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Editors Selection IGR 12-3

OCT: Lamina cribrosa thickness and 3D structure

Comment by Joel Schuman on:

22656 Three-dimensional high-speed optical coherence tomography imaging of lamina cribrosa in glaucoma, Inoue R; Hangai M; Kotera Y et al., Ophthalmology, 2009; 116: 214-222

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Inoue et al. (203) describe the three dimensional (3D) structure of the lamina cribrosa (LC) in glaucoma using spectral domain optical coherence tomography (SD-OCT). The authors provide a detailed assessment of the LC structure, especially with regard to thickness and laminar pore characteristics. They compare OCT images and measurements to color optic nerve head photographs and perimetry. The authors demonstrate a high level of correspondence between these traditional clinical parameters and SD-OCT imaging. The relevance of the findings in this study is profound. The LC, previously clinically unapproachable, especially in 3D, may now be considered a diagnostic target for glaucoma. As a putative initial site of injury, 3D OCT LC imaging may become a tool for earlier and more sensitive assessment of the initiation, presence and progression of glaucoma. The limitations of this study are linked to the rapid progress being made in the development of OCT technology ‐ particularly increasing scan speed and resolution in clinical SD-OCT devices, and especially in prototype laboratory units. While this is not the first paper to demonstrate 3D SD-OCT LC imaging (despite the authors' claim to the contrary),^1,2 it is the first to do so specifically in glaucoma and glaucoma suspects. The authors' methodology required a prototype OCT device; however, SD-OCT technology now exists commercially

The lamina cribrosa previously clinically unapproachable may now be considered a diagnostic target for glaucoma

that can be used to image the LC in 3D. Software must still be developed for measurement and quantification, but the structures can be seen even today. While there are other minor limitations to this particular paper, such as the case series nature of this descriptive study and absence of a healthy control group for comparison and technical issues in visualization and interpretation of the 3D LC images, this is an early study and the development of SD-OCT for LC imaging is a work in progress. One must also keep in mind that while the study is cross-sectional, and we do not know how the structures seen will change over time with progressive disease (or in healthy eyes) in a given individual, this is a population study that will give insight for future works. The authors are to be commended for further opening the door to the clinical examination of a previously inaccessible structure for glaucoma diagnostics.

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