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Lamina Cribrosa Morphology Predicts Progressive Retinal Nerve Fiber Layer Loss In Eyes with Suspected Glaucoma
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Edité par CCSD ; Nature Publishing Group -
International audience. Although early diagnosis and treatment reduce the risk of blindness from glaucoma, the decision on whether or not to begin treatment in patients with suspected glaucoma is often a dilemma because the majority of patients never develop definite glaucoma. A growing body of evidences suggests that posterior bowing of the lamina cribrosa (LC) is the earliest structural change preceding the retinal nerve fiber layer (RNFL) loss in glaucomatous optic neuropathy. Based on this notion, we conducted a prospective study enrolling 87 eyes suspected of having glaucoma to investigate whether the future rate of RNFL loss is associated with the baseline LC curve evaluated by measuring the LC curve index (LCCI) using enhanced depth imaging optical coherence tomography. A faster rate of RNFL loss was significantly associated with greater LCCI (P < 0.001;standardized coefficient beta = −0.392), older age (P = 0.008;beta = −0.314), and greater vertical cup-to-disc ratio (P = 0.040;beta = −0.233). Assessment of LC morphology may help predict the disease outcome in eyes with suspected glaucoma. Glaucoma is an optic neuropathy characterized by progressive neuroretinal rim thinning, excavation, and loss of the retinal nerve fiber layer (RNFL). These structural changes are accompanied by irreversible functional loss, and structural damage often occurs earlier than a detectable visual field (VFD) defect 1. In most studies, only a relatively small proportion of patients who were suspected of having glaucoma or who had disease-related risk factors, such as ocular hypertension, have been found to have definite glaucoma with a manifest VFD defect during follow-up 2-5. Therefore, stratification of patients according to the likelihood of progression to glaucoma should facilitate better allocation of limited healthcare resources, allow for enhanced disease surveillance and earlier intervention for those at higher risk, and help avoid unnecessary interventions and treatment side effects in individuals deemed at low risk 6. Studies have shown that certain risk factors, such as older age, high intraocular pressure (IOP), thinner central cornea, disc hemorrhage (DH), and topographic optic disc measurements are predictive of the development of primary open-angle glaucoma among patients with suspected glaucoma or those with ocular hypertension 7-11. Additionally, a visual field (VF) parameter (higher pattern standard deviation [PSD] of the Humphrey perim-etry) 9,10 and structural characteristics of the optic nerve (e.g., larger vertical and horizontal cup-to-disc [C/D] ratio or larger vertical C/D ratio asymmetry) 9-11 have been shown to help predict eyes with a higher chance of developing definitive glaucomatous damage. The lamina cribrosa (LC) is a mesh-like tissue composed of connective tissue, glial cells, and microvessels that support the axons of retinal ganglion cells (RGC) 12,13. Experimental studies have shown that posterior displacement of the LC precedes early surface-detected structural damage and RNFL loss 14-17. Leung et al. demonstrated that the surface of the optic nerve head becomes depressed before RNFL thinning in patients with glaucoma 18 .
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