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Clinical science
HRT-3 Moorfields reference plane: effect on rim area repeatability and identification of progression
  1. R Asaoka1,2,
  2. N G Strouthidis1,3,
  3. V Kappou1,
  4. S K Gardiner3,4,
  5. D F Garway-Heath1
  1. 1
    NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  2. 2
    Department of Ophthalmology, Hamamatsu University, School of Medicine, Shizuoka, Japan
  3. 3
    Optic Nerve Head Research Laboratory, Portland, Oregon, USA
  4. 4
    Discoveries in Sight, Devers Eye Institute, Portland, Oregon, USA
  1. Correspondence to Dr D F Garway-Heath, Glaucoma Research Unit, Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK; david.garway-heath{at}


Aims: To assess the effect of the Moorfields Reference Plane on Heidelberg Retina Tomograph (HRT) rim area repeatability and its effect on progression rates using an event analysis.

Methods: The HRT reference plane (RP) defines structures above as “rim” and below as “cup.” The Moorfields RP applies the Standard RP (located 50 μm posterior to the temporal disc margin) at baseline and maintains the distance between the Standard RP and the reference ring (located in the image periphery) for follow-up images. The Moorfields RP was applied to an HRT test–retest dataset, and rim area repeatability coefficients were calculated. Repeatability coefficients were compared between the Moorfields, Standard and 320 (located 320 μm posterior to the reference ring) RPs. The Moorfields RP was applied to HRT images from 198 ocular hypertensives, acquired over 6 years. HRT progression required rim area baseline/follow-up differences exceeding the repeatability coefficient in two or more sectors, with confirmation in at least one of two consecutive images. Field progression was assessed using Advanced Glaucoma Intervention Study criteria.

Results: The Moorfields RP improved rim area repeatability compared with the Standard RP; repeatability was similar between the Moorfields and the 320 RP. The frequency of identified progression using Moorfields RP was 40% compared with 28% for the 320 RP. There was a greater percentage with concurrent field progression −15.1% (Moorfields RP) compared with 12.1% (320 RP).

Conclusions: Although rim area repeatability was similar using the 320 RP and the Moorfields RP, the latter resulted in greater rates of detection of change.

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  • Funding NGS is funded by a Royal College of Ophthalmologists/Pfizer fellowship and through an unrestricted grant from Heidelberg Engineering. DFG-H has received research support from Heidelberg Engineering, OptoVue and Carl Zeiss Meditec and has acted as a consultant for Carl Zeiss Meditec.

  • Competing interests DFG-H has acted as a consultant to Carl Zeiss Meditec.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval Ethics approval was provided by Moorfields Eye Hospital Ethics Committee.

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