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Editors Selection IGR 18-2

Anatomical Structures: Bruch's Memebrane Opening

Comment by Murray Fingeret on:

70486 Consistency of Bruch Membrane Opening Detection as Determined by Optical Coherence Tomography, Hwang YH; Kim MK; Ahn SI, Journal of Glaucoma, 2016; 25: 873-878

Find related abstracts

Optical coherence tomography (OCT) has become an important tool in the diagnosis and monitoring of glaucomatous optic neuropathy. It was not long ago that imaging devices relied on measurements of the retinal nerve fiber layer (RNFL) with the need for the device to accurately and consistently segment the retinal layers. OCT has evolved and is capable of evaluating the macula region (ganglion cell complex) and the optic nerve head to provide additional diagnostic and monitoring information. In regards to obtaining optic nerve head measurements, the device must locate Bruch's membrane opening (BMO) which becomes the basis for determining the optic disc margin. From the BMO which is located around the entire optic disc, the minimum distance to the surface is determined which allows measurement of the neuroretinal rim. Locating the BMO is not a simple task and the ability of the device to perform this will translate into its ability to recognize glaucomatous damage and progression.

In this paper, the authors evaluate the Cirrus OCT's (Carl Zeiss Meditec, Inc.) ability to consistently recognize the BMO when evaluating one test to another. When monitoring individuals over time, if the points used for the BMO vary from test to test, then measurements will differ and the ability to recognize change reduced. In this study, the Cirrus OCT was able to accurately recognize the BMO locations from one test to another, with only 7% of tests shown to be inconsistent. The clinical pearl is that inconsistency was associated with myopic eyes that had peripapillary atrophy (PPA). This paper provides guidance, alerting clinicians of the importance to assess the B-Scan segmentation and location of the BMO. In myopic individuals and especially those with PPA, this needs to be carefully evaluated as inconsistency is more common.

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