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Imaging of the retinal nerve fiber layer for glaucoma
  1. Kelly A. Townsend (townsend.kelly{at}gmail.com),
  2. Gadi Wollstein (wollsteing{at}upmc.edu),
  3. Joel S Schuman (schumanjs{at}upmc.edu)
  1. University of Pittsburgh School of Medicine, United States
  2. University of Pittsburgh School of Medicine, United States
  3. University of Pittsburgh School of Medicine, United States

    Abstract

    Glaucoma is a group of diseases characterized by retinal ganglion cell dysfunction and death. Detection of glaucoma and its progression are based on identification of abnormalities or changes in the optic nerve head (ONH) or the retinal nerve fiber layer (RNFL), either functional or structural. This review will focus on the identification of structural abnormalities in the RNFL associated with glaucoma.

    A variety of new techniques have been created and developed to move beyond photography, which generally requires subjective interpretation, to quantitative retinal imaging to measure RNFL loss. Scanning laser polarimetry uses polarized light to measure the RNFL birefringence to estimate tissue thickness. Optical coherence tomography (OCT) uses low coherence light to create high resolution tomographic images of the retina from backscattered light in order to measure tissue thickness of the retinal layers and intra-retinal structures. Segmentation algorithms are used to measure the thickness of the retinal nerve fiber layer directly from the OCT images. In addition to these clinically available technologies, new techniques are in the research stages. Polarization sensitive OCT has been developed that combine the strengths of scanning laser polarimetry with those of OCT. Ultra-fast techniques for OCT have been created for research devices. The continued utilization of imaging devices into the clinic is refining glaucoma assessment. In the past twenty years glaucoma has gone from a disease diagnosed and followed using highly subjective techniques to one measured quantitatively and increasingly objectively.

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