Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography

Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography Yeoun Sook Chun, Nam Ju Moon, Ungsoo Samuel Kim, Joon Hyung Yeo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2414786/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Nov, 2023 Read the published version in Eye → Version 1 posted 7 You are reading this latest preprint version Abstract Background: To demonstrate the morphological characteristics of Bergmeister papilla (BMP), a persistent hyaloid remnant tissue, and its effects on the measurements and repeatability of spectral domain optical coherence tomography (OCT). Methods: A prospective cross-sectional study was used to collect 83 patients with BMP and 76 age-matched unaffected individuals from a tertiary care institution. Imaging including 5-line raster and 3 consecutive optic disc cube scans centered on the optic disc were acquired using the Cirrus HD-OCT. Structural characteristics of BMP were classified according to the images of raster scans, and the repeatability of optic nerve head and retinal nerve fiber layer parameters was analyzed by calculating the test-retest standard deviation, coefficient of variance, and intraclass correlation coefficient. Results: BMP was categorized into lifting edge (LE) type where does not cover the entire optic nerve head, but partially covers the corners, and covering disc (CD) type in which covers the entire cupping area like a cap. Among the BMP of 83 eyes, 58 (63.9%) were lifting edge type and 33 (36.1%) were CD type, and some of the optic nerve head parameters in OCT showed significant differences between the CD and LE types and normal control eyes. The analysis of repeatability showed that eyes with LE types affected cup volume and nasal retinal nerve fiber layer parameters and correlated with BMP location. Conclusion: Because BMP might be a pitfall in OCT imaging, it is necessary to be careful when interpreting OCT in an eye with BMP. Health sciences/Signs and symptoms/Eye manifestations Health sciences/Diseases/Eye diseases Figures Figure 1 Figure 2 Introduction Bergmeister papilla (BMP) is a remnant of the hyaloid artery fibrous sheath, which is usually asymptomatic and is observed incidentally during fundus examinations. It is characterized by avascular prepapillary veils and epipapillary membranes. It was reported that various types of BMP can be observed by fundus examination.( 1 , 2 ) However, analysis of the morphological characteristics of BMP using optical coherence tomography (OCT) or the effect of BMP on OCT has not been fully clarified. Currently, OCT is invaluable for assessing the structural changes of eyes with pathologic conditions, because it provides quantitative and noninvasive in vivo measurements of the macula and optic nerve head (ONH) parameters.( 3 – 5 ) In addition, the recent introduction of spectral-domain (SD) OCT has improved image resolution, image speed, and sensitivity;( 6 – 8 ) however, there are still many potential artifacts in OCT imaging. The causes of these artifacts in OCT measurements are related to ocular pathologic features and non-ocular errors including technician or software errors.( 9 ) Epiretinal membrane, posterior vitreous detachment, retinoschisis, high myopia, and media opacities are previously reported representative ocular pathologic features that can cause segmentation errors in OCT imaging.( 9 , 10 ) Furthermore, BMP can be a pitfall in the interpretation of the clinical data in OCT, because it is closely attached to the surface of the ONH. The purpose of this study was to demonstrate the characteristics of BMP based on SD-OCT and to evaluate its influence on disc and peripapillary retinal nerve fiber layer (RNFL) parameters in SD-OCT. In particular, we focused on the repeatability of OCT measurements. Materials & Methods This was a prospective cross-sectional observational study. The Institutional Review Board of the Konyang University Hospital, Daejeon, Korea approved the protocol and the consent form for this study (IRB No. KYUH 2021-07-013-001). We performed all procedures in accordance with the tenets of the World Medical Association’s Declaration of Helsinki, and written informed consent was obtained from all subjects. Study Subjects Subjects were recruited from patients referred to an outpatient clinic for further ophthalmologic evaluation by the Health Screening Center, Konyang University Hospital, Daejeon, Korea between July 2021 and June 2022. All subjects underwent a complete initial ophthalmic examination, including best-corrected visual acuity, intraocular pressure (IOP) by a Goldmann applanation tonometer, noncycloplegic auto refraction, silt lamp examination of the anterior segment, gonioscopy, fundoscopy using a 90D lens, and non-mydriatic fundus photographs (VX-10, Kowa Optimed, Tokyo, Japan). Patients with the following conditions were excluded from this study: best-corrected visual acuity < 20/40, IOP exceeding 21mmHg, cylinder correction + 3.0D, closed angle on gonioscopy, diagnosis of ophthalmologic disease that affects visual functions other than mild dysfunctional tear syndrome (Level 1 by the Delphi Panel Report),( 11 ) and history of ocular surgery other than uncomplicated cataract extraction or pterygium excisional surgery within 6 months. We used funduscopy and fundus images to classify patients into those with BMP and unaffected individuals with no specific structural changes on ONH. When both eyes from one case had a BMP eligible for the study or were unaffected (control subject), only 1 eye was chosen at random for inclusion. To determine the direction of the BMP, we divided the ONH into superior, inferior, nasal, and temporal quadrants in the same way as the 4 RNFL quadrants classification of Cirrus high-definition OCT (HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA). OCT Measurements Two high-definition image scans (HD 5-line raster protocol) in horizontal and vertical directions, and 3 consecutive peripapillary RNFL scans centered on the ONH (optic disc cube 200×200 protocol), were acquired by the same operator on the same day. The ONH and peripapillary RNFL thickness parameters were measured automatically using the RNFL and ONH analysis algorithms, respectively. The optic disc cube 200×200 program obtains ONH images through a 6×6×2 mm cube of data by means of 200×200 axial scans. From this data, the system extracts a B-scan in a 3.46-mm diameter circle, and the algorithm automatically detects the circle and positions around the ONH.