Effects of optic nerve head structures on retinal nerve fiber layer defects in primary open angle glaucoma eyes: Analyses using retinal optical texture analysis (ROTA)

Purpose: To elucidate associations between optic nerve head (ONH) structures and the retinal nerve fiber layer optical texture analysis (ROTA)-detected retinal nerve fiber layer defects (RNFLDs) in primary open-angle glaucoma (POAG) eyes.

Design: Prospective cross-sectional observational study.

Participants: This study enrolled 136 eyes of 109 POAG patients.

Methods: All participants underwent comprehensive ophthalmologic examinations including standard automated perimetry and swept-source optical coherence tomography (SS-OCT). Two independent graders assessed ROTA images for the presence, location, and width of RNFLDs. Multivariable linear mixed effects model was used to investigate factors independently associated with ROTA-detected RNFLDs. Explanatory variables were systemic and ocular factors such as age, axial length (AXL), SS-OCT-derived ONH structural parameters such as Bruch membrane opening-centered circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and gamma zone area, and average visual field sensitivity (1/Lambert) (VFSaverage).

Main Outcome Measures: Width and number of RNFLDs.

Results: RNFLD detection rates by ROTA were 86.8% overall, 69.0% and 94.7% in the early and moderate stages of POAG eyes, and 86.5% and 87.2% in the highly myopic (AXL >26.0 mm) and non-highly myopic eyes, respectively. Summed width of RNFLD per eye was positively correlated with gamma-zone area (P = .0007) and negatively correlated with age, cpRNFLT, and VFSaverage (P = .0111, .0001, .0124), whereas the number of RNFLDs per eye correlated negatively with age, cpRNFLT, and VFSaverage (P = .0153, .0029, .0007).

Conclusions: The ROTA-detected extent of axonal damage was associated with ONH structural change represented by gamma zone area in POAG eyes after adjustment for other possible confounding factors.

*Author(s): Miki A, Araie M, Leung CKS, Nishigaki M, Murata H, Kikawa T, Sugiyama K, Higashide T, Saito H, Aihara M, Iwase A, Tomita G, Nakazawa T, Ohno-Matsui K, Kim TW, Zangwill LM, Weinreb RN. *

Journal: American Journal of Ophthalmology

10.1016/j.ajo.2026.01.035

Link: https://www.sciencedirect.com/science/article/abs/pii/S0002939426000486

Clinical Paper of the Month manager: Nestor Ventura-Abreu

Editors in Chief: Francesco Oddone, Manuele Michelessi