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  • OCT Distinguishes Meningioma From Glaucoma

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    Published online Sept. 23, 2021

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    Tonagel et al. looked for differences in peripapillary retinal nerve fiber layer (RNFL) thickness among patients with primary open-angle glaucoma (POAG), sphenoid wing meningioma (SWM), or optic nerve sheath meningioma (ONSM) to determine whether OCT alone could distinguish these conditions. They found that OCT detected differences in temporal-sector RNFL thickness between patients with glaucoma and patients with meningioma-related compression. Moreover, OCT distinguished these conditions with 80% sensitivity and 100% specificity.

    For this retrospective study, the authors evaluated 45 patients (divided equally among those with POAG, SWM, and ONSM). For participants with two affected eyes, one was chosen ran­domly as the study eye. The median age of study patients was 64 years, 60% were female, and the median decimal visual acuity was 1.0 (range, .5-1.0). Spectral-domain OCT and the Hei­delberg Engineering glaucoma module were used to measure peripapillary RNFL thickness.

    Total peripapillary RNFL thickness was abnormal in 80% of the POAG and SWM groups and in 73% of the ONSM group. Median decreases in RNFL thickness of the temporal sector were ‒17 μm (range, +6 to ‒34 μm) in POAG, ‒44 μm (range, ‒25 to ‒52 μm) in SWM, and ‒43 μm (range, ‒19 to ‒52 μm) in ONSM. The difference in temporal-sector RNFL thickness between patients with glaucoma and those with SWM or ONSM was significant (p < .001), and thickness was abnormal only in patients with meningioma. For other sectors, there were no significant differences between cohorts.

    In general, peripapillary RNFL thickness is within or near normal limits in early and moderate POAG but is considerably reduced in SWM and ONSM. In this study, the finding of temporal-sector RNFL thickness being abnormal only in patients with meningioma suggests that obtaining such measurements may help to distinguish between mild or moderate glauco­ma and SWM/ONSM or to identify patients who have both conditions. However, the authors cautioned, these measurements should not replace traditional tests. To rule out optic nerve compression, they recommended considering magnetic resonance imaging of the head for patients with substantial RNFL thinning in the temporal region.

    The original article can be found here.