Symmetry between the right and left eyes of the normal retinal nerve fiber layer measured with optical coherence tomography (an AOS thesis).

PURPOSE To determine the limits of the normal amount of interocular symmetry in retinal nerve fiber layer (RNFL) thickness measurements obtained with third-generation time domain optical coherence tomography (OCT3). METHODS Both eyes of normal volunteers were scanned using the peripapillary standard and fast RNFL algorithms of OCT3. RESULTS A total of 108 volunteers were included in the analysis. The mean +/- standard deviation (SD) of age of the volunteers was 46.0 +/- 15.0 years (range 20-82). Forty-two participants (39%) were male and 66 (61%) were female. Mean RNFL thickness correlated extremely well, with intraclass correlation coefficients of 0.89 for both algorithms (95% confidence interval [CI], 0.84-0.93). The mean RNFL thickness of the right eye measured 1.3 mum thicker than the left on the standard scan (SD 4.7, 95% CI 0.4-2.2, P = .004) and 1.2 mum on the fast scan (SD 5.2, 95% CI 0.1-2.2, P = .026). The 95% tolerance limits on the difference between the mean RNFL thicknesses of right minus left eye was -10.8 and +8.9 mum with the standard scan algorithm and -10.6 and +11.7 mum with the fast scan algorithm. CONCLUSIONS Mean RNFL thickness between the 2 eyes of normal individuals should not differ by more than approximately 9 to 12 mum, depending on which scanning algorithm of OCT3 is used and which eye measures thicker. Differences beyond this level suggest statistically abnormal asymmetry, which may represent early glaucomatous optic neuropathy.

[1]  G. Marchini,et al.  Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. , 1998, Ophthalmology.

[2]  S. Miglior,et al.  Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. , 2007, Ophthalmology.

[3]  Paul Mitchell,et al.  Symmetry of optical coherence tomography retinal measurements in young children. , 2007, American journal of ophthalmology.

[4]  M. Kass,et al.  The Ocular Hypertension Treatment Study: design and baseline description of the participants. , 1999, Archives of ophthalmology.

[5]  J. T. Ernest,et al.  Becker-Shaffer's Diagnosis and Therapy of the Glaucomas , 1977 .

[6]  A. Sommer,et al.  The nerve fiber layer in the diagnosis of glaucoma. , 1977, Archives of ophthalmology.

[7]  H. Jampel,et al.  Quantitative detection of glaucomatous damage at the posterior pole by retinal thickness mapping. A pilot study. , 1998, Ophthalmology.

[8]  C. Cedrone,et al.  Prevalence of glaucoma in Ponza, Italy: a comparison with other studies. , 1997, Ophthalmic epidemiology.

[9]  Chris A. Johnson,et al.  The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. , 2002, Archives of ophthalmology.

[10]  H. Dua,et al.  Asymmetry in optic disc morphometry as measured by heidelberg retina tomography in a normal elderly population: the Bridlington Eye Assessment Project. , 2005, Investigative ophthalmology & visual science.

[11]  F. Medeiros,et al.  Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. , 2005, American journal of ophthalmology.

[12]  S. Graham,et al.  Multifocal topographic visual evoked potential: improving objective detection of local visual field defects. , 1998, Investigative ophthalmology & visual science.

[13]  S. Drance,et al.  Visual field and retinal nerve fiber layer comparisons in glaucoma. , 1985, Archives of ophthalmology.

[14]  Masanori Hangai,et al.  Measurement of Retinal Nerve Fiber Layer Thickness and Macular Volume for Glaucoma Detection Using Optical Coherence Tomography , 2007, Japanese Journal of Ophthalmology.

[15]  Sung Pyo Hong,et al.  Asymmetry analysis of the retinal nerve fiber layer thickness in normal eyes using optical coherence tomography. , 2005, Korean journal of ophthalmology : KJO.

[16]  B. Schwartz,et al.  Increased preferential optic disc asymmetry in ocular hypertensive patients compared with control subjects. , 1991, Ophthalmology.

[17]  Sek-Tien Hoh,et al.  Evaluating the optic nerve and retinal nerve fibre layer: the roles of Heidelberg retina tomography, scanning laser polarimetry and optical coherence tomography. , 2007, Annals of the Academy of Medicine, Singapore.

[18]  Richard A. Levine,et al.  Asymmetries and visual field summaries as predictors of glaucoma in the ocular hypertension treatment study. , 2006, Investigative ophthalmology & visual science.

