Klemm M.

Department of Ophthalmology, University Hamburg, Martinistr. 52, D - 20248 Hamburg

Introduction: New laser techniques allow the quantitative assessment of the retinal nerve fiber layer (RNFL) in vivo. An early morphologic damage due to glaucoma is thinning of the RNFL. The question arises whether RNFL thickness can serve as diagnostic criterion for glaucoma and how reliable the new imaging techniques can measure the RNFL thickness.
Methods: Healthy and glaucomatous eyes of age-matched patients were included in this prospective study. RNFL thickness was measured on a circle around the optic nerve head using scanning laser tomography with the Heidelberg Retina Tomograph (HRT), scanning laser polarimetry with the Nerve Fiber Analyzer (NFA) and optical coherence tomography (OCT). Considering the results of histologic examinations, RNFL thickness measurements were performed for the total circumference as well as for the superior, inferior, nasal and temporal region.
Results: For glaucomatous eyes compared to healthy eyes all three methods revealed a significant thinner mean RNFL in the superior and inferior regions (p<0.05). Cut-off points to differentiate healthy from glaucomatous eyes could not be defined. The hits according to discriminant analytical classification were 63% for HRT, 69% for NFA, and 73% for OCT.
Discussion: The new laser tecniques are able to quantify RNFS-thickness. Although RNFL thickness measurements in vivo using the new laser techniques as sole diagnostic methods are not sufficient to differentiate glaucomatous from healthy eyes, they add valuable diagnostic parameters to glaucoma diagnostics.

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