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Does the ISNT rule apply to the radial peripapillary capillary vessel density in OCT angiography?

  • Glaucoma
  • Published:
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Abstract

Purpose

To investigate the applicability of ISNT (inferior ≥ superior ≥ nasal ≥ temporal), IST (inferior ≥ superior ≥ temporal), and T min (temporal quadrant with the minimum value) rules to the peripapillary nerve fiber layer (NFL) thickness and radial peripapillary capillary (RPC) vessel density (VD) using Optical Coherence Tomography (OCT) and OCT angiography (OCT-A).

Materials and methods

This cross-sectional study included 134 eyes of 74 healthy individuals. NFL thickness and RPC VD were measured in all four quadrants using OCT and OCT-A in order to determine the number of eyes that obey the ISNT, IST, and T min rules.

Results

Mean age was 48.8 ± 15.5 (range 25–82) years. The ISNT rule was valid in 52 eyes (38.81%) on OCT and only 12 eyes (8.95%) on OCT-A scans. The IST rule was followed by 83 (61.94%) and 37 (27.61%) eyes on OCT and OCT-A scans respectively. The T min rule was valid in 86 eyes (64.18%) in OCT scans and in 26 eyes (19.4%) in OCT-A scans.

Conclusion

The topography of the RPC network does not obey the ISNT rule in healthy eyes. The ISNT rule and its variants were found to be more relevant in OCT NFL thickness measurements compared to OCT-A RPC VD measurements.

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References

  1. Bourne RR, Taylor HR, Flaxman SR, Vision Loss Expert Group of the Global Burden of Disease Study et al (2016) Number of people blind or visually impaired by glaucoma worldwide and in world regions 1990 - 2010: a meta-analysis. PLoS One 11(10):e0162229

    Article  CAS  Google Scholar 

  2. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ (2002) The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 86(2):238–242

    Article  Google Scholar 

  3. Ajtony C, Balla Z, Somoskeoy S, Kovacs B (2007) Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography. Invest Ophthalmol Vis Sci 48(1):258–263

    Article  Google Scholar 

  4. Jonas JB, Gusek GC, Naumann GO (1988) Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci. 29(7):1151–8. Erratum in: Invest Ophthalmol Vis Sci 1991;32(6):1893. Erratum in: Invest Ophthalmol Vis Sci 1992;32(2):474–5

  5. Law SK, Kornmann HL, Nilforushan N, Moghimi S, Caprioli J (2016) Evaluation of the “IS” rule to differentiate glaucomatous eyes from normal. J Glaucoma 25(1):27–32

    Article  Google Scholar 

  6. Harizman N, Oliveira C, Chiang A, Tello C, Marmor M, Ritch R, Liebmann JM (2006) The ISNT rule and differentiation of normal from glaucomatous eyes. Arch Ophthalmol 124(11):1579–1583

    Article  Google Scholar 

  7. Morgan JE, Bourtsoukli I, Rajkumar KN, Ansari E, Cunliffe IA, North RV, Wild JM (2012) The accuracy of the inferior>superior>nasal>temporal neuroretinal rim area rule for diagnosing glaucomatous optic disc damage. Ophthalmology 119(4):723–730

    Article  Google Scholar 

  8. Jonas JB, Budde WM, Lang P (1998) Neuroretinal rim width ratios in morphological glaucoma diagnosis. Br J Ophthalmol 82(12):1366–1371

    Article  CAS  Google Scholar 

  9. Bussel II, Wollstein G, Schuman JS (2014) OCT for glaucoma diagnosis, screening and detection of glaucoma progression. Br J Ophthalmol 98(Suppl 2):ii15-9

    Article  Google Scholar 

  10. Zhang X, Dastiridou A, Francis BA, Advanced Imaging for Glaucoma Study Group et al (2017) Comparison of glaucoma progression detection by optical coherence tomography and visual field. Am J Ophthalmol 184:63–74

    Article  Google Scholar 

  11. Medeiros FA, Zangwill LM, Bowd C, Vessani RM, Susanna R Jr, Weinreb RN (2005) Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. Am J Ophthalmol 139(1):44–55

    Article  Google Scholar 

  12. Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G (2018) Optical coherence tomography angiography. Prog Retin Eye Res 64:1–55

    Article  Google Scholar 

  13. Dastiridou A, Chopra V (2018) Potential applications of optical coherence tomography angiography in glaucoma. Curr Opin Ophthalmol 29(3):226–233

    Article  Google Scholar 

  14. Werner AC, Shen LQ (2019) A review of OCT angiography in glaucoma. Semin Ophthalmol 34(4):279–286

    Article  Google Scholar 

  15. Spaide RF, Klancnik JM Jr, Cooney MJ (2015) Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol 133(1):45–50

    Article  Google Scholar 

  16. Jia Y, Tan O, Tokayer J, Potsaid B, Wang Y, Liu JJ et al (2012) Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express 20(4):4710–4725

    Article  Google Scholar 

  17. Mansoori T, Sivaswamy J, Gamalapati JS, Balakrishna N (2017) Radial peripapillary capillary density measurement using optical coherence tomography angiography in early glaucoma. J Glaucoma 26(5):438–443

