The effect of the menstrual cycle on optic nerve head analysis in healthy women

PURPOSE: To determine the effect of the menstrual cycle on optic nerve head topographic analysis in normally menstruating, healthy women. MATERIAL AND METHODS: The study included single eyes selected randomly from each of 52 healthy women with regular menstrual cycles. All subjects underwent a complete ocular examination. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II, software version 1.6). The analyses were repeated three times during the menstrual cycle: in the follicular phase (days 7-10 of the cycle), at ovulation, and in the late luteal phase (days 1-3 before menstrual bleeding). Serum oestradiol, progesterone and luteinizing hormone levels were measured at each menstrual phase. RESULTS: Fourteen subjects were excluded from the study. The mean age of the subjects (n = 38) was 25.6 +/- 3.7 years (range 21-34 years). Blood oestradiol levels were significantly lower in the late luteal phase (35.8 pg/ml) (p < 0.0001). The mean disc area of the subjects was 1.94 +/- 0.33 mm(2). The neuroretinal rim area decreased significantly during the luteal phase (p < 0.001). However, the linear cup : disc ratio, cup : disc area ratio and the cup area were significantly higher during the luteal phase (p < 0.001). CONCLUSION: These observations raise the possibility that sex hormone fluctuations which occur during a normal menstrual cycle in healthy women significantly alter neuroretinal rim area and cup variables of the optic nerve head. These findings should be taken into consideration in the clinical follow-up of young women with glaucoma.     

Effect of the menstrual cycle on the optic nerve head in diabetes: analysis by confocal scanning laser ophthalmoscopy

BACKGROUND: The purpose of this study was to examine and compare menstrual-cycle-dependent topographic changes in the optic nerve head of normally menstruating women with different grades of type 2 diabetes mellitus. METHODS: We studied the right eyes of 123 normally menstruating women (36 with severe nonproliferative diabetic retinopathy [NPDR], 42 with mild NPDR and 45 healthy subjects). All subjects underwent a complete ocular examination at baseline. At 4 hormonally distinct phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), we analysed the topography of the optic nerve head, using a confocal scanning laser ophthalmoscope, and measured the serum levels of estradiol, progesterone and luteinizing hormone. RESULTS: We excluded from analysis the data for 8 patients with severe NPDR, 10 patients with mild NPDR and 15 control subjects who were lost to follow-up examinations during the menstrual cycle. The mean age and optic disc area did not differ significantly among the 3 groups. The duration of diabetes was significantly longer in the patients with severe NPDR than in those with mild NPDR (p < 0.05). The women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup/disc ratio, cup/disc area ratio and cup area in the late luteal phase compared with the other phases of the menstrual cycle (p < 0.05). Those with mild NPDR or a normal retina had no significant topographic changes in the optic nerve head during the menstrual cycle. INTERPRETATION: Severe NPDR is associated with significant topographic changes in the rim and cup of the optic nerve head during the menstrual cycle. This must be considered in the evaluation of women with both diabetes and glaucoma. The normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seem to affect the optic nerve head more when the disease is advanced.     

Optic disk topography after medical treatment to reduce intraocular pressure

PURPOSE: We examined changes in optic disk topography using confocal scanning laser ophthalmoscopy after reducing intraocular pressure with administration of latanoprost. METHODS: Twenty-nine patients with glaucoma or ocular hypertension were imaged using the Heidelberg Retina Tomograph before and after the administration of latanoprost to decrease intraocular pressure. Average time between pretreatment and posttreatment imaging was 2.7 +/- 1.8 weeks. Heidelberg Retina Tomograph software-measured parameters were mean height of contour, cup area, cup volume, mean cup depth, maximum cup depth, cup shape, rim area, rim volume, cup-to-disk ratio, and retinal nerve fiber thickness. RESULTS: Average intraocular pressure decreased significantly (mean +/- SD) by 7.2 +/- 5.4 mm Hg (25 +/- 16% decrease). No statistically significant changes in measured topographic parameters were found. When data from patients with decreases in intraocular pressure of 7 mm Hg or greater were analyzed separately (mean intraocular pressure decrease = 10.79 +/- 4.32 mm Hg, 36 +/- 8% decrease), cup area (P =.005), cup volume (P =. 002), and cup-to-disk ratio (P =.005) decreased significantly, and rim area (P =.005) increased significantly. Linear regression analysis of the data from all subjects showed that a change in intraocular pressure after latanoprost administration accounted for 12% or more of the variance in two measured topographic parameters (mean cup depth and cup shape). CONCLUSIONS: These results suggest that, in some patients, moderate decreases in intraocular pressure may affect disk topography, as measured by Heidelberg Retina Tomograph. Intraocular pressure should be considered when analyzing consecutive confocal scanning laser ophthalmoscopy images for glaucomatous progression.     

