Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population

A Multicenter Study


      Conventional optic disc margin-based neuroretinal rim measurements lack a solid anatomic and geometrical basis. An optical coherence tomography (OCT) index, Bruch's membrane opening minimum rim width (BMO-MRW), addresses these deficiencies and has higher diagnostic accuracy for glaucoma. We characterized BMO-MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) in a normal population.


      Multicenter cross-sectional study.


      Normal white subjects.


      An approximately equal number of subjects in each decade group (20–90 years of age) was enrolled in 5 centers. Subjects had normal ocular and visual field examination results. We obtained OCT images of the optic nerve head (24 radial scans) and peripapillary retina (1 circular scan). The angle between the fovea and BMO center (FoBMO angle), relative to the horizontal axis of the image frame, was first determined and all scans were acquired and analyzed relative to this eye-specific FoBMO axis. Variation in BMO-MRW and RNFLT was analyzed with respect to age, sector, and BMO shape.

      Main Outcome Measures

      Age-related decline and between-subject variability in BMO-MRW and RNFLT.


      There were 246 eyes of 246 subjects with a median age of 52.9 years (range, 19.8–87.3 years). The median FoBMO angle was −6.7° (range, 2.5° to −17.5°). The BMO was predominantly vertically oval with a median area of 1.74 mm2 (range, 1.05–3.40 mm2). Neither FoBMO angle nor BMO area was associated with age or axial length. Both global mean BMO-MRW and RNFLT declined with age at a rate of −1.34 μm/year and −0.21 μm/year, equivalent to 4.0% and 2.1% loss per decade of life, respectively. Sectorially, the most rapid decrease occurred inferiorly and the least temporally; however, the age association was always stronger with BMO-MRW than with RNFLT. There was a modest relationship between mean global BMO-MRW and RNFLT (r = 0.35), whereas sectorially the relationship ranged from moderate (r = 0.45, inferotemporal) to nonexistent (r = 0.01, temporal).


      There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO-MRW and RNFLT in their relationship with age and between each other. Adjusting BMO-MRW and RNFLT for age and sector is important in ensuring optimal diagnostics for glaucoma.

      Abbreviations and Acronyms:

      BMO (Bruch's membrane opening), FoBMO (fovea to Bruch's membrane opening), MRW (minimum rim width), OCT (optical coherence tomography), ONH (optic nerve head), RNFL (retinal nerve fiber layer), RNFLT (retinal nerve fiber layer thickness)
      To read this article in full you will need to make a payment


