3D Evaluation of the Lamina Cribrosa with Swept-Source Optical Coherence Tomography in Normal Tension Glaucoma

PURPOSE Although the lamina cribrosa (LC) is the primary site of axonal damage in glaucoma, adequate methods to image and measure it are currently lacking. Here, we describe a noninvasive, in vivo method of evaluating the LC, based on swept-source optical coherence tomography (SS-OCT), and determine this method's ability to quantify LC thickness. METHODS This study comprised 54 eyes, including normal (n = 18), preperimetric glaucoma (PPG; n = 18), and normal tension glaucoma (NTG; n = 18) eyes. We used SS-OCT to obtain 3 x 3 mm cube scans of an area centered on the optic disc, and then synchronized reconstructed B- and en-face images from this data. We identified the LC in these B-scan images by marking the visible borders of the LC pores. We marked points on the anterior and posterior borders of the LC in 12 B-scan images in order to create a skeleton model of the LC. Finally, we used B-spline interpolation to form a 3D model of the LC, including only reliably measured scan areas. We calculated the average LC thickness (avgLCT) in this model and used Spearman's rank correlation coefficient to compare it with circumpapillary retinal nerve fiber layer thickness (cpRNFLT). RESULTS We found that the correlation coefficient of avgLCT and cpRNFLT was 0.64 (p < 0.01). The coefficient of variation for avgLCT was 5.1%. AvgLCT differed significantly in the groups (normal: 282.6 ± 20.6 μm, PPG: 261.4 ± 15.8 μm, NTG: 232.6 ± 33.3 μm). The normal, PPG and NTG groups did not significantly differ in age, sex, refractive error or intraocular pressure (IOP), although the normal and NTG groups differed significantly in cpRNFLT and Humphrey field analyzer measurements of mean deviation. CONCLUSION Thus, our results indicate that the parameters of our newly developed method of measuring LC thickness with SS-OCT may provide useful and important data for glaucoma diagnosis and research.