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Optimization Strategies for Bruch's Membrane Opening Minimum Rim Area Calculation: Sequential versus Simultaneous

Philip Enders¹, Werner Adler², Friederike Schaub³

¹Department of Ophthalmology, University Hospital of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany. philip.enders@uk-koeln.de.

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Area of Science:

Ophthalmology
Medical Imaging
Glaucoma Research

Background:

Accurate measurement of the optic nerve head (ONH) is crucial for diagnosing glaucoma.
Spectral domain optical coherence tomography (SD-OCT) is a key technology for ONH imaging.
Standard methods for calculating the Bruch's membrane opening (BMO) minimum rim area (MRA) may not be fully optimized.

Purpose of the Study:

To compare a novel, simultaneously optimized continuous minimum rim surface parameter with the standard sequential minimization method for BMO-MRA calculation using SD-OCT.
To evaluate the diagnostic performance of these parameters in differentiating glaucoma patients.

Main Methods:

A case-control, cross-sectional study involving 704 eyes from 445 participants.
SD-OCT of the ONH, visual field testing, and clinical examination were performed.
Both globally and sector-wise optimized BMO-based minimum rim area (BMO-gMRA and BMO-MRA) were calculated and compared.

Main Results:

Both BMO-MRA and BMO-gMRA showed strong correlation (r=0.995) and minimal difference (0.04 mm²).
The area under the curve (AUC) for differentiating glaucoma was 0.873 for BMO-MRA and 0.866 for BMO-gMRA (P=0.004).
The temporal inferior ONH sector demonstrated the highest AUC for glaucoma differentiation.

Conclusions:

Optimization strategies for BMO-MRA calculation yield significantly different results.
An additional adjacency constraint does not improve the diagnostic power of BMO-MRA.
Global and temporal inferior BMO-MRA are the most effective parameters for differentiating glaucoma.