Clinical Utility of Bruch Membrane Opening-Minimum Rim Width for Detecting Early Glaucoma in Myopic Eyes

Precis: Bruch membrane opening-minimum rim width (BMOMRW) is overall a useful parameter for diagnosing early glaucoma in myopic eyes. Purpose: The aim of this study was to determine the diagnostic value of BMO-MRW compared with peripapillary retinal nerve fiber layer (pRNFL) thickness for detecting early glaucoma in patients with moderate to severe myopia. Methods: One eye was randomly selected from each of the 253 subjects (127 normal controls. 82 with glaucoma suspect, and 44 with early glaucoma). All patients underwent visual acuity testing, refractive error assessment, slit-lamp inspection, intraocular pressure measurement, fundus photography, perimetry. BMO-MRW and pRNFL thickness data were obtained using spectral-domain optical coherence tomography. Area under the receiver operating characteristic curves (AUC) for global and sectoral thickness parameters were calculated. Results: Global analyses for the discrimination of early glaucoma in all myopic subjects showed comparable AUCs between BMO-MRW and pRNFL thickness [AUC 0.952 (95% confidence interval, 0.918-0.975) and 0.934 (95% confidence interval, 0.896-0.961), respectively, P = 0.345]. However, in sectoral analysis, BMO-MRW showed significantly better diagnostic performance than pRNFL thickness except for the superotemporal sector. The AUC for discriminating early glaucoma from glaucoma suspect, BMO-MRW showed statistically better diagnostic performance in the inferotemporal, inferonasal, superonasal, and nasal sectors. When dividing the subject based on a threshold Bruch membrane opening (BMO) area of 2.5 mm(2), the diagnostic power of BMO-MRW was generally lower except for the inferonasal sector in the subgroup with a large BMO area. Conclusions: BMO-MRW was overall a useful parameter for diagnosing early glaucoma in myopic eyes. However, its diagnostic performance was decreased in myopic eyes with large BMO and there were no significant differences from pRNFL thickness.

Automated summary

BMO-MRW is a useful parameter for diagnosing early glaucoma in myopic eyes, but its diagnostic performance may decrease in myopic eyes with large Bruch membrane opening (BMO) area.