Comparison of Optic Disc Topography Between Migrainous and Normal Subjects

The purpose of this study was to compare the optic disc topography parameters in migrainous and normal subjects, by using Heidelberg retinal tomograph (HRT). The topographic optic disc parameters of 29 nonglaucomatous eyes of 29 cases with migraine and 29 eyes of 29 normal subjects were compared with nonparametric Mann Whitney U test. The mean cup area (0.743 mm²) and cup to disc ratio (0.345) of migrainous subjects were greater than the mean cup area (0.591 mm²) and cup to disc ratio (0.288) of normal subjects (p = .009, p = .005). This result suggests that migrainous subjects have larger cup areas and higher cup to disc ratio ratios than normal subjects.     

Scanning laser tomography to evaluate optic discs of normal eyes

PURPOSE: To investigate the effects of age, eye refraction, and disc area on topographic parameters of the optic nerve head in normal volunteers, using the Heidelberg Retina Tomograph. METHODS: Seventy-seven eyes of 77 normal volunteers were examined by scanning laser tomography. The topographic parameters analyzed were disc area, cup area, cup/disc area ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness (MnRNFLT), and retinal nerve fiber layer (RNFL) cross-section area. The effect of age, refraction, and disc area on each parameter was analyzed by the multiple linear regression model. RESULTS: Significant declines in MnRNFLT and RNFL cross-section area were found with increasing age (P < .05). The mean cup depth and maximum cup depth were significantly deeper in myopic subjects (P < .05). Large discs had large cup area, cup/disc area ratio, rim area, cup volume, mean cup depth, cup shape measure (P < .01), and maximum cup depth (P < .05). The MnRNFLT was smaller in large discs (P < .01). Rim volume was unaffected by age, refraction, or disc area. CONCLUSIONS: The age, refraction, and disc area were related to several optic disc parameters obtained by the Heidelberg Retina Tomograph. Because of these relationships, care should be taken to analyze the appearance of the optic disc on the basis of these parameters in patients with glaucoma or other diseases. Rim volume appears to be a good parameter for evaluating the optic disc without considering age, refraction, or disc area.     

Menstrual cycle dependent changes in blue-on-yellow visual field analysis of young diabetic women with severe non-proliferative diabetic retinopathy

PURPOSE: To evaluate menstrual cycle dependent changes on blue-on-yellow visual fields of diabetic women, and to compare the results with those of healthy women. METHODS: Left eyes of 93 normally menstruating women were included in the study, comprising 45 with type-1 diabetes mellitus and severe non-proliferative diabetic retinopathy and 48 healthy controls. All subjects underwent baseline complete ocular examination and achromatic visual field analysis. Blue-on-yellow visual field tests (short-wavelength automated perimetry) were performed in both follicular (days 7-10 of the cycle) and luteal phases (days 3-6 before the bleeding) of two consecutive menstrual cycles. Visual field analyses were performed using Humphrey Field Analyser II with full threshold, central 30-2 program. Visual fields were divided into four regions: superior temporal, inferior temporal, superior nasal and inferior nasal. Visual field mean sensitivity (MS) was calculated for all regions separately. RESULTS: The mean ages of diabetic and control subjects were not significantly different (P > 0.05). Mean MS values of the diabetic group were significantly lower than that of the control group (P < 0.05). Control subjects did not demonstrate any menstrual cycle dependent changes in MS values (P > 0.05). However, diabetic women demonstrated a significant decrease in MS values in the luteal phase (P < 0.05). The decrease in MS was most marked in the nasal visual field (P < 0.05). CONCLUSION: Young diabetic women demonstrated a significant depression in visual field threshold sensitivity in the luteal phase of the menstrual cycle. Nasal visual fields are more prone to have menstrual cycle dependent threshold sensitivity depression. This should be taken into consideration in the clinical assessment of women with advanced diabetes who are at risk of glaucomatous optic neuropathy.     