( 12 ) After the anterior and posterior boundaries of the RNFL are detected, the system calculates the RNFL thickness at each point on the circle. The high-definition images were evaluated for the structural characteristics of BMP, and the following OCT parameters were analyzed for repeatability: the rim area, disc area, average cup to disc ratio, vertical cup to disc ratio, and cup volume for the ONH analysis, and the average, superior, inferior, temporal, and nasal quadrant thickness with the 12-clock-hour thickness for the peripapillary RNFL analysis. From here on, directions are described based on the right eye for convenience; 12 o’clock is the superior direction, 3 o’clock is the nasal side, 6 o’clock is the inferior direction, and 9 o’clock is the temporal side. Subjects with scans showing a signal strength < 6 or artifacts caused by eye movements or blinking were excluded from the study. Statistical Analysis To evaluate the effect of BMP on consecutive OCT scans (repeatability), three statistical analyses were performed: mean within subject standard deviation ( S w), which is the square root of the average of each variance, derived by one-way ANOVA; coefficient of variation (CoV), which is a percentage of the standard deviation divided by the mean; and intraclass correlation coefficient (ICC), which is centered and scaled using a pooled mean and standard deviation. For comparisons between the BMP and normal control groups, the tolerance index was used in the current study, as described by Bergin et al.( 13 ) In brief, this is computed as a log of the ratio between the repeatability from a pathological cohort and from the healthy population. The tolerance index, denoted as T is calculated using the equation: $$T{r}_{i}{= {\text{log}}_{n}\left(\frac{{r}_{{P}_{i}}}{{r}_{{H}_{i}}}\right)}_{ }$$ where r is the repeatability, i is the parameters of the OCT, and P and H correspond to the pathological cohort and healthy population, respectively. Therefore, a T value of 0 represents perfect alignment between the respective limits of repeatability, and the larger the difference from 0 the greater divergence between the limits. In addition, Bergin et al. documented cutoff values of T based on sample size, because the statistical significance of the divergence depends on the sample size. Differences in demographic and clinical characteristics between patients with BMP and unaffected individuals were assessed by one-way ANOVA and Chi-square test. We included Tukey and Scheffe tests for post-hoc analyses. The probability level for statistical significance was set at 5%. Data were recorded and analyzed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results BMP was confirmed by OCT scans in all subjects with raised glial tissue on the surface of the ONH by fundus examination and photographs. As a result of image analysis of the BMP by OCT, we classified cases into two main categories. First, is the lifting edge (LE) type where the BMP does not cover the entire ONH, but partially covers the corners, and a representative case of LE type is presented in Fig. 1 . The BMP rides up along the neuroretinal rim of the ONH in the raster scan, and the automatic segmentation of the internal limiting membrane (ILM) is raised in the area where the BMP is located. Second is the covering disc (CD) type, in which the BMP covers the entire cupping area of the ONH like a cap, and a representative case of CD type is shown in Fig. 2 . Cases where empty space was observed between the BMP and the anterior lamina tissue in the horizontal and vertical tomograms of the raster protocol and the optic disc cube protocol were classified as CD type. It can be seen that the automatic segmentation of the ILM (red line) is different from reality in the optic disc cube protocol. Overall, 159 eyes from 159 subjects (83 eyes with BMP and 76 normal control eyes) were included in this study. The demographic and quantitative measurements of ocular characteristics from the BMP and unaffected control groups are presented in Table 1 . The morphological classification of BMP showed the LE type was more common (n = 53 eyes) than the CD type (n = 30 eyes), and there was no significant difference in age, sex, best corrected visual acuity, spherical equivalent, and IOP between the 3 groups including the normal control group. For most CD types, topographical analysis was not performed because they spanned more than 3 quadrants, and for LE types, they were located more frequently in the nasal (35 eyes, 66.0%) quadrant than the inferonasal (8 eyes, 15.1%), inferior (5 eyes, 9.4%), superior (2 eyes, 3.8%), superonasal (2 eyes, 3.8%), and temporal (1 eye, 1.9%) quadrants of the ONH. Table 1 Demographic and ocular characteristics from the BMP and unaffected control groups Lifting edge type (n = 53) Covering disc type (n = 30) Control (n = 76) P a Age, mean (SD), years 52.9 (16.1) 52.4 (11.8) 49.8 (16.4) 0.513 Male Sex (%) 28 (52.8) 16 (53.3) 33 (43.4) 0.481 BCVA, mean (SD), logMAR 0.02 (0.05) 0.06 (0.25) 0.02 (0.05) 0.223 SE, mean (SD), Diopter -1.21 (2.51) -1.86 (2.23) -1.45 (2.22) 0.476 IOP, mean (SD), mmHg 15.72 (2.62) 16.22 (3.19) 15.77 (2.81) 0.715 Topographical distribution of BMP (%) Superior Superonasal Nasal Inferonasal Inferior Temporal 2 (3.8%) 2 (3.8%) 35 (66.0%) 8 (15.1%) 5 (9.4%) 1 (1.9%) N/A N/A N/A a ANOVA was performed for items excluding sex, and the chi-square test was performed for sex. BCVA: best corrected visual acuity, MAR: minimum angle of resolution, SE: spherical equivalent, IOP: intraocular pressure, BMP: Bergmeister papilla The OCT parameters are summarized in Table 2 . Among the ONH parameters, the average and vertical cup to disc ratios were significantly lower in the CD group than in the other groups ( P < 0.05). The cup volume was largest in the order LE, control, and CD groups, with a significant difference only between the CD and LE groups ( P < 0.05). No significant differences in the RNFL parameters including the 4 quadrant and the 12 clock-hour domain were observed between the three groups. Table 2 OCT parameters from the BMP and unaffected control groups Lifting edge (LE) type Covering disc (CD) type Control P Signal strength 6.55 6.51 6.53 0.944 Optic nerve head parameters Rim area, mean, mm 2 1.07 1.13 1.09 0.707 Disc area, mean, mm 2 2.07 1.91 2.06 0.177 Average C/D ratio 0.66 0.58 0.65 0.028 (LE vs CD: 0.041) a (CD vs Control: 0.040) a Vertical C/D ratio 0.64 0.55 0.62 0.019 (LE vs CD: 0.019) a (CD vs Control: 0.048) a Cup Volume, mean, mm 3 0.396 0.223 0.337 0.015 (LE vs CD: 0.011) a Retinal nerve fiber layer parameters, mean, µm Average thickness 87.61 85.30 88.30 0.556 Superior quadrant 107.94 108.54 111.31 0.644 Nasal quadrant 65.08 62.46 62.64 0.313 Inferior quadrant 110.01 103.54 112.00 0.205 Temporal quadrant 67.30 66.88 67.70 0.955 12 o’clock hour 107.35 113.93 113.07 0.486 1 o’clock hour 97.24 98.77 97.25 0.955 2 o’clock hour 76.05 72.82 73.23 0.508 3 o’clock hour 57.47 57.36 55.58 0.433 4 o’clock hour 61.64 56.94 59.07 0.141 5 o’clock hour 86.97 82.70 88.11 0.411 6 o’clock hour 118.33 109.98 115.96 0.451 7 o’clock hour 124.52 117.96 131.91 0.085 8 o’clock hour 71.32 69.76 68.23 0.593 9 o’clock hour 53.62 54.60 54.64 0.827 10 o’clock hour 78.13 76.31 79.14 0.751 11 o’clock hour 123.59 112.78 119.34 0.116 a Post-hoc analysis values using Tukey’s method. BMP: Bergmeister papilla, C/D: Cup to Disc The repeatability of the OCT parameters is presented in Table 3 . For the repeatability, the cup volume among ONH parameters of the LE type was different from that of the other groups. The cup volume measurements were as follows: control eyes (n = 76), S w = 0.022 and CoV = 6.59%; LE type of BMP eyes (n = 53), S w = 0.051 and CoV = 15.12%; CD type of BMP eyes (n = 30), S w = 0.022 and CoV = 9.78%. Tr values of Sw between control and BMP eyes were Log n (0.05/0.02) = 0.40 in the LE type and Log n (0.02/0.02) = 0 in the CD type. Tr values of CoV between control and BMP eyes were Log n (15.12/6.59) = 0.36 in the LE type and Log n (9.78/6.59) = 0.17 in the CD type. The respective Tr cutoffs according to the number of sample sizes were 0.22 and 0.26 between the control and LE groups and between the control and CD groups, respectively.