariate and multivariate linear regression analyses.
RESULTS
In all three groups, both pORT and pCT were thinnest in the inferior area among the four quadrants. In the healthy group, the mean peripapillary RNFL, pORT, and LCT were significantly greater in comparison with those of the GS and glaucoma groups (p < 0.001, p < 0.038, and p < 0.001, respectively). The pCT demonstrated no significant differences among the three groups (p = 0.083). Only age and AXL were associated with pCT by multivariate analysis.
CONCLUSIONS
The pCT is substantially thinner in the inferior area of the ONH. In addition, the pCT demonstrates the strongest correlation with age and AXL, but was not associated with glaucoma or LCT.

Keyword

Choroidal thickness; Glaucoma; Lamina cribrosa thickness; Optical coherence tomography; Outer retinal thickness

MeSH Terms

Choroid/*pathology
Female
Follow-Up Studies
Glaucoma, Open-Angle/*diagnosis
Humans
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Retina/*pathology
Severity of Illness Index
Tomography, Optical Coherence/*methods

Reference

1. Cioffi GA, Wang L, Fortune B, et al. Chronic ischemia induces regional axonal damage in experimental primate optic neuropathy. Arch Ophthalmol. 2004; 122:1517–1525.

2. Duijm HF, van den Berg TJ, Greve EL. Choroidal haemodynamics in glaucoma. Br J Ophthalmol. 1997; 81:735–742.

3. Margolis R, Spaide RF. A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol. 2009; 147:811–815.

4. Mwanza JC, Hochberg JT, Banitt MR, et al. Lack of association between glaucoma and macular choroidal thickness measured with enhanced depth-imaging optical coherence tomography. Invest Ophthalmol Vis Sci. 2011; 52:3430–3435.

5. Ikuno Y, Maruko I, Yasuno Y, et al. Reproducibility of retinal and choroidal thickness measurements in enhanced depth imaging and high-penetration optical coherence tomography. Invest Ophthalmol Vis Sci. 2011; 52:5536–5540.

6. Branchini L, Regatieri CV, Flores-Moreno I, et al. Reproducibility of choroidal thickness measurements across three spectral domain optical coherence tomography systems. Ophthalmology. 2012; 119:119–123.

7. Maul EA, Friedman DS, Chang DS, et al. Choroidal thickness measured by spectral domain optical coherence tomography: factors affecting thickness in glaucoma patients. Ophthalmology. 2011; 118:1571–1579.

8. Ehrlich JR, Peterson J, Parlitsis G, et al. Peripapillary choroidal thickness in glaucoma measured with optical coherence tomography. Exp Eye Res. 2011; 92:189–194.

9. Mwanza JC, Sayyad FE, Budenz DL. Choroidal thickness in unilateral advanced glaucoma. Invest Ophthalmol Vis Sci. 2012; 53:6695–6701.

10. Usui S, Ikuno Y, Miki A, et al. Evaluation of the choroidal thickness using high-penetration optical coherence tomography with long wavelength in highly myopic normal-tension glaucoma. Am J Ophthalmol. 2012; 153:10–16.

11. Fujiwara T, Imamura Y, Margolis R, et al. Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes. Am J Ophthalmol. 2009; 148:445–450.

12. Sugiyama K, Gu ZB, Kawase C, et al. Optic nerve and peripapillary choroidal microvasculature of the rat eye. Invest Ophthalmol Vis Sci. 1999; 40:3084–3090.

13. Park HY, Jeon SH, Park CK. Enhanced depth imaging detects lamina cribrosa thickness differences in normal tension glaucoma and primary open-angle glaucoma. Ophthalmology. 2012; 119:10–20.

14. Lee EJ, Kim TW, Weinreb RN, et al. Visualization of the lamina cribrosa using enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol. 2011; 152:87–95.

15. Kim S, Sung KR, Lee JR, Lee KS. Evaluation of lamina cribrosa in pseudoexfoliation syndrome using spectral-domain optical coherence tomography enhanced depth imaging. Ophthalmology. 2013; 120:1798–1803.

16. Park SC, De Moraes CG, Teng CC, et al. Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma. Ophthalmology. 2012; 119:3–9.

17. Kim CS, Seong GJ, Lee NH, et al. Prevalence of primary open-angle glaucoma in central South Korea the Namil study. Ophthalmology. 2011; 118:1024–1030.

18. Iwase A, Suzuki Y, Araie M, et al. The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology. 2004; 111:1641–1648.

19. Sung KR, Cho JW, Lee S, et al. Characteristics of visual field progression in medically treated normal-tension glaucoma patients with unstable ocular perfusion pressure. Invest Ophthalmol Vis Sci. 2011; 52:737–743.

20. Sung KR, Lee S, Park SB, et al. Twenty-four hour ocular perfusion pressure fluctuation and risk of normal-tension glaucoma progression. Invest Ophthalmol Vis Sci. 2009; 50:5266–5274.

21. Sung KR, Sun JH, Na JH, et al. Progression detection capability of macular thickness in advanced glaucomatous eyes. Ophthalmology. 2012; 119:308–313.

22. Na JH, Sung KR, Baek S, et al. Detection of glaucoma progression by assessment of segmented macular thickness data obtained using spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2012; 53:3817–3826.

23. Cho JW, Sung KR, Lee S, et al. Relationship between visual field sensitivity and macular ganglion cell complex thickness as measured by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2010; 51:6401–6407.

24. Seong M, Sung KR, Choi EH, et al. Macular and peripapillary retinal nerve fiber layer measurements by spectral domain optical coherence tomography in normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2010; 51:1446–1452.

25. Na JH, Sung KR, Baek S, et al. Macular and retinal nerve fiber layer thickness: which is more helpful in the diagnosis of glaucoma? Invest Ophthalmol Vis Sci. 2011; 52:8094–8101.

26. Um TW, Sung KR, Wollstein G, et al. Asymmetry in hemifield macular thickness as an early indicator of glaucomatous change. Invest Ophthalmol Vis Sci. 2012; 53:1139–1144.

27. Sung KR, Kim S, Lee Y, et al. Retinal nerve fiber layer normative classification by optical coherence tomography for prediction of future visual field loss. Invest Ophthalmol Vis Sci. 2011; 52:2634–2639.

28. Quigley HA, Addicks EM. Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage. Arch Ophthalmol. 1981; 99:137–143.

29. Radius RL, Gonzales M. Anatomy of the lamina cribrosa in human eyes. Arch Ophthalmol. 1981; 99:2159–2162.

30. Jonas JB, Mardin CY, Schlotzer-Schrehardt U, Naumann GO. Morphometry of the human lamina cribrosa surface. Invest Ophthalmol Vis Sci. 1991; 32:401–405.

31. Usui S, Ikuno Y, Akiba M, et al. Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci. 2012; 53:2300–2307.

32. Toyokawa N, Kimura H, Fukomoto A, Kuroda S. Difference in morning and evening choroidal thickness in Japanese subjects with no chorioretinal disease. Ophthalmic Surg Lasers Imaging. 2012; 43:109–114.

33. Tan CS, Ouyang Y, Ruiz H, Sadda SR. Diurnal variation of choroidal thickness in normal, healthy subjects measured by spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2012; 53:261–266.

34. Chakraborty R, Read SA, Collins MJ. Diurnal variations in axial length, choroidal thickness, intraocular pressure, and ocular biometrics. Invest Ophthalmol Vis Sci. 2011; 52:5121–5129.