Laser scanning tomography of the optic nerve head in a normal elderly population: the Bridlington eye assessment project

PURPOSE: To assess optic nerve head topographic parameters using the Heidelberg Retina Tomograph (HRT) II (Heidelberg Engineering GmbH, Dossenheim, Germany) in a normal elderly population. METHODS: Optic nerve head analysis of 918 eyes of 459 normal elderly patients was performed. All patients were consecutive in a cohort screened for eye disease. Normal subjects were defined with a normal visual field on automated suprathreshold screening, intraocular pressure less than 22 mmHg, and minimum corrected visual acuity of 6/12. All optic discs were contoured by two investigators and the mean parameters analyzed. The effects of age, sex, and disc size were assessed. RESULTS: Subjects' (262 women and 197 men) mean age was 72.6 +/- 5.1 (SD) years (range, 65.5-89.3). Mean +/- SD global disc area, cup/disc area ratio, and neuroretinal rim area were 1.98 +/- 0.36 mm2, 0.22 +/- 0.14, and 1.52 +/- 0.31 mm2, respectively. Disc area did not differ significantly based on eye side or sex. The women were found to have a significantly larger rim volume, mean retinal nerve fiber layer (RNFL) thickness, and cross-sectional area than the men and tended to have smaller cup areas/volumes and cup/disc area ratios. Most tomography parameters were found to be significantly influenced by disc size. CONCLUSIONS: To the authors' knowledge, this is the first large study of optic nerve head parameters in the elderly normal population using the HRT II. This age range is particularly relevant to glaucoma detection and pertinent to discriminant analyses separating normal subjects from glaucoma in screening for the disease. Given the systematic differences between the parameters in men and women, reference ranges should be quoted by sex.     

Changes in the optic disc excavation of children affected by cerebral visual impairment: a tomographic analysis

PURPOSE: To obtain quantitative data on the optic disc excavation in children affected by cerebral visual impairment (CVI) by using the Heidelberg Retinal Tomograph (HRT)-II (Heidelberg Engineering, Heidelberg, Germany). METHODS: A total of 24 subjects affected by CVI (mean age, 7.28 years) were examined: 16 in alert conditions and 8 under general anesthesia. The following parameters of the optic nerve head were examined: disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, and mean retinal nerve fiber layer (RNFL) thickness. The tomographic results in children with CVI were compared with those of 88 normal, alert subjects of similar age. RESULTS: The optic disc of patients with CVI appeared smaller than normal. Its excavation, however, was more pronounced. Several tomographic parameters were altered in CVI-affected subjects. Statistical analysis showed a highly significant probability in cup-to-disc area ratio (P < 0.01, both eyes), rim area (P < 0.01, both eyes), cup shape measure (P < 0.01, right eye; P < 0.01, left eye), and mean RNFL thickness (P < 0.01, right eye; P < 0.01, left eye). A novel observation was temporal atrophy of the optic nerve head in CVI. CONCLUSIONS: The data provide a tridimensional, objective evaluation of the anatomic alterations of the optic nerve head in children with CVI. Furthermore, tomographic standards for optic disc shape in normal children are set for the first time.     

Heidelberg retina tomograph in ocular Behçet's disease

PURPOSE: To compare the optic disc topography of patients with ocular Beh?et's disease (BD) with age-matched controls, using Heidelberg retina tomograph (HRT). METHODS: This study included 32 patients (51 eyes) with ocular BD (active and/or inactive), 38 patients (74 eyes) with nonocular BD, and 62 normal subjects (62 eyes). All patients and control group underwent complete ophthalmologic evaluation. Intraocular pressure was less than 22 mmHg in patients and in the control group. The optic nerve heads of all subjects were imaged with the HRT (software 2.01a-M). The following stereometric parameters were calculated for each patient: disc area, cup area, cup/disc area ratio, rim area, height variation contour, cup volume, rim volume, mean cup depth, cup shape measure, mean RNFL thickness, and RNFL cross-sectional area. Differences among the groups were evaluated by Kruskal-Wallis variance analysis. When the Kruskal-Wallis test revealed a significant difference between groups, multiple comparison tests were used to find out which groups differed from which others. RESULTS: The mean disc area was significantly smaller (P<0.05) in patients with ocular and nonocular BD. The mean cup area, mean cup depth, and mean cup volume were significantly smaller (P<0.05) in patients with ocular BD. No significant differences were found between the groups in terms of the other stereometric parameters (P>0.05). CONCLUSION: A small disc and cup may be an additional risk factor for retinal vaso-occlusion in ocular Beh?et's disease.     