( 13 ) Tr values of the CD type were smaller than the cutoff, whereas Tr values of the LE type were greater than the cutoff, indicating that the repeatability of cup volume measurements was significantly worse in eyes with the LE type of BMP. Among the RNFL parameters, only 4 o’clock hour thickness had worse repeatability in LE types compared with control eyes: Tr values of Sw and CoV were 0.27 (= Log n [6.56/3.52]) and 0.25 (= Log n [10.64/5.97]), respectively, whereas all Tr values obtained from the comparison of other RNFL parameters between control and BMP eyes were smaller than the cutoff value. Table 3 The repeatability of the OCT parameters from the BMP and unaffected control groups Lifting edge Covering disc type Control Sw CV ICC Sw CV ICC Sw CV ICC Optic nerve head parameters Rim area 0.07 6.07 0.830 0.05 4.31 0.985 0.07 6.35 0.889 Disc area 0.09 4.20 0.940 0.06 3.06 0.979 0.09 4.50 0.956 Average C/D ratio 0.02 2.79 0.983 0.02 3.16 0.992 0.02 2.56 0.969 Vertical C/D ratio 0.03 4.27 0.921 0.02 4.04 0.989 0.02 3.75 0.949 Cup Volume 0.051 b 15.12 a 0.965 0.022 9.78 0.990 0.022 6.59 0.990 Retinal nerve fiber layer parameters Average thickness 2.44 2.78 0.968 2.23 2.62 0.986 2.47 2.80 0.929 Superior quadrant 4.64 4.30 0.957 3.92 3.61 0.984 3.77 3.38 0.944 Nasal quadrant 4.46 6.82 0.880 3.67 5.93 0.872 2.93 4.65 0.907 Inferior quadrant 3.77 3.43 0.973 4.01 3.87 0.980 3.84 3.43 0.958 Temporal quadrant 2.13 3.16 0.967 1.97 2.95 0.990 2.14 3.16 0.959 12 o’clock hour 7.37 6.86 0.944 7.41 6.50 0.959 5.97 5.28 0.949 1 o’clock hour 5.49 5.64 0.950 6.17 6.25 0.967 6.50 6.68 0.906 2 o’clock hour 6.15 8.08 0.860 6.93 9.51 0.852 4.30 5.87 0.908 3 o’clock hour 4.00 6.96 0.873 4.39 7.66 0.765 3.63 6.52 0.811 4 o’clock hour 6.56 a 10.64 a 0.793 4.01 7.04 0.793 3.52 5.97 0.869 5 o’clock hour 5.37 6.18 0.940 4.16 5.03 0.961 5.35 6.07 0.895 6 o’clock hour 6.14 5.19 0.961 6.55 5.95 0.964 5.41 6.07 0.957 7 o’clock hour 5.99 4.81 0.957 6.77 5.74 0.970 6.22 4.71 0.952 8 o’clock hour 4.29 6.29 0.929 2.93 4.20 0.987 4.51 6.32 0.888 9 o’clock hour 2.27 4.16 0.929 2.16 3.96 0.981 1.76 3.29 0.960 10 o’clock hour 3.50 4.42 0.951 3.61 4.73 0.974 3.02 3.86 0.955 11 o’clock hour 7.17 6.01 0.928 6.2 5.50 0.959 5.15 4.17 0.936 a P < 0.05 compared with the control group. b P < 0.05 compared with the lifting edge group and the control group. Sw = Within-subject standard deviation, CV = Coefficient of variation, ICC = Intra correlation coefficient, C/D = Cup to Disc When comparing LE and CD types, only the cup volume had worse repeatability in LE compared with CD type eyes: Tr values of S w and CoV were 0.40 (= Log n [0.05/0.02]) and 0.19 (= Log n [15.12/9.78]), respectively. Because the sample sizes were 30 and 53, the corresponding Tr cutoff was 0.28.( 13 ) There was a significant change in repeatability based on the S w between the CD and LE types of BMP, whereas Tr was smaller than the cutoff based on the CoV. Regarding the ICC guidelines reported by Koo and Li,( 14 ) all the index values of the three groups were 0.75 or higher, indicating good agreement, but the rim area, 3, 4, 5, and 8 o’clock hour parameters of the control group, nasal quadrant, 2, 3, and 4 o’clock hour parameters of the CD type, and the rim area, nasal quadrant, 2, 3, and 4 o’clock hour parameters of the LE type were smaller than the excellent standard of 0.9. Discussion In this study, we investigated the characteristics of BMP and its effect on SD-OCT. BMP can be divided into a LE type, which lines up the neuroretinal rim in partial areas of the optic nerve, and a CD type, which presents with an empty space created by covering the entire cupping of ONH. The LE type was observed more frequently than the CD type, and the most common location was the nasal quadrant. It was confirmed that BMP could affect automatic segmentation of the ILM, although the overall effect on OCT was marginal. CD type could affect cup to disc ratio and cup volume measurements, and LE type could affect repeatability of cup volume and nasal RNFL parameters. To the best of our knowledge, we are unaware of previous reports in PubMed about the influence of the BMP on SD-OCT scans. Persistent hyaloid remnants are caused by incomplete atrophy of the hyaloid artery during embryonic life or at the beginning of postembryonic life, and the prevalence varies by study. In pediatric studies, a prevalence of 3% in mature infants (n = 100) and 95% in premature infants (n = 100) was reported using traditional ophthalmoscopy after pupil dilation,( 15 ) whereas a study using OCT reported a prevalence of 67.8% in myopic children born full-term with good growth and development.( 16 ) In studies of adults, the prevalence was 0.03–0.8% when using fundus photography( 17 , 18 ) and 50% using OCT,( 19 ) indicating this difference might be due to the better visualization of OCT at the vitreoretinal interface and posterior vitreous cortex. ( 19 ) 19 19 In addition, persistent BMP is not thought to be an uncommon ophthalmic condition because the prevalence was 32.14% (n = 162/504) in an autopsy study.( 20 ) There have been previous studies to classify the BMP based on histological characteristics by Jokl( 21 ) or features of regression on OCT images by Lin et al.,( 16 ) and these embryological classification may be useful for pediatric subjects. However, a case in 50s with asymptomatic BMP demonstrated optic nerve elevation with traction creating macular schisis on OCT has been reported,( 22 ) and it is impossible for the hyaloid artery to be absorbed further in adults. The purpose of this study was to analyze the effect of asymptomatic BMP found incidentally on OCT scans, and invasive biopsies cannot be performed in asymptomatic subjects; therefore, cases were divided into CD and LE types according to the presence of empty space between the BMP and ONH in the raster protocol. Among the ONH parameters, the disc area did not show a significant difference compared with the other groups, but the mean and vertical C/D ratio were significantly smaller in the CD group (Table 2 ), which means that the cup boundary was detected as smaller. A special algorithm is applied for auto-segmentation for each OCT device. For the Cirrus used in this study, the optic disc edge is determined by the termination of Bruch’s membrane, and the rim width around the circumference of the optic disc is determined by measuring the minimum cross section between the Bruch’s membrane opening and ILM. As shown in Fig. 2 , in the CD group, auto-segmentation of the ILM is affected by BMP, and although there was no statistically significant difference, the rim area quantification might be larger than the actual size. Because of this, the cup boundary may appear smaller than in other groups, and this small cup volume may be associated with segmentation errors of ILM. Although the C/D ratio may not have much clinical significance as a single indicator, it is necessary to consider the error factor because traditionally the ratio between cup and disc has been analyzed in glaucoma to diagnose a pathologic ONH and trend in the ratio to identify progression. It is important to be aware of factors that can affect repeatability, because the amount of measurement noise often changes with disease stage or pathology type.