Korean J Ophthalmol.  2019 Oct;33(5):422-429. 10.3341/kjo.2018.0105.

Influence of Epiretinal Membranes on the Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Glaucoma

• Kim JM
• Kim KN
• Kim WJ
• Kim CS

• KMID: 2459523
• DOI: http://doi.org/10.3341/kjo.2018.0105

Abstract

PURPOSE
We investigated changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) following the onset of an epiretinal membrane (ERM) in glaucoma patients.
METHODS
Among regularly monitored glaucoma patients, patients with a newly diagnosed ERM were consecutively enrolled. Before and after the onset of ERM, the RNFL thickness was measured using spectral domain optical coherence tomography, and a visual field examination was performed using a Humphrey field analyzer. Changes in RNFL thickness parameters and global indices of the visual field analyzer were assessed.
RESULTS
In a total of 28 eyes from 28 patients, the average RNFL thickness increased by a mean of 4.0 ± 7.4 µm (p = 0.009) after ERM onset. There was an increase in the superior, nasal, and temporal quadrant RNFL thicknesses, and the change in the temporal RNFL thickness was significant (14.4 ± 21.2 µm, p < 0.001). However, the inferior RNFL thickness decreased by −0.6 ± 7.5 µm (p = 0.116). In the visual field examination, the mean deviation decreased significantly by −0.8 ± 1.7 dB (p = 0.038), from −14.6 to −15.4 dB.
CONCLUSIONS
A significant increase in average RNFL thickness was detected following ERM onset in glaucoma patients, although there was deterioration of the mean deviation in the visual field. When ERM occurs in glaucoma patients, clinicians should be aware that RNFL thickness measurements obtained with a spectral domain optical coherence tomography may underestimate the status of glaucomatous optic neuropathy.

Keyword

Epiretinal membrane; Glaucoma; Optical coherence tomography; Peripapillary retinal nerve fiber layer; Visual field examination

MeSH Terms

Epiretinal Membrane*
Glaucoma*
Humans
Nerve Fibers*
Optic Nerve Diseases
Retinaldehyde*
Tomography, Optical Coherence*
Visual Fields
Retinaldehyde

Figure

• 

  Fig. 1 Peripapillary involvement of the epiretinal membrane (ERM) was confirmed using (A) an axial view and (B) en face view of the high-definition line raster scan including the macular and optic disc. (A) The distance from the nasal boundary of the ERM to the nasal end of the scanned image was measured using a scale embedded in Cirrus HD optical coherence tomography. (C) After the scan circle of the peripapillary retinal nerve fiber layer overlapped on an en face view of the macular scan, (B) the distance from the crossing point of the scan circle of the peripapillary retinal nerve fiber layer and raster scan line to the nasal end of the raster scan line was measured using the same embedded scale. ERM with peripapillary involvement was defined as a case with a longer distance measured in (B) than in (A).

• 

  Fig. 2 Representative case of the right eye of a 54-year-old female patient with bilateral primary open-angle glaucoma. Fundus photography, spectral domain-optical coherence tomography, and Humphrey visual field (HVF) results performed before the onset of an epiretinal membrane (ERM) (A), and after ERM onset (B). The interval of the fundus photograph and spectral domain-optical coherence tomography between (A) and (B) was 18 months; the interval of the HVF examinations between (A) and (B) was 22 months. The average retinal nerve fiber layer thickness increased from 70 to 79 µm after ERM development. The retinal nerve fiber layer thicknesses in all quadrants increased; however, the mean deviation decreased from −12.41 to −13.18 dB on HVF examinations. T = temporal; S = superior; N = nasal; I = inferior.

Reference

1. Stein JD, Talwar N, Laverne AM, et al. Trends in use of ancillary glaucoma tests for patients with open-angle glaucoma from 2001 to 2009. Ophthalmology. 2012; 119:748–758.

2. Aref AA, Budenz DL. Spectral domain optical coherence tomography in the diagnosis and management of glaucoma. Ophthalmic Surg Lasers Imaging. 2010; 41:S15–S27.

3. Mwanza JC, Oakley JD, Budenz DL, et al. Ability of cirrus HD-OCT optic nerve head parameters to discriminate normal from glaucomatous eyes. Ophthalmology. 2011; 118:241–248.

4. Oh JH, Kim YY. Scanning laser polarimetry and optical coherence tomography for detection of retinal nerve fiber layer defects. Korean J Ophthalmol. 2009; 23:169–175.

5. Leung CK, Lam S, Weinreb RN, et al. Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: analysis of the retinal nerve fiber layer map for glaucoma detection. Ophthalmology. 2010; 117:1684–1691.

6. Liu X, Shen M, Huang S, et al. Repeatability and reproducibility of eight macular intra-retinal layer thicknesses determined by an automated segmentation algorithm using two SD-OCT instruments. PLoS One. 2014; 9:e87996.

