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KMID : 0360220200610080921
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Journal of the Korean Ophthalmological Society
2020 Volume.61 No. 8 p.921 ~ p.928
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Applicability of ISNT Rule Using Bruch's Membrane Opening-based Optic Nerve Head Parameters
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Choi Hyun-Sup
Park Sung-Pyo
Na Kyeong-Ik
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Abstract
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Purpose: To evaluate the applicability of the ISNT rule (neuroretinal rim thickness order: inferior > superior > nasal > temporal) when using Bruch's membrane opening-based optic nerve head parameters to discriminate between normal and glaucomatous eyes.
Methods: The medical records of 41 normal eyes and 62 open-angle glaucoma eyes were reviewed retrospectively. We analyzed the neuroretinal rim thickness values corresponding to the superior, inferior, nasal, and temporal sides of the optic disc as measured using color stereo optic-disc photographs, Bruch’s membrane opening-minimum rim width (BMO-MRW), the BMO-MRW average, and Bruch’s membrane opening-minimum rim area (BMO-MRA). The sensitivity and specificity of the ISNT rule in differentiating normal and glaucomatous eyes were compared across the four methods.
Results: In normal and glaucomatous eyes, measuring neuroretinal rim thickness in color stereo optic-disc photographs produced larger values for the superior, inferior, nasal, and temporal sides compared to measurements using BMO-MRW and the BMO-MRW average (p < 0.001). With respect to ISNT rule compliance using the four methods, the sensitivities of the BMO-MRW average and BMO-MRA methods were significantly higher than that when disc photographs were used (82.3% vs. 98.4%, p < 0.05; and 82.3% vs. 95.2%, p < 0.05, respectively). Specificity did not differ significantly among the four methods.
Conclusion: BMO-based optic nerve head parameters exhibited higher diagnostic power for differentiating between normal and glaucomatous eyes based on the ISNT rule, compared with the classic method of using disc photographs.
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KEYWORD
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Bruch’s membrane opening-minimum rim area, Diagnostic ability, ISNT rule, Glaucoma optic disc
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