( 23 ) When comparing the average values of ONH parameters, the cup-related factors of the CD type differed from other groups, whereas in the repeatability comparison applying the concept of T , only the cup volume of the LE type showed lower repeatability. In the high-definition image scans, the LE type was attached to part of the disc and auto-segmentation of the ILM followed the BMP and showed a slight lift at the end of the vitreous cavity. Although quantitative analysis was not performed, the structural characteristics of the vitreous end of the BMP might be related to the lower repeatability of the LE type. For the comparison of RNFL parameters, only the 4 o’clock thickness of the LE type showed significantly low repeatability compared with control eyes, which might be related to the orientation in which the BMP is attached to the ONH. In our study, the BMP in > 90% LE types showed attachment to the nasal and inferior quadrants, and was rarely distributed in the superior and temporal quadrants even if superonasal (3.8%) direction was included in the superior quadrants. These findings are similar to the results observed by Roth et al.( 20 ) in autopsied eyes (74.5% in nasal quadrants and 24.2% in inferonasal quadrants), and Lin et al.( 16 ) who studied myopic children by swept-source OCT (72.2% in nasal quadrants and 22.39% in inferior quadrants of the ONH). This is associated with a low repeatability of the 4 o’clock thickness, corresponding to the nasal and inferior quadrants, where the BMP of the LE type are predominantly located. This study had some limitations. First, the findings were obtained from highly population-specific (Korean) subjects. Additional data acquisition and verification in different racial groups is needed for a more generalizable interpretation. Second, there were limitations in classification type or attachment direction analysis of BMP in this study because the morphological analysis was performed using a horizontal and vertical HD 5-line raster protocol. Although multiple raster scans in several different directions might have been a solution, additional OCT scans were practically limited in our study because at least 5 OCT scans were required, including horizontal and vertical raster scans for morphological analysis and three consecutive optic disc cube scans for evaluating repeatability. It is necessary to investigate a method for more detailed morphological analysis of BMP such as 3D reconstruction. In conclusion, this study classified asymptomatic BMPs into two types according to their morphological characteristics using OCT and demonstrated their effects on OCT parameters. Although it is difficult to demonstrate definite clinical significance, we confirmed that the BMP affected the auto-segmentation of the ILM in OCT scans. BMP, a remnant of the hyaloid tissue, might be a pitfall, and it is necessary to be careful when interpreting OCT data related to cup volume and nasal RNFL thickness when diagnosing and discriminating the progression of an optic nerve disease such as glaucoma. Declarations Acknowledgement and Funding Statement This research was supported by the Chung-Ang University Research Grants in 2022. (20220283) Author Contribution statement YSC was responsible for collecting the data and writing the paper. NJM was responsible for collecting data. USK was responsible for contributing the data and analysis tools. JHY was responsible for performing the analysis. 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Quantitative comparison of static perimetric strategies in early glaucoma: test-retest variability. J Glaucoma. 2000;9(3):247–53. Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Published Journal Publication published 18 Nov, 2023 Read the published version in Eye → Version 1 posted Editorial decision: revise 20 Feb, 2023 Review # 1 received at journal 13 Feb, 2023 Reviewer # 1 agreed at journal 27 Jan, 2023 Reviewers invited by journal 26 Jan, 2023 Editor assigned by journal 23 Jan, 2023 Submission checks completed at journal 05 Jan, 2023 First submitted to journal 26 Dec, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2414786","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":170945219,"identity":"51653f79-ff6e-4194-8da0-a46e18ab05b9","order_by":0,"name":"Yeoun Sook Chun","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yeoun","middleName":"Sook","lastName":"Chun","suffix":""},{"id":170945220,"identity":"f7a933b6-a3d2-4eb1-b78f-22bb587372d3","order_by":1,"name":"Nam Ju Moon","email":"","orcid":"","institution":"College of Medicine, Chung-Ang University Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nam","middleName":"Ju","lastName":"Moon","suffix":""},{"id":170945221,"identity":"e53206f3-83ce-4591-8a28-10fd30de05be","order_by":2,"name":"Ungsoo Samuel Kim","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ungsoo","middleName":"Samuel","lastName":"Kim","suffix":""},{"id":170945222,"identity":"17c4651c-1276-4fd0-b57c-e32a07b047fc","order_by":3,"name":"Joon Hyung Yeo","email":"","orcid":"","institution":"College of Medicine, Chung-Ang University Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Joon","middleName":"Hyung","lastName":"Yeo","suffix":""},{"id":170945223,"identity":"f168603b-e927-4123-a2d4-e2a9a812ea34","order_by":4,"name":"Jae Hoon Jeong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACxvYexocfKg6AOQceEKWl5wyzscQZqJYEIMFDUI9EDpsEbxtECwNRWpgbcg9ISM67I28udvgh0JY7cvYEHdZwLsGgcNszw52z0wyAWp4ZE7SFsbHHIEFy22HGDbcTQFoOJ/YQ1NLMY3CAd85h+w230z+AtNQT1tLGY9jA23A4ccPtHLAtCYQd1sNjzCxx7HAyUEvBgQSDw4Y9BwhoMZz/xvznh5rDtkCHbf7woeKwPHsDIS2oCgwIuQoI5IlQMwpGwSgYBSMdAAB1WEqZRkEOLQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-7311-7080","institution":"Chung-Ang University Gwangmyeong Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jae","middleName":"Hoon","lastName":"Jeong","suffix":""}],"badges":[],"createdAt":"2022-12-26 06:31:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2414786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2414786/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41433-023-02818-z","type":"published","date":"2023-11-18T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":32235869,"identity":"f9d29474-547c-40e7-bb87-3a8cfe2a033f","added_by":"auto","created_at":"2023-01-30 22:38:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2145030,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative case of the lifting edge type of Bergmeister papilla.\u003c/p\u003e\n\u003cp\u003e(A) Fundus photograph of the right eye with a Bergmeister papilla superonasal to the optic disc. (B) Horizontal (upper image) and vertical (lower image) high-definition optical coherence tomography images show the persistent hyaloid remnant tissue rides up along the neuroretinal rim of the optic disc (arrows). (C) Three consecutive optic disc cube scans centered on the optic disc show the automatic segmentation of the internal limiting membrane (red line) is raised in the area where the BMP is located (empty arrows).\u003c/p\u003e","description":"","filename":"FigLE02.