7. Budenz DL, Fredette MJ, Feuer WJ, Anderson DR. Reproducibility of peripapillary retinal nerve fiber thickness measurements with stratus OCT in glaucomatous eyes. Ophthalmology. 2008; 115:661–666.

8. Giani A, Cigada M, Esmaili DD, et al. Artifacts in automatic retinal segmentation using different optical coherence tomography instruments. Retina. 2010; 30:607–616.

9. Sull AC, Vuong LN, Price LL, et al. Comparison of spectral/Fourier domain optical coherence tomography instruments for assessment of normal macular thickness. Retina. 2010; 30:235–245.

10. Asrani S, Essaid L, Alder BD, Santiago-Turla C. Artifacts in spectral-domain optical coherence tomography measurements in glaucoma. JAMA Ophthalmol. 2014; 132:396–402.

11. Lee YH, Bae HW, Seo SJ, et al. Influence of epiretinal membrane on the measurement of peripapillary retinal nerve fibre layer thickness using spectral-domain coherence tomography. Br J Ophthalmol. 2016; 100:1035–1040.

12. Kim YW, Jeoung JW, Yu HG. Vitreopapillary t raction in eyes with idiopathic epiretinal membrane: a spectral-domain optical coherence tomography study. Ophthalmology. 2014; 121:1976–1982.

13. Nomura Y, Tamaki Y, Yanagi Y. Vitreopapillary t raction diagnosed by spectral domain optical coherence tomography. Ophthalmic Surg Lasers Imaging. 2010; 41:S74–S76.

14. Oh J, Oh JH, Do JR, et al. Retinal nerve fiber layer configuration in eyes with epiretinal membrane. Optom Vis Sci. 2014; 91:1328–1334.

15. Kim KY, Yu SY, Kim MS, et al. Changes of parafoveal retinal nerve fiber layer thickness analyzed by spectral-domain optical coherence tomography after pars plana vitrectomy. Retina. 2013; 33:776–784.

16. Yamashita T, Uemura A, Kita H, Sakamoto T. Analysis of the retinal nerve fiber layer after indocyanine green-assisted vitrectomy for idiopathic macular holes. Ophthalmology. 2006; 113:280–284.

17. Arroyo JG, Irvine AR. Retinal distortion and cotton-wool spots associated with epiretinal membrane contraction. Ophthalmology. 1995; 102:662–668.

18. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121:2081–2090.

19. Xiao W, Chen X, Yan W, et al. Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies. BMJ Open. 2017; 7:e014644.

20. Fraser-Bell S, Ying-Lai M, Klein R, et al. Prevalence and associations of epiretinal membranes in latinos: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2004; 45:1732–1736.

21. Fraser-Bell S, Guzowski M, Rochtchina E, et al. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology. 2003; 110:34–40.

22. Klein R, Klein BE, Wang Q, Moss SE. The epidemiology of epiretinal membranes. Trans Am Ophthalmol Soc. 1994; 92:403–425.

23. Pearlstone AD. The incidence of idiopathic preretinal macular gliosis. Ann Ophthalmol. 1985; 17:378–380.

24. Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes. Ultrastructural characteristics and clinicopathologic correlation. Ophthalmology. 1989; 96:811–820.

25. Roth AM, Foos RY. Surface wrinkling retinopathy in eyes enucleated at autopsy. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75:1047–1058.

26. Gupta P, Sadun AA, Sebag J. Multifocal retinal contraction in macular pucker analyzed by combined optical coherence tomography/scanning laser ophthalmoscopy. Retina. 2008; 28:447–452.

27. Lee HJ, Kim MS, Jo YJ, Kim JY. Thickness of the macula, retinal nerve fiber layer, and ganglion cell layer in the epiretinal membrane: the repeatability study of optical coherence tomography. Invest Ophthalmol Vis Sci. 2015; 56:4554–4559.

28. Lee SB, Shin YI, Jo YJ, Kim JY. Longitudinal changes in retinal nerve fiber layer thickness after vitrectomy for epiretinal membrane. Invest Ophthalmol Vis Sci. 2014; 55:6607–6611.

29. Bengtsson B, Heijl A. A visual field index for calculation of glaucoma rate of progression. Am J Ophthalmol. 2008; 145:343–353.

30. Savini G, Zanini M, Carelli V, et al. Correlation between retinal nerve fibre layer thickness and optic nerve head size: an optical coherence tomography study. Br J Ophthalmol. 2005; 89:489–492.

31. Gass CA, Haritoglou C, Messmer EM, et al. Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence. Br J Ophthalmol. 2001; 85:549–551.

32. Lalezary M, Shah RJ, Reddy RK, et al. Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study: twelve-month findings. Ophthalmology. 2014; 121:1983–1989.