    Article  Google Scholar 

  18. Van Melkebeke L, Barbosa-Breda J, Huygens M, Stalmans I (2018) Optical coherence tomography angiography in glaucoma: a review. Ophthalmic Res 60(3):139–151

    Article  Google Scholar 

  19. Poon LY, Solá-Del Valle D, Turalba AV, Falkenstein IA, Horsley M, Kim JH et al (2017) The ISNT rule: how often does it apply to disc photographs and retinal nerve fiber layer measurements in the normal population? Am J Ophthalmol 184:19–27

    Article  Google Scholar 

  20. Alasil T, Wang K, Keane PA, Lee H, Baniasadi N, de Boer JF, Chen TC (2013) Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography. J Glaucoma 22(7):532–541

    Article  Google Scholar 

  21. Dave P, Jethani J, Shah J (2015) Applicability of the ISNT and IST rules on retinal nerve fiber layer measurement on spectral-domain optical coherence tomography in normal Indian children. Graefes Arch Clin Exp Ophthalmol 253(10):1795–1799

    Article  Google Scholar 

  22. Pradhan ZS, Braganza A, Abraham LM (2016) Does the ISNT rule apply to the retinal nerve fiber layer? J Glaucoma 25(1):e1-4

    Article  Google Scholar 

  23. Wang Y, Xu L, Jonas JB (2007) Shape of the neuroretinal rim and its correlations with ocular and general parameters in adult chinese: the beijing eye study. Am J Ophthalmol 144(3):462–464

    Article  Google Scholar 

  24. Maupin E, Baudin F, Arnould L, Seydou A, Binquet C, Bron AM, Creuzot-Garcher CP (2020) Accuracy of the ISNT rule and its variants for differentiating glaucomatous from normal eyes in a population-based study. Br J Ophthalmol 104(10):1412–1417

    Article  Google Scholar 

  25. Dave P, Shah J (2015) Applicability of ISNT and IST rules to the retinal nerve fibre layer using spectral domain optical coherence tomography in early glaucoma. Br J Ophthalmol 99(12):1713–1717

    Article  Google Scholar 

  26. Qiu K, Wang G, Lu X, Zhang R, Sun L, Zhang M (2018) Application of the ISNT rules on retinal nerve fibre layer thickness and neuroretinal rim area in healthy myopic eyes. Acta Ophthalmol 96(2):161–167

    Article  CAS  Google Scholar 

  27. Mansoori T, Sivaswamy J, Gamalapati JS, Agraharam SG, Balakrishna N (2017) Measurement of radial peripapillary capillary density in the normal human retina using optical coherence tomography angiography. J Glaucoma 26(3):241–246

    Article  Google Scholar 

  28. Yu PK, Cringle SJ, Yu DY (2014) Correlation between the radial peripapillary capillaries and the retinal nerve fibre layer in the normal human retina. Exp Eye Res 129:83–92

    Article  CAS  Google Scholar 

  29. Henkind P (1967) Symposium on glaucoma: joint meeting with the National Society for the Prevention of Blindness. New observations on the radial peripapillary capillaries. Invest Ophthalmol 6(2):103–8

    PubMed  CAS  Google Scholar 

  30. Scoles D, Gray DC, Hunter JJ et al (2009) In-vivo imaging of retinal nerve fiber layer vasculature: imaging histology comparison. BMC Ophthalmol 9:9

    Article  Google Scholar 

  31. Mase T, Ishibazawa A, Nagaoka T, Yokota H, Yoshida A (2016) Radial peripapillary capillary network visualized using wide-field montage optical coherence tomography angiography. Invest Ophthalmol Vis Sci 57(9):OCT504-10

    Article  Google Scholar 

  32. Henkind P (1967) Radial peripapillary capillaries of the retina. I. Anatomy: human and comparative. Br J Ophthalmol 51(2):115–23

    Article  CAS  Google Scholar 

  33. Mansoori T, Sivaswamy J, Gamalapati JS, Balakrishna N (2018) Topography and correlation of radial peripapillary capillary density network with retinal nerve fibre layer thickness. Int Ophthalmol 38(3):967–974

    Article  Google Scholar 

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Authors and Affiliations

  1. 2Nd Ophthalmology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Anna Dastiridou, Ioannis Kassos, Asterios Diafas & Nikolaos Ziakas

  2. Ophthalmology Department, University of Thessalia, Larissa, Greece

    Anna Dastiridou & Sofia Androudi

  3. Ophthalmology Department, University of Ioannina, Ioannina, Greece

    Andreas Katsanos

  4. Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA

    Vikas Chopra & Brian A. Francis

Authors
  1. Anna Dastiridou
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  2. Ioannis Kassos
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Correspondence to Anna Dastiridou.

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Dastiridou, A., Kassos, I., Katsanos, A. et al. Does the ISNT rule apply to the radial peripapillary capillary vessel density in OCT angiography?. Graefes Arch Clin Exp Ophthalmol 260, 265–270 (2022). https://doi.org/10.1007/s00417-021-05367-x

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  • DOI: https://doi.org/10.1007/s00417-021-05367-x

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