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The Shape of Glaucoma

Quantitative Neural Imaging Techniques

edited by: H.G. Lemij & J.S. Schuman

Price: € 104.00 / US $ 130.00

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Publication details: Book. 2000. x and 331 pages. Publication date: 2000-04-26. 103 figures, of which 55 in full color, and 55 tables. Hardbound.

ISBN: 978-90-6299-175-4 (ISBN 10: 90-6299-175-0; Kugler Publications)



Clinicians managing glaucoma have long felt the desire to have objective, reliable, user-friendly, and preferably fast and inexpensive technologies at their disposal that assist them in making the diagnosis of glaucoma and monitoring its change over time. For screening programs, such technologies might also be of great benefit. Over the years, many promising imaging technologies that might serve these purposes have become commercially available. Some of these technologies have died an early death, others are probably on the verge of extinction, while the remainder are struggling to find a niche in the broad ophthalmic diagnostic armamentarium. Clinicians are faced with the decision of whether or not to purchase such technology, funds permitting, and if so, which technology to choose. The choice is not easy, for various reasons. For one thing, each .technology has its inherent limitations, which may not be readily put forward by the inventors/manufacturers. In addition, the various technologies are in different stages of their development. As a result, potentially more promising technologies could, in principle, `lose out' to-more developed (but less appropriate) ones. In addition, it is usually difficult to compare reports in the literature on the various technologies, because different scientific testing methods were used; there is no standard for technology evaluation. Also, few research workers are probably totally impartial to the technology they are testing. Investigators may have an emotional interest, or even a financial one. What is more, few research groups have access to all technologies to allow objective comparison. Even provided these groups were equally committed to each technology, they would still have to deal with the different stages of development of each of them. Unless a dramatic advantage were present for a new technology, each time a new device came onto the market, or an existing one was upgraded, long-term follow-up studies adopting all technologies would have to be started all over again, in order to allow a fair comparison between them. These are just a few of the many problems associated with comparing technologies. To explore and compare the various glaucoma diagnostic technologies, a closed imaging meeting was held on February 10th-12th, 1999, at The Rotterdam Eye Hospital in The Netherlands. We invited 30 researchers dedicated to five imaging technologies: red-free fundus photography, scanning laser tomography, scanning laser polarimetry, optical coherence tomography, and retinal thickness mapping. Unfortunately, some invitees did not attend, and, as a result, red-free fundus photography and the Heidelberg Retina Tomograph (HRT) were under-represented. The meeting was enjoyable and fruitful. About a third of the time was spent on prepared presentations, and the remainder on discussions, during which most speakers were put to the test of their peers' scrutiny. The discussions were audiotaped. The reader will find the proceedings of this meeting in this book, as submitted chapters with the discussions added, abridged to avoid any redundancies. Some discussions appear to have been omitted. In these cases, the authors chose to completely revise their chapters, following the comments of their peers. We have taken great care to maintain the tenet of the discussions. We greatly acknowledge the sponsors of the meeting, namely (in alphabetical order), Allergan, Heidelberg Engineering, Humphrey Systems, Laser Diagnostic Technologies, Pharmacia and Upjohn, and Talia Technology. We believe that this book will provide an invaluable insight into the various imaging technologies, their assets, limitations and potential use.

Table of Contents

Table of Contents



Basic issues in the sensitive and specific detection of optic nerve head surface change within longitudinal LDT TopSS images.

Introduction to the LSU Experimental Glaucoma (LEG) study
C.F. Burgoyne, H.W. Thompson, D.E. Mercante and R. Amin 

Essentials of clinical scanning laser polarimetry
N.T. Choplin

The sensitivity and specificity of scanning laser polarimetry in the detection of glaucoma in a clinical setting
N.T. Choplin

New technology for ultra high resolution optical coherence tomograph of the retina
W. Drexler, U. Morgner, R.K. Ghanta, J.S. Schuman, F.X. Kartner, M.R. Hee, E.P. Ippen and J.G. Fujimoto

From NFA to GDx. Evolution of the Nerve Fiber Analyzer
H.G. Lemij, T.P. Colen and M.J.H. Tjon-Fo-Sang

Studies with the GDx Nerve Fiber Analyzer
R.P. Mills and P.P. Chen

Optical Coherence Tomography of the retinal nerve fiber layer, with comparison to Heidelberg Retina Tomography optic nerve head measurements, in normal and glaucomatous human eyes
H.M. Pakter, J.S. Schuman, E. Hertzmark, T. Pedut-Kloizman, I.D. Peiris, J. MacNutt, V.M. Miller, S. So, R.K. Ghanta, W. Drexler, J. G. Fujimoto, CA. Puliafito, C. Mattox, E.-S. Rasheed and V.R.F Guedes

Following retinal thickness changes in rabbits with optic nerve transection using the Retinal Thickness Analyzer
Y. Solberg, N. BenYossef, A. Solomon, M. Rosner and M. Belkin 

Retinal Thickness Analyzer imaging of a model eye and the optic nerve head. Comparison with Heidelberg Retina Tomograph measurements
G. Wollstein, E. Binnun, N. Ben-Yosef and Y. Rozenman

