Vol 2, No 2 (2017)
Original paper
Published online: 2017-06-28

open access

Page views 780
Article views/downloads 1814
Get Citation

Connect on Social Media

Connect on Social Media

Intereye asymmetry of optic nerve head parameters and retinal nerve fibre layer thickness in patients with open angle glaucoma detected by spectral domain optical coherence tomography

Jakub J. Kaluzny12, Mateusz Burduk23
Ophthalmol J 2017;2(2):35-41.


INTRODUCTION. The aim of the study is to evaluate intereye asymmetry of optic nerve head (ONH) parameters and the circumpapillary retinal nerve fibre layer (cpRNFL) thickness in patients with primary open angle glaucoma (POAG).

MATERIA LS AND METHODS. The study included 44 patients with POAG in both eyes, 48 binocular glaucoma suspects, and 75 individuals with two healthy eyes. A mixed group of 20 patients had only one eye that met the criteria for POAG. We evaluated the differences between right and left eyes and absolute intereye asymmetry for the individual ONH parameters and cpRNFL thickness, measured by spectral domain optical coherence tomography (SdOCT).

RESULTS. The comparison of average values of the ONH parameters between the right and left eyes in the group of healthy subjects showed no significant differences apart from the significantly higher rim volume (RV) in the right eye. In addition, the cpRNFL was an average of 4.23 μm thicker in the right eye than in the left eye in healthy subjects. The absolute difference of ONH parameters between the eyes of patients with POAG was higher than in healthy patients for most parameters, but statistical significance was only reached for cup volume (CV). The asymmetry of the cpRNFL thickness increased in patients with glaucoma compared with healthy subjects. The absolute asymmetry of the average cpRNFL thickness in all quadrants was 12.07 μm in patients with glaucoma versus 6.56 μm in healthy subjects (p < 0.05). In the group of glaucoma suspects, cpRNFL intereye asymmetry decreased in almost all parameters in comparison to healthy patients with statistical significance for superior and inferior quadrant.

CONCLUSIONS. In patients with POAG, the intereye asymmetry increases for ONH and cpRNFL parameters compared with healthy eyes; however, statistically significant differences were only found for the cup volume and cpRNFL thickness average for all quadrants. The onset of glaucoma is associated with a reduction of the physiologically occurring asymmetry that results from greater cpRNFL thickness in the right eye.


  1. Fishman RS. Optic disc asymmetry. A sign of ocular hypertension. Arch Ophthalmol. 1970; 84(5): 590–594.
  2. Leske MC, Connell AM, Wu SY, et al. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994; 112(6): 821–829.
  3. Wang JJ, Mitchell P, Smith W, et al. Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996; 103(10): 1661–1669.
  4. Wolfs RC, Borger PH, Ramrattan RS, et al. Changing views on open-angle glaucoma: definitions and prevalences — The Rotterdam Study. Invest Ophthalmol Vis Sci. 2000; 41(11): 3309–3321.
  5. Ong LS, Mitchell P, Healey PR, et al. Asymmetry in optic disc parameters: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci. 1999; 40(5): 849–857.
  6. Hawker MJ, Vernon SA, Tattersall CL, et al. Detecting glaucoma with RADAAR: the Bridlington Eye Assessment Project. Br J Ophthalmol. 2006; 90(6): 744–748.
  7. Shaikh A, Salmon JF. The role of scanning laser polarimetry using the GDx variable corneal compensator in the management of glaucoma suspects. Br J Ophthalmol. 2006; 90(12): 1454–1457.
  8. Mwanza JC, Durbin MK, Budenz DL, et al. Cirrus OCT Normative Database Study Group. Symmetry between the right and left eyes of the normal retinal nerve fiber layer measured with optical coherence tomography (an AOS thesis). Trans Am Ophthalmol Soc. 2008; 106(3): 252–275.
  9. Park JJ, Oh DR, Hong SP, et al. Asymmetry analysis of the retinal nerve fiber layer thickness in normal eyes using optical coherence tomography. Korean J Ophthalmol. 2005; 19(4): 281–287.
  10. Mwanza JC, Durbin MK, Budenz DL, et al. Cirrus OCT Normative Database Study Group. Interocular symmetry in peripapillary retinal nerve fiber layer thickness measured with the Cirrus HD-OCT in healthy eyes. Am J Ophthalmol. 2011; 151(3): 514–521.e1.
  11. Seo JeH, Kim TW, Weinreb RN, et al. Detection of localized retinal nerve fiber layer defects with posterior pole asymmetry analysis of spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2012; 53(8): 4347–4353.
  12. Sullivan-Mee M, Ruegg CC, Pensyl D, et al. Diagnostic precision of retinal nerve fiber layer and macular thickness asymmetry parameters for identifying early primary open-angle glaucoma. Am J Ophthalmol. 2013; 156(3): 567–77.e1.
  13. Field MG, Alasil T, Baniasadi N, et al. Facilitating Glaucoma Diagnosis With Intereye Retinal Nerve Fiber Layer Asymmetry Using Spectral-Domain Optical Coherence Tomography. J Glaucoma. 2016; 25(2): 167–176.
  14. Li H, Healey PR, Tariq YM, et al. Symmetry of optic nerve head parameters measured by the heidelberg retina tomograph 3 in healthy eyes: the Blue Mountains Eye study. Am J Ophthalmol. 2013; 155(3): 518–523.e1.
  15. Fansi AAK, Boisjoly H, Chagnon M, et al. Comparison of different methods of inter-eye asymmetry of rim area and disc area analysis. Eye (Lond). 2011; 25(12): 1590–1597.
  16. Meier KL, Greenfield DS, Hilmantel G, et al. Special commentary: Food and Drug Administration and American Glaucoma Society co-sponsored workshop: the validity, reliability, and usability of glaucoma imaging devices. Ophthalmology. 2014; 121(11): 2116–2123.