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2414786/v1/665f1082f8efe31ffed2b39e.jpg"},{"id":32235267,"identity":"1319901a-ded7-46b9-ba80-0d606610a485","added_by":"auto","created_at":"2023-01-30 22:30:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1487226,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative case of the covering disc type of Bergmeister papilla.\u003c/p\u003e\n\u003cp\u003e(A) Fundus photograph of the left eye with a Bergmeister papilla. (B) Horizontal (upper image) and vertical (lower image) high-definition optical coherence tomography images show the persistent hyaloid remnant tissue covers the entire cupping area of the optic disc like a cap. (C) The identification of the neuroretinal rim in the nasal (arrows) and superior (empty arrows) directions is affected by the Bergmeister papilla, so the automatic segmentation of the internal limiting membrane (red line) appears different from reality in three consecutive optic disc cube scans. Empty spaces (asterisk) are identified between the BMP and the anterior lamina tissue when using the raster protocol and the optic disc cube protocol.\u003c/p\u003e","description":"","filename":"FigCD03.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2414786/v1/10916382a5a7098b6b801652.jpg"},{"id":46719545,"identity":"4d6c089f-07bf-434f-a713-48d44d6503a5","added_by":"auto","created_at":"2023-11-19 08:19:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":620664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2414786/v1/0c767582-4bea-4c08-a938-1b64dad94b1d.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBergmeister papilla (BMP) is a remnant of the hyaloid artery fibrous sheath, which is usually asymptomatic and is observed incidentally during fundus examinations. It is characterized by avascular prepapillary veils and epipapillary membranes. It was reported that various types of BMP can be observed by fundus examination.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) However, analysis of the morphological characteristics of BMP using optical coherence tomography (OCT) or the effect of BMP on OCT has not been fully clarified.\u003c/p\u003e \u003cp\u003eCurrently, OCT is invaluable for assessing the structural changes of eyes with pathologic conditions, because it provides quantitative and noninvasive \u003cem\u003ein vivo\u003c/em\u003e measurements of the macula and optic nerve head (ONH) parameters.(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) In addition, the recent introduction of spectral-domain (SD) OCT has improved image resolution, image speed, and sensitivity;(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) however, there are still many potential artifacts in OCT imaging. The causes of these artifacts in OCT measurements are related to ocular pathologic features and non-ocular errors including technician or software errors.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Epiretinal membrane, posterior vitreous detachment, retinoschisis, high myopia, and media opacities are previously reported representative ocular pathologic features that can cause segmentation errors in OCT imaging.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, BMP can be a pitfall in the interpretation of the clinical data in OCT, because it is closely attached to the surface of the ONH. The purpose of this study was to demonstrate the characteristics of BMP based on SD-OCT and to evaluate its influence on disc and peripapillary retinal nerve fiber layer (RNFL) parameters in SD-OCT. In particular, we focused on the repeatability of OCT measurements.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003eThis was a prospective cross-sectional observational study. The Institutional Review Board of the Konyang University Hospital, Daejeon, Korea approved the protocol and the consent form for this study (IRB No. KYUH 2021-07-013-001). We performed all procedures in accordance with the tenets of the World Medical Association\u0026rsquo;s Declaration of Helsinki, and written informed consent was obtained from all subjects.\u003c/p\u003e \u003cp\u003eStudy Subjects\u003c/p\u003e \u003cp\u003eSubjects were recruited from patients referred to an outpatient clinic for further ophthalmologic evaluation by the Health Screening Center, Konyang University Hospital, Daejeon, Korea between July 2021 and June 2022. All subjects underwent a complete initial ophthalmic examination, including best-corrected visual acuity, intraocular pressure (IOP) by a Goldmann applanation tonometer, noncycloplegic auto refraction, silt lamp examination of the anterior segment, gonioscopy, fundoscopy using a 90D lens, and non-mydriatic fundus photographs (VX-10, Kowa Optimed, Tokyo, Japan). Patients with the following conditions were excluded from this study: best-corrected visual acuity\u0026thinsp;\u0026lt;\u0026thinsp;20/40, IOP exceeding 21mmHg, cylinder correction \u0026lt; \u0026minus;\u0026thinsp;3.0D or \u0026gt;\u0026thinsp;+\u0026thinsp;3.0D, closed angle on gonioscopy, diagnosis of ophthalmologic disease that affects visual functions other than mild dysfunctional tear syndrome (Level 1 by the Delphi Panel Report),(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and history of ocular surgery other than uncomplicated cataract extraction or pterygium excisional surgery within 6 months.\u003c/p\u003e \u003cp\u003eWe used funduscopy and fundus images to classify patients into those with BMP and unaffected individuals with no specific structural changes on ONH. When both eyes from one case had a BMP eligible for the study or were unaffected (control subject), only 1 eye was chosen at random for inclusion. To determine the direction of the BMP, we divided the ONH into superior, inferior, nasal, and temporal quadrants in the same way as the 4 RNFL quadrants classification of Cirrus high-definition OCT (HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA).\u003c/p\u003e \u003cp\u003eOCT Measurements\u003c/p\u003e \u003cp\u003eTwo high-definition image scans (HD 5-line raster protocol) in horizontal and vertical directions, and 3 consecutive peripapillary RNFL scans centered on the ONH (optic disc cube 200\u0026times;200 protocol), were acquired by the same operator on the same day. The ONH and peripapillary RNFL thickness parameters were measured automatically using the RNFL and ONH analysis algorithms, respectively.\u003c/p\u003e \u003cp\u003eThe optic disc cube 200\u0026times;200 program obtains ONH images through a 6\u0026times;6\u0026times;2 mm cube of data by means of 200\u0026times;200 axial scans. From this data, the system extracts a B-scan in a 3.46-mm diameter circle, and the algorithm automatically detects the circle and positions around the ONH.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) After the anterior and posterior boundaries of the RNFL are detected, the system calculates the RNFL thickness at each point on the circle.