      Subscribe to Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Strouthidis N.G.
        • Yang H.
        • Reynaud J.F.
        • et al.
        Comparison of clinical and spectral domain optical coherence tomography optic disc margin anatomy.
        Invest Ophthalmol Vis Sci. 2009; 50: 4709-4718
        • Reis A.S.
        • Sharpe G.P.
        • Yang H.
        • et al.
        Optic disc margin anatomy in patients with glaucoma and normal controls with spectral domain optical coherence tomography.
        Ophthalmology. 2012; 119: 738-747
        • Srinivasan V.J.
        • Adler D.C.
        • Chen Y.
        • et al.
        Ultrahigh-speed optical coherence tomography for three-dimensional and en face imaging of the retina and optic nerve head.
        Invest Ophthalmol Vis Sci. 2008; 49: 5103-5110
        • Strouthidis N.G.
        • Grimm J.
        • Williams G.A.
        • et al.
        A comparison of optic nerve head morphology viewed by spectral domain optical coherence tomography and by serial histology.
        Invest Ophthalmol Vis Sci. 2010; 51: 1464-1474
        • Reis A.S.
        • O’Leary N.
        • Yang H.
        • et al.
        Influence of clinically invisible, but optical coherence tomography detected, optic disc margin anatomy on neuroretinal rim evaluation.
        Invest Ophthalmol Vis Sci. 2012; 53: 1852-1860
        • Povazay B.
        • Hofer B.
        • Hermann B.
        • et al.
        Minimum distance mapping using three-dimensional optical coherence tomography for glaucoma diagnosis.
        J Biomed Optics. 2007; 12: 041204
        • Chen T.C.
        Spectral domain optical coherence tomography in glaucoma: qualitative and quantitative analysis of the optic nerve head and retinal nerve fiber layer: an AOS thesis.
        Trans Am Ophthalmol Soc. 2009; 107: 254-281
        • Strouthidis N.G.
        • Fortune B.
        • Yang H.
        • et al.
        Longitudinal change detected by spectral domain optical coherence tomography in the optic nerve head and peripapillary retina in experimental glaucoma.
        Invest Ophthalmol Vis Sci. 2011; 52: 1206-1219
        • Chauhan B.C.
        • Burgoyne C.F.
        From clinical examination of the optic disc to clinical assessment of the optic nerve head: a paradigm change.
        Am J Ophthalmol. 2013; 156: 218-227.e2
        • Chauhan B.C.
        • O’Leary N.
        • Almobarak F.A.
        • et al.
        Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter.
        Ophthalmology. 2013; 120: 535-543
        • Mizumoto K.
        • Gosho M.
        • Zako M.
        Correlation between optic nerve head structural parameters and glaucomatous visual field indices.
        Clin Ophthalmol. 2014; 8: 1203-1208
        • Pollet-Villard F.
        • Chiquet C.
        • Romanet J.P.
        • et al.
        Structure-function relationships with spectral-domain optical coherence tomography retinal nerve fiber layer and optic nerve head measurements.
        Invest Ophthalmol Vis Sci. 2014; 55: 2953-2962
        • Gardiner S.K.
        • Ren R.
        • Yang H.
        • et al.
        A method to estimate the amount of neuroretinal rim tissue in glaucoma: comparison with current methods for measuring rim area.
        Am J Ophthalmol. 2014; 157: 540-549.e1–2
        • Danthurebandara V.M.
        • Sharpe G.P.
        • Hutchison D.M.
        • et al.
        Enhanced structure-function relationship in glaucoma with an anatomically and geometrically accurate neuroretinal rim measurement.
        Invest Ophthalmol Vis Sci. 2015; 56: 98-105
        • He L.
        • Ren R.
        • Yang H.
        • et al.
        Anatomic vs. acquired image frame discordance in spectral domain optical coherence tomography minimum rim measurements.
        PLoS One. 2014; 9: e92225
        • Amini N.
        • Nowroozizadeh S.
        • Cirineo N.
        • et al.
        Influence of the disc-fovea angle on limits of RNFL variability and glaucoma discrimination.
        Invest Ophthalmol Vis Sci. 2014; 55: 7332-7342
        • See J.L.
        • Nicolela M.T.
        • Chauhan B.C.
        Rates of neuroretinal rim and peripapillary atrophy area change: a comparative study of glaucoma patients and normal controls.
        Ophthalmology. 2009; 116: 840-847
        • Leung C.K.
        • Yu M.
        • Weinreb R.N.
        • et al.
        Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: a prospective analysis of age-related loss.
        Ophthalmology. 2012; 119: 731-737
        • O’Leary N.
        • Artes P.H.
        • Hutchison D.M.
        • et al.
        Rates of retinal nerve fibre layer thickness change in glaucoma patients and control subjects.
        Eye (Lond). 2012; 26: 1554-1562
        • Funk J.
        • Dieringer T.
        • Grehn F.
        Correlation between neuroretinal rim area and age in normal subjects.
        Graefes Arch Clin Exp Ophthalmol. 1989; 227: 544-548
        • Tsai C.S.
        • Ritch R.
        • Shin D.H.
        • et al.
        Age-related decline of disc rim area in visually normal subjects.
        Ophthalmology. 1992; 99: 29-35
        • Varma R.
        • Tielsch J.M.
        • Quigley H.A.
        • et al.
        Race-, age-, gender-, and refractive error-related differences in the normal optic disc.
        Arch Ophthalmol. 1994; 112: 1068-1076
        • Garway-Heath D.F.
        • Wollstein G.
        • Hitchings R.A.
        Aging changes of the optic nerve head in relation to open angle glaucoma.
        Br J Ophthalmol. 1997; 81: 840-845
        • Nakamura H.
        • Maeda T.
        • Suzuki Y.
        • Inoue Y.
        Scanning laser tomography to evaluate optic discs of normal eyes.
        Jpn J Ophthalmol. 1999; 43: 410-414
        • Ramrattan R.S.
        • Wolfs R.C.
