Abstract
The presentation and measurement of the internal retinal layers by current optical coherence tomography (OCT) instruments allow a precise topographic localization of macular glaucomatous damage. Ganglion cell analysis in particular can reveal slight central defects and can effectively be correlated with perimetric strategies with centrally condensed stimuli, so that small glaucomatous defects can be confirmed earlier and more confidently. Progression can also be verified in the early stages of the disease as enlargement and deepening of small localized defects. Macular OCT (mOCT) cannot sufficiently detect peripheral glaucomatous defects and may be impaired by macular pathologies; therefore, mOCT should be combined with other morphometric examinations. In order to take advantage of the technical capabilities of current OCT devices appropriate perimetric strategies should also be applied. As the algorithms for documentation and evaluation of the results of current OCT instruments are far less advanced than the technical capabilities, OCT results still have to be visually scrutinized together with the visual field results to benefit from the technical possibilities provided by modern OCT devices.
Zusammenfassung
Die Darstellung und Messung der inneren Retinaschichten mit den aktuellen OCT-Geräten erlaubt eine sehr präzise topografische Lokalisation von makulären Glaukomschäden. Vor allem mit der Ganglienzellanalyse lassen sich auch dezente zentrale Veränderungen erfassen und gut mit Perimetriebefunden entsprechend feiner Prüfpunktraster korrelieren. Dadurch lassen sich geringe Glaukomschäden früher und sicherer erfassen. Auch für die Progressionsbeurteilung eignet sich das makuläre OCT – zumindest in den Frühstadien – sehr gut, da sich die Progression auch von kleinen umschriebenen Defekten gut darstellen lässt. Makuläre OCT-Untersuchungen erfassen periphere Glaukomschäden nicht ausreichend und können durch Makulopathien erheblich beeinträchtigt werden, sodass sie immer im Zusammenhang mit anderen morphometrischen Untersuchungen betrachtet werden sollten. Da die Algorithmen der Befunddokumentation und -auswertung der OCT-Geräte den technischen Möglichkeiten noch erheblich hinterherhinken, hat die sorgfältige visuelle Analyse der OCT- und Perimetriebefunde immer noch große Bedeutung, wenn man die technischen Möglichkeiten, die die mOCT-Untersuchung bietet, ausnutzen möchte.
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Abbreviations
- GCC:
-
ganglion cell complex
- GCL:
-
ganglion cell body layer
- GCL+:
-
ganglion cell body layer plus inner plexiform layer
- VF:
-
visual field
- IPL:
-
inner plexiform layer
- MD:
-
mean deviation
- LV:
-
loss variance
- mOCT:
-
macular optical coherence tomography
- MVZ:
-
macular vulnerability zone
- NFL:
-
nerve fiber layer
- OCT:
-
ocular coherence tomography
- PD:
-
pattern deviation
- pRNLF:
-
peripapillary retinal nerve fiber layer
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Acknowledgements
The authors wish to thank Corinna Vogel, Heike Tretschog, Jeanette Böttger, and Elke Spielmann for their continuous engagement in VF and OCT examinations.
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A. Sturm and W. Noske state that there are no conflicts of interest.
The accompanying manuscript does not include studies on humans or animals.
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Sturm, A., Noske, W. Comparative glaucomatous diagnosis using macular optical coherence tomography and perimetry with centrally condensed stimuli. Ophthalmologe 113 (Suppl 1), 1–12 (2016). https://doi.org/10.1007/s00347-015-0104-9
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DOI: https://doi.org/10.1007/s00347-015-0104-9