\u003c/p\u003e \u003cp\u003eThe high-definition images were evaluated for the structural characteristics of BMP, and the following OCT parameters were analyzed for repeatability: the rim area, disc area, average cup to disc ratio, vertical cup to disc ratio, and cup volume for the ONH analysis, and the average, superior, inferior, temporal, and nasal quadrant thickness with the 12-clock-hour thickness for the peripapillary RNFL analysis. From here on, directions are described based on the right eye for convenience; 12 o\u0026rsquo;clock is the superior direction, 3 o\u0026rsquo;clock is the nasal side, 6 o\u0026rsquo;clock is the inferior direction, and 9 o\u0026rsquo;clock is the temporal side. Subjects with scans showing a signal strength\u0026thinsp;\u0026lt;\u0026thinsp;6 or artifacts caused by eye movements or blinking were excluded from the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eTo evaluate the effect of BMP on consecutive OCT scans (repeatability), three statistical analyses were performed: mean within subject standard deviation (\u003cem\u003eS\u003c/em\u003ew), which is the square root of the average of each variance, derived by one-way ANOVA; coefficient of variation (CoV), which is a percentage of the standard deviation divided by the mean; and intraclass correlation coefficient (ICC), which is centered and scaled using a pooled mean and standard deviation. For comparisons between the BMP and normal control groups, the tolerance index was used in the current study, as described by Bergin et al.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) In brief, this is computed as a log of the ratio between the repeatability from a pathological cohort and from the healthy population. The tolerance index, denoted as \u003cem\u003eT\u003c/em\u003e is calculated using the equation:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$T{r}_{i}{= {\\text{log}}_{n}\\left(\\frac{{r}_{{P}_{i}}}{{r}_{{H}_{i}}}\\right)}_{ }$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cem\u003er\u003c/em\u003e is the repeatability, \u003cem\u003ei\u003c/em\u003e is the parameters of the OCT, and \u003cem\u003eP\u003c/em\u003e and \u003cem\u003eH\u003c/em\u003e correspond to the pathological cohort and healthy population, respectively. Therefore, a \u003cem\u003eT\u003c/em\u003e value of 0 represents perfect alignment between the respective limits of repeatability, and the larger the difference from 0 the greater divergence between the limits. In addition, Bergin et al. documented cutoff values of \u003cem\u003eT\u003c/em\u003e based on sample size, because the statistical significance of the divergence depends on the sample size.\u003c/p\u003e \u003cp\u003eDifferences in demographic and clinical characteristics between patients with BMP and unaffected individuals were assessed by one-way ANOVA and Chi-square test. We included Tukey and Scheffe tests for post-hoc analyses. The probability level for statistical significance was set at 5%. Data were recorded and analyzed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBMP was confirmed by OCT scans in all subjects with raised glial tissue on the surface of the ONH by fundus examination and photographs. As a result of image analysis of the BMP by OCT, we classified cases into two main categories. First, is the lifting edge (LE) type where the BMP does not cover the entire ONH, but partially covers the corners, and a representative case of LE type is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The BMP rides up along the neuroretinal rim of the ONH in the raster scan, and the automatic segmentation of the internal limiting membrane (ILM) is raised in the area where the BMP is located. Second is the covering disc (CD) type, in which the BMP covers the entire cupping area of the ONH like a cap, and a representative case of CD type is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Cases where empty space was observed between the BMP and the anterior lamina tissue in the horizontal and vertical tomograms of the raster protocol and the optic disc cube protocol were classified as CD type. It can be seen that the automatic segmentation of the ILM (red line) is different from reality in the optic disc cube protocol.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOverall, 159 eyes from 159 subjects (83 eyes with BMP and 76 normal control eyes) were included in this study. The demographic and quantitative measurements of ocular characteristics from the BMP and unaffected control groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The morphological classification of BMP showed the LE type was more common (n\u0026thinsp;=\u0026thinsp;53 eyes) than the CD type (n\u0026thinsp;=\u0026thinsp;30 eyes), and there was no significant difference in age, sex, best corrected visual acuity, spherical equivalent, and IOP between the 3 groups including the normal control group. For most CD types, topographical analysis was not performed because they spanned more than 3 quadrants, and for LE types, they were located more frequently in the nasal (35 eyes, 66.0%) quadrant than the inferonasal (8 eyes, 15.1%), inferior (5 eyes, 9.4%), superior (2 eyes, 3.8%), superonasal (2 eyes, 3.8%), and temporal (1 eye, 1.9%) quadrants of the ONH.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and ocular characteristics from the BMP and unaffected control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLifting edge type\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCovering disc type\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.9 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.8 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Sex (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA, mean (SD), logMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06 (0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSE, mean (SD), Diopter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.21 (2.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.86 (2.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.45 (2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOP, mean (SD), mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.72 (2.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.22 (3.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.77 (2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTopographical distribution of BMP (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior\u003c/p\u003e \u003cp\u003eSuperonasal\u003c/p\u003e \u003cp\u003eNasal\u003c/p\u003e \u003cp\u003eInferonasal\u003c/p\u003e \u003cp\u003eInferior\u003c/p\u003e \u003cp\u003eTemporal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.8%)\u003c/p\u003e \u003cp\u003e2 (3.8%)\u003c/p\u003e \u003cp\u003e35 (66.0%)\u003c/p\u003e \u003cp\u003e8 (15.1%)\u003c/p\u003e \u003cp\u003e5 (9.4%)\u003c/p\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e ANOVA was performed for items excluding sex, and the chi-square test was performed for sex.