Effect of topical glaucoma medications on optic disc topography in normal tension glaucoma

PURPOSE: To investigate the effects of topical glaucoma medications on optic disc topography in patients with normal tension glaucoma (NTG) using confocal scanning laser ophthalmoscopy. SUBJECTS AND METHODS: We enrolled 39 NTG patients (39 eyes) who had not been treated for glaucoma. A combined medication of 0.005% latanoprost and 0.5% timolol gel was administered. Optic disc parameters were measured before and after the treatment using the Heidelberg Retina Tomograph (HRT). The treatment period was 20.2 +/- 6.4 days (mean +/- SD). RESULTS: Administration of these two drugs significantly decreased the intraocular pressure (IOP) from 16.7 +/- 1.9 mmHg to 12.3 +/- 1.9 mmHg (26.7 +/- 8.7% decrease). Cup area, cup/disk area ratio and cup volume decreased significantly, while the rim area increased significantly. Linear progression analysis showed a significant correlation between the percent decrease in the IOP and the topographic changes in the cup area, cup/disk area ratio, rim area, cup volume, rim volume, and height variation contour. When the subjects were divided into two groups: patients with high baseline IOP of more than 16 mmHg (HNTG group) and those with low baseline IOP below 15 mmHg (LNTG group), significant changes in several parameters were observed only in the HNTG group. CONCLUSIONS: These results suggest that the topographic changes in the optic disc were induced by the short-term topical glaucoma medications prescribed for the NTG patients, and the changes in several HRT parameters correlated with the percent decrease in the IOP.     

Menstrual cycle-dependent changes in visual field analysis of healthy women

PURPOSE: To determine the effect of menstrual cycle phases on the visual field analysis of healthy females. MATERIAL AND METHODS: One randomly selected eye each of 59 healthy normally menstruating women, and of 54 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination, and standard achromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3-7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using a Model 750 Humphrey Field Analyzer II (Humphrey Instruments Inc., San Leandro, Calif., USA) with full-threshold, central 30-2 program. Visual fields were divided into four regions as superior temporal, inferior temporal, superior nasal and inferior nasal, respectively. RESULTS: The mean age of female (n = 59) and the male subjects (n = 54) were 34.6 +/- 2.9 and 35.0 +/- 2.7 years, respectively (p = 0.49). SWAP tests demonstrated a significantly decreased mean MS value in the luteal phase (p < 0.05). However, it did not change significantly with SAP tests. Regional MS values of both SAP and SWAP tests were not different in both phases of the menstrual cycle (all p values >0.05). Mean perimetric test durations obtained with both SAP and SWAP were not different throughout the menstrual cycle (both p values >0.05). CONCLUSION: Clinicians should verify menstrual status when evaluating a suspected loss of visual field sensitivity in menstruating women. The findings of the present study suggest that the SWAP test may be more sensitive to determine subtle sex hormone-dependent changes in visual field analysis of healthy women.     

Retinal tomographic measurements in optic disc pit

Background: The aim was to assess the Heidelberg Retina Tomograph II measurements in optic disc pit. Methods: The study included 10 patients with a unilateral optic disc pit. The patients had no other ocular conditions except refractive errors. Normal fellow eyes of the patients were used as a control group. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, Heidelberg Retina Tomograph II (HRT II). Results: The topographic parameters of the eyes with optic disc pit and normal fellow eyes were as follows, respectively: disc area (3.77 ± 1.50 and 3.07 ± 0.83 mm²), cup area (1.99 ± 1.71 and 1.09 ± 0.54 mm²), rim area (1.67 ± 0.55 and 1.87 ± 0.75 mm²), cup volume (0.94 ± 1.24 and 0.34 ± 0.27 mm³), rim volume (0.51 ± 0.40 and 0.55 ± 0.19 mm³), mean cup depth (0.44 ± 0.20 and 0.31 ± 0.11 mm) and mean retinal nerve fibre layer thickness (0.25 ± 0.20 and 0.28 ± 0.59 mm). Eyes with an optic disc pit were found to have significantly larger disc area compared to fellow eyes (p = 0.038). All the other parameters showed no statistically significant interocular differences (p > 0.05). Conclusion: Our study demonstrates that the optic disc pit affects only the disc area measurement in HRT II. Other changes in optic nerve head morphometric parameters were insignificant. The clinician must be careful in the evaluation of HRT II results with respect to optic disc area in a disc with a pit.     

