The impact of optic nerve and related characteristics on disc area measurements derived from different imaging techniques

Purpose: Optic nerve head (ONH) assessment and its interpretation in healthy patients and those with glaucoma remains a pivotal topic specifically considering rapid advancements in imaging technologies. We undertook a large-scale, mixed cohort, comparative study to assess the correlation of optic disc measurements between different imaging modalities and investigated the impact of patient and disc associated parameters. Methods: ONH sizes were obtained from one randomly selected eye of each of 209 patients using stereophotography, confocal scanning laser ophthalmoscopy and two different optical coherence tomographers (OCT). Patient related data, glaucoma status and optic disc variables, specifically oblique insertion, torsion, presence of beta PPA and spherical equivalent were recorded. Measurements between imaging modalities were analysed using Pearson correlation, linear regression analysis and Blend-Altman plots. Individual variables were compared applying multivariate regression analysis, ANOVA and chi square statistics was used to determine correlations between patient and clinical characteristics. Results: Absolute measurements significantly differed between imaging modalities generally producing smaller measurements for OCT derived measurements of Bruch’s membrane opening (BMO). Pairwise correlations between imaging modalities were between 0.83 and 0.93 for discs without myopia, oblique insertion, or beta PPA. These features impacted on measurements for individual modalities and consequently contributed to inconsistencies and variability. Conclusion: In comparison to planimetry, OCT derived BMO measurements are more variable in the presence of oblique insertion, beta PPA or magnification errors due to myopia. Impact of these factors, however, differs between instruments and needs to be considered to accurately interpret optic disc features in particular within the context of glaucoma diagnosis.