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBCVA: best corrected visual acuity, MAR: minimum angle of resolution, SE: spherical equivalent, IOP: intraocular pressure, BMP: Bergmeister papilla\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe OCT parameters are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the ONH parameters, the average and vertical cup to disc ratios were significantly lower in the CD group than in the other groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The cup volume was largest in the order LE, control, and CD groups, with a significant difference only between the CD and LE groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences in the RNFL parameters including the 4 quadrant and the 12 clock-hour domain were observed between the three groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOCT parameters from the BMP and unaffected control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLifting edge (LE) type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCovering disc (CD) type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignal strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eOptic nerve head parameters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRim area, mean, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc area, mean, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage C/D ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003cp\u003e(LE vs CD: 0.041) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(CD vs Control: 0.040) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical C/D ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003cp\u003e(LE vs CD: 0.019) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(CD vs Control: 0.048) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCup Volume, mean, mm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003cp\u003e(LE vs CD: 0.011) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eRetinal nerve fiber layer parameters, mean, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasal quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInferior quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemporal quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e Post-hoc analysis values using Tukey\u0026rsquo;s method.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMP: Bergmeister papilla, C/D: Cup to Disc\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe repeatability of the OCT parameters is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. For the repeatability, the cup volume among ONH parameters of the LE type was different from that of the other groups. The cup volume measurements were as follows: control eyes (n\u0026thinsp;=\u0026thinsp;76), \u003cem\u003eS\u003c/em\u003ew\u0026thinsp;=\u0026thinsp;0.022 and CoV\u0026thinsp;=\u0026thinsp;6.59%; LE type of BMP eyes (n\u0026thinsp;=\u0026thinsp;53), \u003cem\u003eS\u003c/em\u003ew\u0026thinsp;=\u0026thinsp;0.051 and CoV\u0026thinsp;=\u0026thinsp;15.12%; CD type of BMP eyes (n\u0026thinsp;=\u0026thinsp;30), \u003cem\u003eS\u003c/em\u003ew\u0026thinsp;=\u0026thinsp;0.022 and CoV\u0026thinsp;=\u0026thinsp;9.78%. \u003cem\u003eTr\u003c/em\u003e values of Sw between control and BMP eyes were Log\u003csub\u003en\u003c/sub\u003e(0.05/0.02)\u0026thinsp;=\u0026thinsp;0.40 in the LE type and Log\u003csub\u003en\u003c/sub\u003e(0.02/0.02)\u0026thinsp;=\u0026thinsp;0 in the CD type. \u003cem\u003eTr\u003c/em\u003e values of CoV between control and BMP eyes were Log\u003csub\u003en\u003c/sub\u003e(15.12/6.59)\u0026thinsp;=\u0026thinsp;0.36 in the LE type and Log\u003csub\u003en\u003c/sub\u003e(9.78/6.59)\u0026thinsp;=\u0026thinsp;0.17 in the CD type. The respective \u003cem\u003eTr\u003c/em\u003e cutoffs according to the number of sample sizes were 0.22 and 0.26 between the control and LE groups and between the control and CD groups, respectively.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) \u003cem\u003eTr\u003c/em\u003e values of the CD type were smaller than the cutoff, whereas \u003cem\u003eTr\u003c/em\u003e values of the LE type were greater than the cutoff, indicating that the repeatability of cup volume measurements was significantly worse in eyes with the LE type of BMP. Among the RNFL parameters, only 4 o\u0026rsquo;clock hour thickness had worse repeatability in LE types compared with control eyes: \u003cem\u003eTr\u003c/em\u003e values of Sw and CoV were 0.27 (=\u0026thinsp;Log\u003csub\u003en\u003c/sub\u003e[6.56/3.52]) and 0.25 (=\u0026thinsp;Log\u003csub\u003en\u003c/sub\u003e[10.64/5.97]), respectively, whereas all \u003cem\u003eTr\u003c/em\u003e values obtained from the comparison of other RNFL parameters between control and BMP eyes were smaller than the cutoff value.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe repeatability of the OCT parameters from the BMP and unaffected control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLifting edge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eCovering disc type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eOptic nerve head parameters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRim area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage C/D ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertical C/D ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCup Volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.051\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.12\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eRetinal nerve fiber layer parameters\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNasal quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInferior quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemporal quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.56 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.64 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11 o\u0026rsquo;clock hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with the control group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003eb\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with the lifting edge group and the control group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eSw\u0026thinsp;=\u0026thinsp;Within-subject standard deviation, CV\u0026thinsp;=\u0026thinsp;Coefficient of variation, ICC\u0026thinsp;=\u0026thinsp;Intra correlation coefficient, C/D\u0026thinsp;=\u0026thinsp;Cup to Disc\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen comparing LE and CD types, only the cup volume had worse repeatability in LE compared with CD type eyes: \u003cem\u003eTr\u003c/em\u003e values of \u003cem\u003eS\u003c/em\u003ew and CoV were 0.40 (=\u0026thinsp;Log\u003csub\u003en\u003c/sub\u003e[0.05/0.02]) and 0.19 (=\u0026thinsp;Log\u003csub\u003en\u003c/sub\u003e[15.12/9.78]), respectively. Because the sample sizes were 30 and 53, the corresponding \u003cem\u003eTr\u003c/em\u003e cutoff was 0.28.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) There was a significant change in repeatability based on the \u003cem\u003eS\u003c/em\u003ew between the CD and LE types of BMP, whereas \u003cem\u003eTr\u003c/em\u003e was smaller than the cutoff based on the CoV.\u003c/p\u003e \u003cp\u003eRegarding the ICC guidelines reported by Koo and Li,(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) all the index values of the three groups were 0.75 or higher, indicating good agreement, but the rim area, 3, 4, 5, and 8 o\u0026rsquo;clock hour parameters of the control group, nasal quadrant, 2, 3, and 4 o\u0026rsquo;clock hour parameters of the CD type, and the rim area, nasal quadrant, 2, 3, and 4 o\u0026rsquo;clock hour parameters of the LE type were smaller than the excellent standard of 0.9.