Clinical evaluation of the Heidelberg Retina Tomograph II

PURPOSE: To evaluate the usefulness of Heidelberg Retina Tomograph (HRT) II prototype, which is an easily handled model for routine optic disc examination in glaucoma clinics. METHODS: Ten eyes of 10 normal volunteers and 18 eyes of 18 open-angle glaucoma patients followed at Gifu University were studied. The reproducibility of three consecutive optic disc measurements with a 15 degrees x 15 degrees field using HRT II and with a 10 degrees x 10 degrees field using HRT (version 2.01) were evaluated by the same examiner on the same day. We also examined the correlation of the main topographic parameters (disc area, cup area, cup/disc area ratio, rim area, cup volume, rim volume, cup shape measure) between HRT II and HRT. RESULTS: The mean (+/- standard deviation) reproducibility of optic disc measurements with HRT II and HRT were 17.5 +/- 7.6 microns and 19.3 +/- 9.6 microns, respectively. This difference was not significant. All topographic parameters obtained from HRT II and HRT (R = 0.86-0.98, p < 0.01) showed statistically significant correlations with each other. CONCLUSION: The HRT II has high reproducibility of measurements and reliable stereometric parameters comparable to the conventional HRT.     

视网膜断层扫描仪在青光眼性视神经病变中的诊断价值

目的　评价视网膜断层扫描仪在青光眼性视神经病变中的诊断价值。方法　应用海德堡视网膜断层扫描仪 (HRT)检测 116例 (116只眼 )正常人和 6 3例 (99只眼 )原发性开角型青光眼(POAG)患者的视乳头地形图参数 ,比较两者间各参数的差异 ;将正常人与POAG患者的视乳头地形图参数进行逐步判别分析 ,建立判别函数 ,筛选出诊断POAG的敏感参数并进行回代分析。结果POAG患者的视盘面积 (DA)、视杯面积 (CA)、杯 /盘面积 (C/DAR)、盘沿面积 (RA)、视乳头轮廓线高度变化值 (HVC)、视杯容积 (CV)、盘沿容积 (RV)、平均视杯深度 (MCD)、最大视杯深度 (MxCD)、视杯形态测量 (CSM)、平均视网膜神经纤维层厚度 (mRNFLT)、视网膜神经纤维层截面面积 (RNFLA)与正常人比较差异有显著意义 (P <0 0 0 1) ;对POAG诊断敏感的视盘地形图参数为C/DAR、RA、CSM、CV和MxCD ;判别函数式为Y =- 2 0 83- 4 833×C/DAR - 2 0 379×CSM 2 0 35×RA 3 95 5×CV - 3 70 1×MxCD ;对POAG诊断的敏感性、特异性及诊断符合率分别为 81 8%、86 2 %及 84 2 % ,与HRT自动分析程序相当。结论　POAG患者视乳头地形图与正常人差异较大 ;利用我国人的数据资料建立的判别函数对POAG诊断效能与HRT自动分析程序相当 ,说明HRT自动分析程序在一定程     

