advertisement

Topcon

Editors Selection IGR 18-4

Clinical Forms of Glaucoma: Optic nerve sheath diameter in NTG

Hanspeter Killer

Comment by Hanspeter Killer on:

48780 Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma, Abegã,o Pinto L; Vandewalle E; Pronk A et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2012; 250: 1075-1080


Find related abstracts


Pinto et al. measured the diameter of the optic nerve sheath with ultrasound in patients with normal tension glaucoma (n = 46; 6.03 ± 0.69) and found similar optic nerve sheath diameters (ONSD) as in healthy controls (n = 42; 6.09 ± 0.78). There were smaller diameters in patients with POAG (n = 61; 5.71 ± 0.83). The authors conclude from this study that indirect ICP measurements by ultrasound may provide insight into the retrolaminar pressure component in glaucoma. This approach is interesting and promising but this study and the interpretation of the authors also raise some important questions. Compared to other studies with ultrasound, the normal controls in the study by Pinto measured markedly larger ONSD.1,2 Unfortunately, the authors do not comment on this obvious discrepancy between their findings and the literature. As the ONSD gains more interest in glaucoma studies, and different imaging modalities (MRI, CT, ultrasound) are going to be involved, this difference within the same method (ultrasound) is therefore of high interest. The measurements for the normal controls in the study by Pinto are close to the measurements in the study by Jaggi et al.3 that used CT imaging ‐ and not MRI as stated by Pinto. In order to explain the difference of the ONSD in this CT based study compared with the present study, Pinto et al. argue that the application of 10 ml iopamidol as well as the prone position during cisternography (CT measurement) could have influenced the diameter. However, in the study by Jaggi et al. some CSF was taken prior to the injection of iopamidol and the total volume of CSF did therefore not markedly change. Due to the stiffness of the sheath, the prone position seems unlikely to have influenced the ONSD. The difference in these two groups needs further explanation. For a better understanding of the interesting associations between IOP and ONSD in patients with POAG, it would be helpful to know more about the statistical power of the data.

References

  1. Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus Br J Ophthalmol 2002; 86: 1109-1113.
  2. Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS. Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. J Appl Physiol 2009; 106: 1207-1211.
  3. Jaggi GP, Miller NR, Flammer J, Weinreb RN, Remonda L, and Killer HE. Optic nerve sheath diameter in normal-tension glaucoma patients. Br J Ophthalmol 2012; 96: 53-56.


Comments

The comment section on the IGR website is restricted to WGA#One members only. Please log-in through your WGA#One account to continue.

Log-in through WGA#One

Issue 18-4

Change Issue


advertisement

Oculus