A Comparative Study of Bruch's Membrane Opening-Minimum Rim Width in Glaucoma, Chiasm Compression and Controls

Pathologic optic disc cupping is often related to glaucoma, but can also be caused by compressive optic pathway diseases. The differentiation between these conditions in some cases may be challenging. We compared the ability of Bruch's Membrane Opening - Minimum Rim Width (BMO-MRW) measurements in detecting structural abnormalities in patients with band atrophy (BA) of the optic nerve from compressive chiasmal lesions, glaucoma and controls.

Poster 189 A Comparative Study of Bruch's Membrane Opening-Minimum Rim Width in Glaucoma, Chiasm Compression and Controls Thais Andrade1, Rafael Araujo2, Arthur Rocha2, Luiz Mello2, Mário Monteiro2 1 Division of Ophthalmology and LIM-33, University of São Paulo Medical School, Brazil, São Paulo, Brazil, 2Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil Introduction: Pathologic optic disc cupping is often related to glaucoma, but can also be caused by compressive optic pathway diseases. The differentiation between these conditions in some cases may be challenging. We compared the ability of Bruch's Membrane Opening - Minimum Rim Width (BMO-MRW) measurements in detecting structural abnormalities in patients with band atrophy (BA) of the optic nerve from compressive chiasmal lesions, glaucoma and controls. Methods: Cross-sectional, observational, prospective study with 31 eyes of 22 patients with BA and temporal hemianopia from chiasmal compression, 20 eyes (18 patients) with perimetric glaucoma and 18 eyes of 9 normal age-matched controls were examined including Humphrey 24-2 visual field(VF) testing and SpectralisÒOCT for BMO-MRW measurement. Glaucoma and BA eyes were matched for severity of field loss based on VF Mean Deviation. BMO-MRW was averaged in superior(S), inferior(I), nasal(N), temporal(T), horizontal (N+T average) and vertical (S+I average) sectors. Data were compared using GEE models. Area under the ROC Curves(AUC) were used to evaluate the discrimination ability of each parameter. Results: BMO-MRW mean values were significantly thinner in glaucoma and BA when compared to controls in all parameters with AUC ranging from 0.953 to 1.000 for glaucoma and from 0.835 to 0.934 for chiasmal lesions. Glaucoma eyes differed significantly from BA eyes in all but the temporal sector, with AUC ranging from 0.748 to 0.929. Measurements from the vertical and inferior sectors showed the best discriminatory between BA and glaucoma eyes (AUC 0.929 and 0.927, respectively) (Table). Conclusions: BMO-MRW parameters provide comparable diagnostic performance to differentiate glaucoma and BA eyes from healthy subjects, with larger AUCs for glaucoma patients. Our results show that while BMO-MRW reduction is more pronounced in glaucoma eyes, compressive lesions of the anterior optic pathway may also lead to significant cupping and may to some extent mimic glaucomatous optic disc abnormalities. References: 1. Monteiro ML, Leal BC, Rosa AA, Bronstein MD. "Optical coherence tomography analysis of axonal loss in band atrophy of the optic nerve." Br J Ophthalmol 88 (7):896-9. 2004 2. Monteiro ML, Moura FC, Medeiros FA."Diagnostic ability of optical coherence tomography with a normative database to detect band atrophy of the optic nerve." Am J Ophthalmol143 (5):8969. 2007 3. Danthurebandara VM, Vianna JR, Sharpe GP et al. "Diagnostic accuracy of glaucoma with sector-based and a new total profile based analysis of neuroretinal rim and retinal nerve fiber layer thickness." Investigative Ophthalmology and Visual Science 57 (1):181-187. 2016 4. Reis ASC, Zangalli CES, Abe RY et al. "Intra- and interobserver reproducibility of Bruch's membrane opening minimum rim width measurements with spectral domain optical coherence tomography." Acta ophthalmologica:1-8. 2017 5. Danesh-Meyer, HV, Yap J, Frampton C, Savino PJ. "Differentiation of Compressive from Glaucomatous Optic Neuropathy with Spectral-Domain Optical Coherence Tomography." Ophthalmology 121 (8):1516-1523. 2014 Keywords: Optic neuropathy, Diagnostic tests (ERG, VER, OCT, HRT, mfERG, etc), Eyelid & adnexal disease, Tumors Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Thais de Souza Andrade, MD, Faculdade de Medicina FMUSP, Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, São Paulo, Brazil, 05403-001; Phone: [phone] Email: [e-mail] 342 | North American Neuro-Ophthalmology Society