Acute orbital effects of retrobulbar injection on optic nerve head topography

AIM: To assess the effects of acute orbital volume changes after retrobulbar injection on optic nerve head topography. METHODS: The study population consisted of 95 patients with type 2 diabetes mellitus with clinically significant macular oedema who required focal pattern laser photocoagulation therapy in one eye. Before each laser treatment, 49 patients required a retrobulbar injection (approximately 7 ml of a mix of lidocaine 2% with epinephrine and bupivacaine 0.75% in equal volumes) to provide ocular akinesia. Both eyes of all patients underwent optic nerve head topographic analysis once before laser treatment (within 30 minutes), and repeated within 1 hour, 1 day, 1 week, 2 weeks, and 4 weeks after treatment, respectively. Topographic analyses were performed using a confocal scanning laser ophthalmoscope, HRT-II. The disc area, topography standard deviation, and a total of 12 topographic parameters were calculated by HRT-II. RESULTS: The mean age of the patients was 37.9 (SD 3.2) years. The mean disc area of the subjects was 2.12 (0.44) mm(2). Fellow eyes which were not treated with laser, and those treated eyes which did not receive retrobulbar injection before therapy were found not to reveal significant changes in disc topography in any of the examinations (all p values >0.05). In the topographic examinations in the first hour, first day, and first week, laser treated eyes which underwent retrobulbar injection demonstrated significant increase in the disc area, rim area, rim volume, rim area/disc area, and cup shape measure parameters while optic cup parameters significantly decreased (all p values <0.05). In the second week examinations, they did not show significant difference in disc area measurements (p>0.05). By the fourth week, all of the optic nerve head topographic variables were not significantly different from the pre-injection values (all p values >0.05). Colour stereoscopic photographs did not reveal any differences in optic disc appearance. CONCLUSION: Acute orbital volume change following retrobulbar injection may cause significant topographic evidence of optic disc oedema lasting approximately 1 week. Significant changes in optic rim and cup area may last for 2 weeks after injection, with all topographic changes returning to baseline by 1 month after injection. The present findings could be a model to reflect the pathological processes that occur in cases of acute orbital volume changes such as retrobulbar haemorrhage.     

Reproducibility of the measurements of the optic nerve head topographic variables with a confocal scanning laser ophthalmoscope

PURPOSE: To determine the optic nerve head topographic parameters with the least variability in repeat measurements. METHODS: We randomly selected and evaluated 1 eye each of 20 healthy subjects, a total of 20 eyes. We used the confocal scanning laser ophthalmoscope (CSLO) for optic nerve head analysis. The disc area and a total of 13 parameters were determined by Top SS. Each subject was examined five times, each time on a different day, during a 2-month period. We obtained a series of five 10 x 10 degrees images for each eye per visit. Three of the five images were randomly selected to create a mean image. Coefficients of variation of each of the 13 variables studied were calculated separately by using those five different optic nerve head topographic measurements. RESULTS: The subjects were 11 women and 9 men. The mean age of the subjects was 30.5 +/- 6.9. The mean optic disc areas were 2.26 +/- 0.39 mm(2) and 1.96 +/- 0.37 mm(2) for the men and the women, respectively (P >.05). The mean coefficient of variation for measurement of the variables was found to range between 1.2% and 9.8%. The variables, cup shape, volume above, average depth, and volume below, were found to yield the best reproducible measurements. CONCLUSION: The CSLO with its highly reproducible measurements (<10% error) offers a highly objective, safe, and effective method for clinical use in measurements of the topography of the optic nerve head. The subtle differences in the variables, cup shape, volume above, average depth, and volume below, may be of vital importance in the follow-up of those diseases requiring longitudinal monitoring of the optic nerve head, namely ocular hypertension and glaucoma.     

Distribution of optic disc parameters measured by OCT: findings from a population-based study of 6-year-old Australian children

PURPOSE: To study the distribution of optic disc, cup, and neural rim size by ocular and demographic variables in a population-based sample of 6-year-old children. METHODS: The Sydney Childhood Eye Study examined 1765 of 2238 eligible 6-year-old children (78.9%) from 34 randomly selected Sydney schools during 2003 to 2004. Comprehensive standardized eye examination included cycloplegic autorefraction, optical biometry and "fast optic disc" scans performed using optical coherence tomography. RESULTS: Scans of adequate quality were available for 1309 children (75% of participants), with 70% aged 6 years; 50.9% were boys. Mean (+/- SD) horizontal and vertical disc diameter and disc area was 1.53 +/- 0.21 mm, 1.79 +/- 0.28 mm, and 2.20 +/- 0.39 mm(2), respectively. Corresponding cup dimensions were 0.70 +/- 0.28 mm, 0.73 +/- 0.27 mm, and 0.48 +/- 0.32 mm(2). A definable optic cup was absent in 7.4%, 87% of whom were European white. Cup-to-disc diameter ratios were 0.46 +/- 0.16 horizontally and 0.42 +/- 0.15 vertically, whereas cup-to-disc area ratio was 0.22 +/- 0.13. Mean +/- SD neural rim area was 1.76 +/- 0.44 mm(2) and increased with disc size (Pearson correlation = 0.68, P < 0.0001). Horizontal and vertical average nerve widths were 0.36 +/- 0.05 and 0.28 +/- 0.05 mm, respectively. In analyses adjusting for potential confounders, disc area increased significantly with axial length (P(trend) < 0.0001) and refraction (P(trend) = 0.02). Rim area increased only with axial length (P(trend) = 0.01). There were no gender differences, except for average nerve width, marginally greater in boys. Most disc and cup dimensions were significantly larger in East-Asian than European white and Middle Eastern children. CONCLUSIONS: Disc, cup, and neural rim parameters were generally normally distributed in this young population. Axial length appeared to be a stronger determinant of disc and rim size than refraction. Some ethnic but not gender differences were demonstrated for most parameters.     

