PMID- 23768651
OWN - NLM
STAT- MEDLINE
DCOM- 20131029
LR  - 20220408
IS  - 1879-1891 (Electronic)
IS  - 0002-9394 (Print)
IS  - 0002-9394 (Linking)
VI  - 156
IP  - 2
DP  - 2013 Aug
TI  - From clinical examination of the optic disc to clinical assessment of the optic 
      nerve head: a paradigm change.
PG  - 218-227.e2
LID - S0002-9394(13)00260-2 [pii]
LID - 10.1016/j.ajo.2013.04.016 [doi]
AB  - PURPOSE: To review and interpret the anatomy of the optic nerve head (ONH) 
      detected with spectral-domain optical coherence tomography (SD OCT) pertaining to 
      the clinical examination of the optic disc and to propose that a paradigm change 
      for clinical assessment of the ONH is necessary. DESIGN: Perspective. METHODS: 
      Presently, the clinician evaluates neuroretinal rim health according to the 
      appearance of the optic disc, the clinically visible surface of the ONH. Recent 
      anatomic findings with SD OCT have challenged the basis and accuracy of current 
      rim evaluation. We demonstrate why incorporation of SD OCT imaging of the ONH 
      into the clinical examination of the disc is required. RESULTS: Disc margin-based 
      rim evaluation lacks a solid anatomic basis and results in variably inaccurate 
      measurements for 2 reasons. First, the clinically visible disc margin is an 
      unreliable outer border of rim tissue because of clinically and photographically 
      invisible extensions of Bruch's membrane. Second, rim tissue orientation is not 
      considered in width measurements. We propose alternative anatomically and 
      geometrically accurate SD OCT-based approaches for rim assessment that have 
      enhanced detection of glaucoma. We also argue for new data acquisition and 
      analysis strategies with SD OCT that account for the large interindividual 
      variability in the angle between the fovea and ONH. CONCLUSIONS: We propose a 
      4-point paradigm change for clinical assessment of the ONH that is anchored to 
      the eye-specific anatomy and geometry of the ONH and fovea. Our approach is 
      designed to enhance the accuracy and consistency of rim width, as well as of 
      peripapillary and macular intraretinal thickness measurements.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Chauhan, Balwantray C
AU  - Chauhan BC
AD  - Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, 
      Nova Scotia, Canada. bal@dal.ca
FAU - Burgoyne, Claude F
AU  - Burgoyne CF
LA  - eng
GR  - R01EY021281/EY/NEI NIH HHS/United States
GR  - MOP11357/CAPMC/CIHR/Canada
GR  - R01 EY021281/EY/NEI NIH HHS/United States
GR  - R01 EY011610/EY/NEI NIH HHS/United States
GR  - R01EY011610/EY/NEI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20130612
PL  - United States
TA  - Am J Ophthalmol
JT  - American journal of ophthalmology
JID - 0370500
SB  - IM
MH  - Bruch Membrane/anatomy & histology
MH  - Humans
MH  - Nerve Fibers
MH  - Optic Disk/*anatomy & histology
MH  - Photography
MH  - Retinal Ganglion Cells/cytology
MH  - Tomography, Optical Coherence/*methods
PMC - PMC3720683
MID - NIHMS471994
EDAT- 2013/06/19 06:00
MHDA- 2013/10/30 06:00
PMCR- 2014/08/01
CRDT- 2013/06/18 06:00
PHST- 2013/02/15 00:00 [received]
PHST- 2013/04/10 00:00 [revised]
PHST- 2013/04/11 00:00 [accepted]
PHST- 2013/06/18 06:00 [entrez]
PHST- 2013/06/19 06:00 [pubmed]
PHST- 2013/10/30 06:00 [medline]
PHST- 2014/08/01 00:00 [pmc-release]
AID - S0002-9394(13)00260-2 [pii]
AID - 10.1016/j.ajo.2013.04.016 [doi]
PST - ppublish
SO  - Am J Ophthalmol. 2013 Aug;156(2):218-227.e2. doi: 10.1016/j.ajo.2013.04.016. Epub 
      2013 Jun 12.