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• Optic nerve head analysis to rule out glaucoma
  Sagnik Sen, Rebika Dhiman
  Published on: 11 September 2018

• Published on: 11 September 2018

  Optic nerve head analysis to rule out glaucoma

  • Sagnik Sen, Ophthalmologist AIIMS, New Delhi, India
  • Other Contributors:
    • Rebika Dhiman, Ophthalmologist

  Dear authors,

  We congratulate the authors for bringing out an ingenious theory regarding pathogenesis of cupping in glaucomatous (GC) and non-glaucomatous (NGC) eyes using this optical coherence tomography (OCT) model. (1) Differentiating a NGC from GC has been a point of discussion for decades and to finally have an objective parameter “anterior laminar depth (ALD)” which appears specific for glaucomatous cupping from this study is indeed beneficial. The authors have used a linear regression model to compare the GC and NGC eyes with healthy controls with adjustment of age, axial length and peripapillary choroidal thickness (PCT). However, it remains to be further studied, how the ALD is to be used for an individual patient, for eg., what cut-off of ALD above which a patient can be labelled as falling in the glaucomatous range. In this regard, we had a doubt regarding inclusion of PCT in ALD calculation. Since the authors have finally adjusted for PCT in the end, we wonder how the results will turn out if they would remove PCT from ALD measurement and compare the remainder measurement (ALD - PCT) between NGC and GC groups.
  Finally, we observed that in this sentence “No significant difference was found in visual field mean deviation (MD) <0.001).”, there is a typographical error and an inadequacy of explanation. No significant difference in visual field MD was indeed seen between NGC and GC groups (p should be >0.99 and not <0.001, as seen in Table...

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  Dear authors,

  We congratulate the authors for bringing out an ingenious theory regarding pathogenesis of cupping in glaucomatous (GC) and non-glaucomatous (NGC) eyes using this optical coherence tomography (OCT) model. (1) Differentiating a NGC from GC has been a point of discussion for decades and to finally have an objective parameter “anterior laminar depth (ALD)” which appears specific for glaucomatous cupping from this study is indeed beneficial. The authors have used a linear regression model to compare the GC and NGC eyes with healthy controls with adjustment of age, axial length and peripapillary choroidal thickness (PCT). However, it remains to be further studied, how the ALD is to be used for an individual patient, for eg., what cut-off of ALD above which a patient can be labelled as falling in the glaucomatous range. In this regard, we had a doubt regarding inclusion of PCT in ALD calculation. Since the authors have finally adjusted for PCT in the end, we wonder how the results will turn out if they would remove PCT from ALD measurement and compare the remainder measurement (ALD - PCT) between NGC and GC groups.
  Finally, we observed that in this sentence “No significant difference was found in visual field mean deviation (MD) <0.001).”, there is a typographical error and an inadequacy of explanation. No significant difference in visual field MD was indeed seen between NGC and GC groups (p should be >0.99 and not <0.001, as seen in Table 1), however, both MD of NGC and GC were individually significantly different from the control group (p<0.001).

  References
  1. Fard MA, Moghimi S, Sahraian A, et al Optic nerve head cupping in glaucomatous and non-glaucomatous optic neuropathy British Journal of Ophthalmology Published Online First: 23 May 2018. doi: 10.1136/bjophthalmol-2018-312161

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  Conflict of Interest:
  None declared.

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