Optic disc topographic parameters measured in the normal cynomolgus monkey by confocal scanning laser tomography

AIM: To study optic disc topographic parameters in normal cynomolgus monkeys by Heidelberg retina tomograph (HRT). METHODS: 12 optic disc topographic parameters were investigated in 36 normal eyes in 18 male monkeys. Mean (SD) and interocular differences were obtained for each parameter from three independent measurements made during a 1 week period. Correlations among the topographic parameters were analysed, too. RESULTS: No significant differences between right and left eyes were detected for any topographic parameters. Disc area, rim area, and height variation contour showed smaller right-left differences than other parameters. The coefficients of variation for rim area, height variation contour, rim volume, mean cup depth, maximum cup depth, mean retinal nerve fibre layer (RNFL) thickness, and RNFL cross section area were less than 10% (for rim area, less than 5%). Rim area and height variation contour showed relatively weak interrelations and neither showed a correlation with disc area. CONCLUSION: For evaluating time related changes in the optic disc by HRT in monkeys, rim area and height variation contour might be useful parameters because coefficients of variation and right-left differences were lower than for other parameters and because these parameters showed weak interrelations and no correlation with disc area.     

Effect of the menstrual cycle on standard achromatic and blue-on-yellow visual field analysis of women with migraine

BACKGROUND: It has been postulated that migraine and glaucoma may have common vascular causative factors. Significant sex-based differences in the incidence of many important ocular conditions raise the possibility that estrogens may have direct effects on the eye. We performed a study to determine the effect of the menstrual cycle on standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) (blue-on-yellow perimetry) of women with migraine. METHODS: Both eyes of 73 normally menstruating women (31 subjects with migraine and 42 healthy control subjects) were included in the study. Subjects underwent a complete ocular examination including SAP and SWAP in both the follicular phase (12th to 13th day of the cycle) and the luteal phase (1 to 2 days before the onset of bleeding) of two consecutive menstrual cycles.We performed visual field analysis using the Humphrey Field Analyzer II with the full-threshold central 30-2 program. Mean sensitivity was calculated for the superior temporal, inferior temporal, superior nasal and inferior nasal regions separately. RESULTS: Thirteen subjects were lost to follow-up (5 in the migraine group and 8 in the control group), leaving 26 subjects and 34 subjects respectively. There was no significant difference in mean age between the two groups (33.9 years [standard deviation (SD) 3.4 years] vs. 35.1 years [SD 3.3 years]). The mean duration of migraine was 7.6 (SD 3.1) years (range 3-14 years). In both groups, serum estradiol levels were significantly lower (p = 0.001) and serum progesterone levels were significantly higher (p < 0.001) in the luteal phase than in the follicular phase. In the control group, the mean sensitivity values with SWAP were significantly lower in the luteal phase than in the follicular phase (p = 0.04). A similar decrease was observed for the subjects with migraine with both SAP and SWAP (p = 0.01). There was no difference in regional mean sensitivity between the two phases with either perimetric test in the control group. For the subjects with migraine, there was no difference in regional mean sensitivity between the two phases with SAP. However, with SWAP, the mean sensitivity for the nasal visual field locations was significantly lower in the luteal phase than in the follicular phase (p = 0.01). INTERPRETATION: Our study provides further evidence of an effect of sex hormones on the visual field of women with migraine. In addition to assessment of intraocular pressure, menstrual cycle phases should be considered in women with migraine at risk for glaucomatous optic neuropathy.