Enhanced structure-function relationship in glaucoma with an anatomically and geometrically accurate neuroretinal rim measurement

yesPurpose: To evaluate the structure–function relationship between disc margin–based rim area (DM-RA) obtained with confocal scanning laser tomography (CSLT), Bruch's membrane opening–based horizontal rim width (BMO-HRW), minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer thickness (RNFLT) obtained with spectral-domain optical coherence tomography (SD-OCT), and visual field sensitivity. Methods: We examined 151 glaucoma patients with CSLT, SD-OCT, and standard automated perimetry on the same day. Optic nerve head (ONH) and RNFL with SD-OCT were acquired relative to a fixed coordinate system (acquired image frame [AIF]) and to the eye-specific fovea-BMO center (FoBMO) axis. Visual field locations were mapped to ONH and RNFL sectors with fixed Garway-Heath (VFGH) and patient-specific (VFPS) maps customized for various biometric parameters. Results: Globally and sectorally, the structure–function relationships between DM-RA and VFGH, BMO-HRWAIF and VFGH, and BMO-HRWFoBMO and VFPS were equally weak. The R2 for the relationship between DM-RA and VFGH ranged from 0.1% (inferonasal) to 11% (superotemporal) whereas that between BMO-HRWAIF and VFGH ranged from 0.1% (nasal) to 10% (superotemporal). Relatively stronger global and sectoral structure–function relationships with BMO-MRWAIF and with BMO-MRWFoBMO were obtained. The R2 between BMO-MRWAIF and VFGH ranged from 5% (nasal) to 30% (superotemporal), whereas that between BMO-MRWFoBMO and VFPS ranged from 5% (nasal) to 25% (inferotemporal). The structure–function relationship with RNFLT was not significantly different from that with BMO-MRW, regardless of image acquisition method. Conclusions: The structure–function relationship was enhanced with BMO-MRW compared with the other neuroretinal rim measurements, due mainly to its geometrically accurate properties