[19]  A. Sommer,et al.  Race-, age-, gender-, and refractive error-related differences in the normal optic disc. , 1994, Archives of ophthalmology.

[20]  J. Katz,et al.  Sensitivity and specificity of the StratusOCT for perimetric glaucoma. , 2005, Ophthalmology.

[21]  J. Jonas,et al.  Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. , 1988, Investigative ophthalmology & visual science.

[22]  L. Wilson,et al.  SPECTRAL REFLECTANCE PHOTOGRAPHY OF THE RETINA. , 1965, American journal of ophthalmology.

[23]  W. Hoyt.  Ophthalmoscopy of the Retinal Nerve Fibre Layer in Neuro‐Ophthalmologic Diagnosis* , 1976 .

[24]  S Kangovi,et al.  An interocular comparison of the multifocal VEP: a possible technique for detecting local damage to the optic nerve. , 2000, Investigative ophthalmology & visual science.

[25]  H. Quigley,et al.  Clinical evaluation of nerve fiber layer atrophy as an indicator of glaucomatous optic nerve damage. , 1980, Archives of ophthalmology.

[26]  R. Radius.  Thickness of the retinal nerve fiber layer in primate eyes. , 1980, Archives of ophthalmology.

[27]  K. Richardson.  Optic cup symmetry in normal newborn infants. , 1968, Investigative Ophthalmology.

[28]  A. Hofman,et al.  Changing views on open-angle glaucoma: definitions and prevalences--The Rotterdam Study. , 2000, Investigative ophthalmology & visual science.

[29]  M. C. Leske,et al.  The Barbados Eye Study. Prevalence of open angle glaucoma. , 1994, Archives of ophthalmology.

[30]  H. A. Kahn,et al.  Alternative definitions of open-angle glaucoma. Effect on prevalence and associations in the Framingham eye study. , 1980, Archives of ophthalmology.

[31]  Alfred Sommer,et al.  How to use nerve fiber layer examination in the management of glaucoma. , 1987, Transactions of the American Ophthalmological Society.

[32]  H. Alanko,et al.  OPTIC DISC HAEMORRHAGES PRECEDE RETINAL NERVE FIBRE LAYER DEFECTS IN OCULAR HYPERTENSION , 1981, Acta ophthalmologica.

[33]  M. Kass,et al.  Prognostic significance of optic disk cupping in ocular hypertensive patients. , 1980, American journal of ophthalmology.

[34]  W. Feuer,et al.  Static threshold asymmetry in early glaucomatous visual field loss. , 1989, Ophthalmology.

[35]  P. Mitchell,et al.  Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. , 1996, Ophthalmology.

[36]  J Katz,et al.  Risk factors for the development of glaucomatous visual field loss in ocular hypertension. , 1994, Archives of ophthalmology.

[37]  Dong Myung Kim,et al.  Ability of Stratus OCT to identify localized retinal nerve fiber layer defects in patients with normal standard automated perimetry results. , 2007, Investigative ophthalmology & visual science.

[38]  E A Swanson,et al.  Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. , 1995, Archives of ophthalmology.

[39]  D. Snydacker.  THE NORMAL OPTIC DISC. OPHTHALMOSCOPIC AND PHOTOGRAPHIC STUDIES. , 1964, American journal of ophthalmology.

[40]  W. M. Grant,et al.  Chandler and Grant's Glaucoma , 1986 .

[41]  Redmond J. H. Smith.  Becker-Shaffer's Diagnosis and Therapy of the Glaucomas , 1977 .

[42]  S L Graham,et al.  Objective VEP Perimetry in Glaucoma: Asymmetry Analysis to Identify Early Deficits , 2000, Journal of glaucoma.

[43]  H. Quigley,et al.  Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons. , 2000, Investigative ophthalmology & visual science.

[44]  The use of RADAAR (ratio of rim area to disc area asymmetry) in detecting glaucoma and its severity. , 2004, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[45]  Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma (low-tension glaucoma). , 1988, Archives of ophthalmology.

[46]  J. G. Babu,et al.  Diagnostic capability of optical coherence tomography (Stratus OCT 3) in early glaucoma. , 2007, Ophthalmology.

[47]  P J Airaksinen,et al.  Initial glaucomatous optic disk and retinal nerve fiber layer abnormalities and their progression. , 1991, American journal of ophthalmology.

