Lamina Cribrosa Morphology Predicts Progressive Retinal Nerve Fiber Layer Loss In Eyes with Suspected Glaucoma

Although early diagnosis and treatment reduce the risk of blindness from glaucoma, the decision on whether or not to begin treatment in patients with suspected glaucoma is often a dilemma because the majority of patients never develop definite glaucoma. A growing body of evidences suggests that posterior bowing of the lamina cribrosa (LC) is the earliest structural change preceding the retinal nerve fiber layer (RNFL) loss in glaucomatous optic neuropathy. Based on this notion, we conducted a prospective study enrolling 87 eyes suspected of having glaucoma to investigate whether the future rate of RNFL loss is associated with the baseline LC curve evaluated by measuring the LC curve index (LCCI) using enhanced depth imaging optical coherence tomography. A faster rate of RNFL loss was significantly associated with greater LCCI (P < 0.001; standardized coefficient beta = -0.392), older age (P = 0.008; beta = -0.314), and greater vertical cup-to-disc ratio (P = 0.040; beta = -0.233). Assessment of LC morphology may help predict the disease outcome in eyes with suspected glaucoma.