Temporal Raphe Sign in Elderly Patients With Large Optic Disc Cupping: Its Evaluation as a Predictive Factor for Glaucoma Conversion

Latent retinal structural patterns with aging

Optical coherence tomography (OCT) is an efficient tool for non-invasively evaluating retinal structures. Retinal thinning changes assessed using OCT are recognized as potential biomarkers for systemic conditions such as Alzheimer's disease, Parkinson's disease, and chronic kidney disease. However, age-related retinal changes remain largely unexplored, complicating the differentiation between physiological and pathological alterations. Here, we introduced a highly granular approach to assess age-related spatial changes in the inner retina using latent retinal archetypes, identifying 36 retinal archetypes of macula and peripapillary sector images from 189,387 OCTs of 22,494 individuals. Subsequently, we evaluated the associations between these archetypes and age; age-related archetypes are characterized by total or superior thinning in the macula sector. Among individuals with myopia, the inferior thinning pattern in the macula ganglion cell-inner plexiform layer was associated with aging. The age-related effects in the peripapillary sector were primarily reflected in the shape of retinal artery trajectories. Overall, latent retinal archetypes would offer new avenues for the effective utilization of retinal biomarkers in age-related diseases.

How to diagnose glaucoma in myopic eyes by detecting structural changes?

Myopia is rapidly escalating globally, especially in East and Southeast Asia, where its prevalence among younger populations reaches alarming levels of 80-90 %. This surge contributes to a myopia epidemic linked to several ocular complications, including glaucoma. As myopic individuals age, the risk of developing glaucoma increases, and an additional concern arises from the growing frequency of refractive surgeries among younger individuals, making precise optic nerve assessments critical before surgery. Evaluating the optic nerve head (ONH) in myopic eyes is challenging, as structural changes due to myopia often resemble glaucomatous alterations. Techniques such as optical coherence tomography (OCT) have improved the examination of ONH microstructures, but interpreting results remains complex due to potential false-positive findings. Myopic eyes exhibit unique changes, such as peripapillary atrophy and altered neuroretinal rim configurations, making it crucial to distinguish these from true glaucomatous signs. Recent advancements in OCT technology and the establishment of myopia-specific normative databases have enhanced diagnostic accuracy. Parameters such as minimum rim width, ganglion cell-inner plexiform layer thickness and temporal raphe sign show promise in differentiating between glaucomatous and nonglaucomatous changes. Ultimately, a comprehensive approach incorporating multiple OCT metrics is essential for accurately diagnosing glaucoma in myopic patients. By integrating various structural evaluations and leveraging advanced imaging techniques, clinicians can better navigate the complexities of glaucoma diagnosis amidst the challenges posed by myopia. This review highlights the need for increased attention and tailored strategies in managing glaucoma risk within this increasingly affected population.

Wide-field optical coherence tomography deviation map for early glaucoma detection

BACKGROUND/AIMS

This study aimed to establish a wide-field optical coherence tomography (OCT) deviation map obtained from swept-source OCT (SS-OCT) scans. Moreover, it also aimed to compare the diagnostic ability of this wide-field deviation map with that of the peripapillary and macular deviation maps currently being used for the detection of early glaucoma (EG).

METHODS

Four hundred eyes, including 200 healthy eyes and 200 eyes with EG were enrolled in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT (DRI-OCT Triton; Topcon, Tokyo, Japan). The individual wide-field scan was converted into a uniform template using the fovea and optic disc centres as fixed landmarks. Subsequently, the wide-field deviation map was obtained via the comparison between individual wide-field data and a normative wide-field database that had been created by combining images of healthy eyes into a uniform template in a previous study. The ability of the new wide-field deviation map to distinguish between EG and healthy eyes was assessed by comparing it with conventional deviation maps based on the area under the receiver operating characteristic curve (AUC).

RESULTS

The wide-field deviation map obtained using the normative wide-field database showed the highest diagnostic ability for the diagnosis of EG (AUC=0.980 and 961 for colour-coded pixels presenting <5% and <1%, respectively) among various deviation maps. Its AUC was significantly superior to that of most conventional deviation maps (p<0.05). The wide-field deviation map demonstrated early structural glaucomatous damage well over a wider area.

CONCLUSION

The wide-field SS-OCT deviation map exhibited good performance for distinguishing between eyes with EG and healthy eyes. The visualisation of the wider damaged area on the wide-field deviation map could be useful for the diagnosis of EG in clinical settings.

Macular Optical Coherence Tomography Imaging in Glaucoma

The advent of spectral-domain optical coherence tomography has played a transformative role in posterior segment imaging of the eye. Traditionally, images of the optic nerve head and the peripapillary area have been used to evaluate the structural changes associated with glaucoma. Recently, there is growing evidence in the literature supporting the use of macular spectral-domain optical coherence tomography as a complementary tool for clinical evaluation and research purposes in glaucoma. Containing more than 50% of retinal ganglion cells in a multilayered pattern, macula is shown to be affected even at the earliest stages of glaucomatous structural damage. Risk assessment for glaucoma progression, earlier detection of glaucomatous structural damage, monitoring of glaucoma especially in advanced cases, and glaucoma evaluation in certain ocular conditions including eyes with high myopia, positive history of disc hemorrhage, and certain optic disc phenotypes are specific domains where macular imaging yields complementary information compared to optic nerve head and peripapillary evaluation using optical coherence tomography. Moreover, the development of artificial intelligence models in data analysis has enabled a tremendous opportunity to create an integrated representation of structural and functional alterations observed in glaucoma. In this study, we aimed at providing a brief review of the main clinical applications and future potential utility of macular spectral-domain optical coherence tomography in glaucoma.