[48]  H A Quigley,et al.  Quantitative studies of retinal nerve fiber layer defects. , 1982, Archives of ophthalmology.

[49]  S. Klein,et al.  The topography of visual evoked response properties across the visual field. , 1994, Electroencephalography and clinical neurophysiology.

[50]  P. Mitchell,et al.  Intraocular pressure asymmetry and undiagnosed open-angle glaucoma in an older population. , 2004, American journal of ophthalmology.

[51]  J Katz,et al.  Evaluation of nerve fiber layer assessment. , 1984, Archives of ophthalmology.

[52]  Comparison of a Simple Ophthalmoscopic and Planimetric Measurement of Glaucomatous Neuroretinal Rim Areas , 1995, Journal of glaucoma.

[53]  Samin Hong,et al.  Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography. , 2007, Ophthalmology.

[54]  M. F. Armaly.  Genetic determination of cup/disc ratio of the optic nerve. , 1967, Archives of ophthalmology.

[55]  Douglas R. Anderson,et al.  Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. , 2007, Ophthalmology.

[56]  F. Mikelberg,et al.  Optic nerve axon count and axon diameter in patients with ocular hypertension and normal visual fields. , 1995, Ophthalmology.

[57]  P. Carpineto,et al.  Humphrey Matrix Frequency Doubling Technology Perimetry and Optical Coherence Tomography Measurement of the Retinal Nerve Fiber Layer Thickness in Both Normal and Ocular Hypertensive Subjects , 2006, Journal of glaucoma.

[58]  R. Hitchings,et al.  Frequency of asymmetric visual field defects in normal-tension and high-tension glaucoma. , 1998, Ophthalmology.

[59]  P J Airaksinen,et al.  Diffuse and localized nerve fiber loss in glaucoma. , 1984, American journal of ophthalmology.

[60]  J M Miller,et al.  Measurements of peripapillary nerve fiber layer contour in glaucoma. , 1989, American journal of ophthalmology.

[61]  D. R. Anderson,et al.  The mode of progressive disc cupping in ocular hypertension and glaucoma. , 1980, Archives of ophthalmology.

[62]  N. Newman,et al.  The earliest observable defect in glaucoma? , 1972, Lancet.

[63]  Lori M. Ventura,et al.  Pattern electroretinogram in glaucoma , 2006, Current opinion in ophthalmology.

[64]  Sung-Won Choi,et al.  Thickness Changes in the Fovea and Peripapillary Retinal Nerve Fiber Layer Depend on the Degree of Myopia , 2006, Korean journal of ophthalmology : KJO.

[65]  G. Dunkelberger,et al.  Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. , 1989, American journal of ophthalmology.

[66]  A. Sommer,et al.  Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. , 1991, JAMA.

[67]  S. Orgül,et al.  Asymmetry in Intraocular Pressure and Retinal Nerve Fiber Layer Thickness in Normal-Tension Glaucoma , 1999, Ophthalmologica.

[68]  M. L. Salvetat,et al.  Comparison between GDx VCC scanning laser polarimetry and Stratus OCT optical coherence tomography in the diagnosis of chronic glaucoma. , 2006, Acta ophthalmologica Scandinavica.

[69]  C. Cheung,et al.  Retinal nerve fiber layer measurements in myopia: An optical coherence tomography study. , 2006, Investigative ophthalmology & visual science.

[70]  J Caprioli,et al.  Progression of disc and field damage in early glaucoma. , 1993, Archives of ophthalmology.

[71]  Lori M. Ventura,et al.  Normative data for a user-friendly paradigm for pattern electroretinogram recording. , 2004, Ophthalmology.

[72]  R. Woolson,et al.  Interocular differences of the visual field in normal subjects. , 1986, Investigative ophthalmology & visual science.

[73]  A. Crichton,et al.  Unequal intraocular pressure and its relation to asymmetric visual field defects in low-tension glaucoma. , 1989, Ophthalmology.

[74]  F. Medeiros,et al.  Influence of disease severity and optic disc size on the diagnostic performance of imaging instruments in glaucoma. , 2006, Investigative ophthalmology & visual science.

[75]  Robert N Weinreb,et al.  Combining structural and functional testing for detection of glaucoma. , 2006, Ophthalmology.

[76]  R. Varma,et al.  The Optic Nerve in Glaucoma , 1993 .

[77]  R N Weinreb,et al.  Reproducibility of nerve fiber layer thickness measurements. , 1997, Ophthalmology.