        • Jonas J.B.
        • et al.
        Determinants of optic disc characteristics in a general population: the Rotterdam Study.
        Ophthalmology. 1999; 106: 1588-1596
        • Xu L.
        • Wang Y.
        • Yang H.
        • et al.
        Size of the neuroretinal rim and optic cup and their correlations with ocular and general parameters in adult Chinese: the Beijing eye study.
        Br J Ophthalmol. 2007; 91: 1616-1619
        • Bourne R.R.
        • Foster P.J.
        • Bunce C.
        • et al.
        The morphology of the optic nerve head in the Singaporean Chinese population (the Tanjong Pagar study): part 1. Optic nerve head morphology.
        Br J Ophthalmol. 2008; 92: 303-309
        • Balazsi A.G.
        • Rootman J.
        • Drance S.M.
        • et al.
        The effect of age on the nerve fiber population of the human optic nerve.
        Am J Ophthalmol. 1984; 97: 760-766
        • Mikelberg F.S.
        • Drance S.M.
        • Schulzer M.
        • et al.
        The normal human optic nerve. Axon count and axon diameter distribution.
        Ophthalmology. 1989; 96: 1325-1328
        • Jonas J.B.
        • Muller-Bergh J.A.
        • Schlotzer-Schrehardt U.M.
        • Naumann G.O.
        Histomorphometry of the human optic nerve.
        Invest Ophthalmol Vis Sci. 1990; 31: 736-744
        • Demirkaya N.
        • van Dijk H.W.
        • van Schuppen S.M.
        • et al.
        Effect of age on individual retinal layer thickness in normal eyes as measured with spectral-domain optical coherence tomography.
        Invest Ophthalmol Vis Sci. 2013; 54: 4934-4940
        • Bendschneider D.
        • Tornow R.P.
        • Horn F.K.
        • et al.
        Retinal nerve fiber layer thickness in normals measured by spectral domain OCT.
        J Glaucoma. 2010; 19: 475-482
        • Quigley H.A.
        • Addicks E.M.
        Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage.
        Arch Ophthalmol. 1981; 99: 137-143
        • Jonas J.B.
        • Mardin C.Y.
        • Schlotzer-Schrehardt U.
        • Naumann G.O.
        Morphometry of the human lamina cribrosa surface.
        Invest Ophthalmol Vis Sci. 1991; 32: 401-405
        • Jansonius N.M.
        • Schiefer J.
        • Nevalainen J.
        • et al.
        A mathematical model for describing the retinal nerve fiber bundle trajectories in the human eye: average course, variability, and influence of refraction, optic disc size and optic disc position.
        Exp Eye Res. 2012; 105: 70-78
        • Lamparter J.
        • Russell R.A.
        • Zhu H.
        • et al.
        The influence of intersubject variability in ocular anatomical variables on the mapping of retinal locations to the retinal nerve fiber layer and optic nerve head.
        Invest Ophthalmol Vis Sci. 2013; 54: 6074-6082
        • Quigley H.A.
        • Addicks E.M.
        • Green W.R.
        • Maumenee A.E.
        Optic nerve damage in human glaucoma. II. The site of injury and susceptibility to damage.
        Arch Ophthalmol. 1981; 99: 635-649
        • Patel N.B.
        • Wheat J.L.
        • Rodriguez A.
        • et al.
        Agreement between retinal nerve fiber layer measures from Spectralis and Cirrus spectral domain OCT.
        Optom Vis Sci. 2012; 89: E652-E666
        • Tsai C.S.
        • Zangwill L.
        • Gonzalez C.
        • et al.
        Ethnic differences in optic nerve head topography.
        J Glaucoma. 1995; 4: 248-257
        • Girkin C.A.
        • McGwin Jr., G.
        • Long C.
        • et al.
        Subjective and objective optic nerve assessment in African Americans and whites.
        Invest Ophthalmol Vis Sci. 2004; 45: 2272-2278
        • Zangwill L.M.
        • Weinreb R.N.
        • Berry C.C.
        • et al.
        Racial differences in optic disc topography: baseline results from the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study.
        Arch Ophthalmol. 2004; 122: 22-28
        • Girkin C.A.
        • Sample P.A.
        • Liebmann J.M.
        • et al.
        African Descent and Glaucoma Evaluation Study (ADAGES): II. Ancestry differences in optic disc, retinal nerve fiber layer, and macular structure in healthy subjects.
        Arch Ophthalmol. 2010; 128: 541-550
        • Girkin C.A.
        • McGwin Jr., G.
        • Sinai M.J.
        • et al.
        Variation in optic nerve and macular structure with age and race with spectral-domain optical coherence tomography.
        Ophthalmology. 2011; 118: 2403-2408
        • Knight O.J.
        • Girkin C.A.
        • Budenz D.L.
        • et al.
        Effect of race, age, and axial length on optic nerve head parameters and retinal nerve fiber layer thickness measured by Cirrus HD-OCT.
        Arch Ophthalmol. 2012; 130: 312-318
        • Zelefsky J.R.
        • Harizman N.
        • Mora R.
        • et al.
        Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes.
        J Glaucoma. 2006; 15: 548-551
        • De Leon-Ortega J.E.
        • Sakata L.M.
        • Monheit B.E.
        • et al.
        Comparison of diagnostic accuracy of Heidelberg Retina Tomograph II and Heidelberg Retina Tomograph 3 to discriminate glaucomatous and nonglaucomatous eyes.
        Am J Ophthalmol. 2007; 144: 525-532
        • Rao H.L.
        • Babu G.J.
        • Sekhar G.C.
        Comparison of the diagnostic capability of the Heidelberg Retina Tomographs 2 and 3 for glaucoma in the Indian population.
        Ophthalmology. 2010; 117: 275-281
        • Girkin C.A.
        • Liebmann J.
        • Fingeret M.
        • et al.
        The effects of race, optic disc area, age, and disease severity on the diagnostic performance of spectral-domain optical coherence tomography.
        Invest Ophthalmol Vis Sci. 2011; 52: 6148-6153