Preliminary studies on the application of the Retinal Thickness Analyzer in the diagnosis of glaucoma
Y. Zhikuan and D. Shuhua

Retinal nerve fiber layer assessment by scanning laser polarimetry, optical coherence tomography and retinal nerve fiber layer photography
L.M. Zangwill, S. Knauer, J.M. Williams and R.N. Weinreb

Use of the Retinal Thickness Analyzer in the diagnosis and monitoring of glaucoma
R. Zeimer and S. Vitale

Understanding your clinical NFA/GDx data
T.P. Colen, M.J.H. Tjon-Fo-Sang, P.G.H. Mulder and H. G. Lemij

Index of authors


Book Reviews

Four-star rating
Presentation *** 
Depth ***
Understandability ***
Clinical applicability **
Up-to-datedness **
Value ***

This book contains the contributions of ophthalmic digital imaging researchers invited to a meeting in Rotterdam, The Netherlands, in 1999. In 13 chapters the reader is exposed to basic and clinical research with scanning laser polarimetry (6 chapters), optical coherence tomography (3 chapters), retinal thickness analysis (4 chapters) and scanning laser tomography (1 chapter). Each chapter contains the edited conference presentation, followed by a section reflecting the subsequent discussion among the participants. Although this format may occasionally compromise the cohesion of individual chapters, it retains much of the immediacy and, freshness of a scientific conference. The oral peer discussions illuminate many of the important statistical issues that bear on any technology developed for screening or early disease detection. Altogether, the book gives detailed insight into some of the problems associated with data acquisition and analysis with these imaging technologies. The chapter on ultra high resolution optical coherence tomography is particularly impressive from a technical perspective and is well presented.

The book will be of most interest to clinicians using the GDx Nerve Fibre Analyzer but regrettably lacks in-depth information on laser scanning tomography with the Heidelberg Retina Tomograph systems. The field of digital optic nerve and nerve fibre layer imaging is still advancing rapidly, and it is difficult to imagine that any compilation of research work would remain up-to-date for very long. Although the book probably does not provide an entirely representative overview of the clinically important imaging technologies, I would recommend it to any researcher with a serious interest in digital imaging in glaucoma.

Paul H. Artes, PhD
Department of Ophthalmology
Dalhousie University
Halifax, NS

New Haven, Connecticut

PROBABLY THE MOST SIGNIFICANT CONTRIBUTION TO our understanding of glaucoma during the final quarter of the twentieth century was the recognition that glaucoma is a group of optic neuropathies with multiple causes and complex mechanisms leading to death of retinal ganglion cells. While scientists continue to search for the precise causes and mechanisms, clinicians are faced with the need for better diagnostic techniques to. document the subtle changes of glaucomatous optic neuropathy.

As Drs Lemij and Schuman note in their book, The Shape of Glaucoma, there are "many promising imaging technologies" and "clinicians are faced with the decision of whether or not to purchase such technology - and, which technology to choose." The purpose of their book, therefore, was "to explore and compare the various glaucoma diagnostic technologies."

The book represents the transactions of a meeting of clinicians and scientists in February 1999 in The Netherlands. A strength of the book is that the contributors are international experts, who share with each other and the reader their recent work and observations regarding image analysis in glaucoma. The scientific merit of the book is seen in the fact that, of the nineteen participants, there are six MDs, nine PhDs, and three MD, PhDs.

A minor weakness of the book is that it focuses almost exclusively on measurement of the retinal nerve fiber layer, using three technologies: scanning laser polarimetry, optic coherence tomography, and retinal thickness mapping. Measurement of optic nerve head topography by confocal scanning laser tomography was the subject of only one chapter and mentioned in two others that compared this technology with nerve fiber layer measurements. There was also an under representation of red-free fundus photography. The authors refer to this problem in their Preface, explaining that some invitees did not attend the meeting.

Notwithstanding a lack of balance in the book, there is much interest and value. Especially interesting was the fourth chapter, which describes a third-generation optic coherence tomography, with ultrahigh bandwidth femto second laser technology that provides retinal imaging with three-micron axial resolution. Also of interest were four chapters on the Retinal Thickness Analyzer (Dicon®, San Diego, CA), which is a relatively new technology that maps retinal thickness by calculating the distance between two peaks of laser-light reflection from the inner limiting membrane and retinal pigment epithelium.

Another interesting feature, especially for the serious student of retinal imaging, was the panel discussions at the end of each chapter. Some chapters begin with a helpful abstract, and the book would have been enhanced by including this feature in each chapter. The book would also have been strengthened by an index.

I believe that this is a valuable book for those who are interested in the study of image analysis of the retinal nerve fiber layer. It may leave clinicians still wondering what technology to incorporate into their practices, although this is probably a question for which there is no clear answer, because the technology is continuing to evolve so rapidly. What it does say to all of us is that the future looks promising for many new imaging technologies that will assist us in diagnosing and managing the glaucomatous optic neuropathies.

Kugler Publications
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