[78]  Oberarzt Dr. A. Vogt.  Herstellung eines gelbblauen Lichtfiltrates, in welchem die Macula centralis in vivo in gelber Färbung erscheint, die Nervenfasern der Netzhaut und andere feine Einzelheiten derselben sichtbar werden, und der Grad der Gelbfärbung der Linse ophthalmoskopisch nachweisbar ist , 1913, Albrecht von Graefes Archiv für Ophthalmologie.

[79]  A. Sommer,et al.  Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. , 1991, Archives of ophthalmology.

[80]  E. Carpel,et al.  The normal cup-disk ratio. , 1981, American journal of ophthalmology.

[81]  J. Fujimoto,et al.  Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. , 1996, Ophthalmology.

[82]  H A Quigley,et al.  Examination of the retinal nerve fiber layer in the recognition of early glaucoma damage. , 1986, Transactions of the American Ophthalmological Society.

[83]  H. Taylor,et al.  The prevalence of glaucoma in the Melbourne Visual Impairment Project. , 1998, Ophthalmology.

[84]  J. Salmon,et al.  The role of scanning laser polarimetry using the GDx variable corneal compensator in the management of glaucoma suspects , 2006, British Journal of Ophthalmology.

[85]  P. Carpineto,et al.  Reliability of nerve fiber layer thickness measurements using optical coherence tomography in normal and glaucomatous eyes. , 2003, Ophthalmology.

[86]  A. Ferreras,et al.  Diagnostic Ability of the Heidelberg Retina Tomograph, Optical Coherence Tomograph, and Scanning Laser Polarimeter in Open-angle Glaucoma , 2007, Journal of glaucoma.

[87]  P. Carpineto,et al.  Custom Measurement of Retinal Nerve Fiber Layer Thickness Using STRATUS OCT in Normal Eyes , 2005, European journal of ophthalmology.

[88]  Valter Torri,et al.  The European glaucoma prevention study design and baseline description of the participants. , 2002, Ophthalmology.

[89]  R. Fishman.  Optic disc asymmetry. A sign of ocular hypertension. , 1970, Archives of ophthalmology.

[90]  R. Klein,et al.  Prevalence of glaucoma. The Beaver Dam Eye Study. , 1992, Ophthalmology.

[91]  R. Cumming,et al.  Asymmetry in optic disc parameters: the Blue Mountains Eye Study. , 1999, Investigative ophthalmology & visual science.

[92]  R. Hitchings,et al.  Relationship between asymmetry of visual field defects and intraocular pressure difference in an untreated normal (low) tension glaucoma population , 1990, Acta ophthalmologica.

[93]  R. Knighton,et al.  Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes. , 2005, Investigative ophthalmology & visual science.

[94]  R. Ritch,et al.  Visual field and intraocular pressure asymmetry in the low-pressure glaucoma treatment study. , 2007, Ophthalmology.

[95]  E. Higginbotham,et al.  Larger optic nerve heads have more nerve fibers in normal monkey eyes. , 1992, Archives of ophthalmology.

[96]  J. Schuman,et al.  Optical coherence tomography. , 2000, Science.

[97]  T. Dawber,et al.  The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. , 1980, Survey of ophthalmology.

[98]  L Frisén,et al.  Fundoscopy of nerve fiber layer defects in glaucoma. , 1973, Investigative ophthalmology.

[99]  A. Tuulonen,et al.  EARLY GLAUCOMA CHANGES IN PATIENTS WITH AND WITHOUT AN OPTIC DISC HAEMORRHAGE , 1984, Acta ophthalmologica.

[100]  Anders Heijl,et al.  Glaucoma Detection by Stratus OCT , 2007, Journal of glaucoma.

[101]  R Varma,et al.  Retinal nerve fiber layer thickness in normal human eyes. , 1996, Ophthalmology.

[102]  Douglas R. Anderson,et al.  Reproducibility of peripapillary retinal nerve fiber thickness measurements with stratus OCT in glaucomatous eyes. , 2008, Ophthalmology.

[103]  L. Zangwill,et al.  Reproducibility of nerve fiber layer thickness measurements by use of optical coherence tomography. , 2000, Ophthalmology.

[104]  Adrian L Jones,et al.  The Humphrey optical coherence tomography scanner: quantitative analysis and reproducibility study of the normal human retinal nerve fibre layer , 2001, The British journal of ophthalmology.