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated the characteristics of BMP and its effect on SD-OCT. BMP can be divided into a LE type, which lines up the neuroretinal rim in partial areas of the optic nerve, and a CD type, which presents with an empty space created by covering the entire cupping of ONH. The LE type was observed more frequently than the CD type, and the most common location was the nasal quadrant. It was confirmed that BMP could affect automatic segmentation of the ILM, although the overall effect on OCT was marginal. CD type could affect cup to disc ratio and cup volume measurements, and LE type could affect repeatability of cup volume and nasal RNFL parameters. To the best of our knowledge, we are unaware of previous reports in PubMed about the influence of the BMP on SD-OCT scans.\u003c/p\u003e \u003cp\u003ePersistent hyaloid remnants are caused by incomplete atrophy of the hyaloid artery during embryonic life or at the beginning of postembryonic life, and the prevalence varies by study. In pediatric studies, a prevalence of 3% in mature infants (n\u0026thinsp;=\u0026thinsp;100) and 95% in premature infants (n\u0026thinsp;=\u0026thinsp;100) was reported using traditional ophthalmoscopy after pupil dilation,(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) whereas a study using OCT reported a prevalence of 67.8% in myopic children born full-term with good growth and development.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) In studies of adults, the prevalence was 0.03\u0026ndash;0.8% when using fundus photography(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and 50% using OCT,(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) indicating this difference might be due to the better visualization of OCT at the vitreoretinal interface and posterior vitreous cortex. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) \u003csup\u003e19 19\u003c/sup\u003e In addition, persistent BMP is not thought to be an uncommon ophthalmic condition because the prevalence was 32.14% (n\u0026thinsp;=\u0026thinsp;162/504) in an autopsy study.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThere have been previous studies to classify the BMP based on histological characteristics by Jokl(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) or features of regression on OCT images by Lin et al.,(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and these embryological classification may be useful for pediatric subjects. However, a case in 50s with asymptomatic BMP demonstrated optic nerve elevation with traction creating macular schisis on OCT has been reported,(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and it is impossible for the hyaloid artery to be absorbed further in adults. The purpose of this study was to analyze the effect of asymptomatic BMP found incidentally on OCT scans, and invasive biopsies cannot be performed in asymptomatic subjects; therefore, cases were divided into CD and LE types according to the presence of empty space between the BMP and ONH in the raster protocol.\u003c/p\u003e \u003cp\u003eAmong the ONH parameters, the disc area did not show a significant difference compared with the other groups, but the mean and vertical C/D ratio were significantly smaller in the CD group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which means that the cup boundary was detected as smaller. A special algorithm is applied for auto-segmentation for each OCT device. For the Cirrus used in this study, the optic disc edge is determined by the termination of Bruch\u0026rsquo;s membrane, and the rim width around the circumference of the optic disc is determined by measuring the minimum cross section between the Bruch\u0026rsquo;s membrane opening and ILM. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, in the CD group, auto-segmentation of the ILM is affected by BMP, and although there was no statistically significant difference, the rim area quantification might be larger than the actual size. Because of this, the cup boundary may appear smaller than in other groups, and this small cup volume may be associated with segmentation errors of ILM. Although the C/D ratio may not have much clinical significance as a single indicator, it is necessary to consider the error factor because traditionally the ratio between cup and disc has been analyzed in glaucoma to diagnose a pathologic ONH and trend in the ratio to identify progression.\u003c/p\u003e \u003cp\u003eIt is important to be aware of factors that can affect repeatability, because the amount of measurement noise often changes with disease stage or pathology type.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) When comparing the average values of ONH parameters, the cup-related factors of the CD type differed from other groups, whereas in the repeatability comparison applying the concept of \u003cem\u003eT\u003c/em\u003e, only the cup volume of the LE type showed lower repeatability. In the high-definition image scans, the LE type was attached to part of the disc and auto-segmentation of the ILM followed the BMP and showed a slight lift at the end of the vitreous cavity. Although quantitative analysis was not performed, the structural characteristics of the vitreous end of the BMP might be related to the lower repeatability of the LE type.\u003c/p\u003e \u003cp\u003eFor the comparison of RNFL parameters, only the 4 o\u0026rsquo;clock thickness of the LE type showed significantly low repeatability compared with control eyes, which might be related to the orientation in which the BMP is attached to the ONH. In our study, the BMP in \u0026gt;\u0026thinsp;90% LE types showed attachment to the nasal and inferior quadrants, and was rarely distributed in the superior and temporal quadrants even if superonasal (3.8%) direction was included in the superior quadrants. These findings are similar to the results observed by Roth et al.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) in autopsied eyes (74.5% in nasal quadrants and 24.2% in inferonasal quadrants), and Lin et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) who studied myopic children by swept-source OCT (72.2% in nasal quadrants and 22.39% in inferior quadrants of the ONH). This is associated with a low repeatability of the 4 o\u0026rsquo;clock thickness, corresponding to the nasal and inferior quadrants, where the BMP of the LE type are predominantly located.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, the findings were obtained from highly population-specific (Korean) subjects. Additional data acquisition and verification in different racial groups is needed for a more generalizable interpretation. Second, there were limitations in classification type or attachment direction analysis of BMP in this study because the morphological analysis was performed using a horizontal and vertical HD 5-line raster protocol. Although multiple raster scans in several different directions might have been a solution, additional OCT scans were practically limited in our study because at least 5 OCT scans were required, including horizontal and vertical raster scans for morphological analysis and three consecutive optic disc cube scans for evaluating repeatability. It is necessary to investigate a method for more detailed morphological analysis of BMP such as 3D reconstruction.\u003c/p\u003e \u003cp\u003eIn conclusion, this study classified asymptomatic BMPs into two types according to their morphological characteristics using OCT and demonstrated their effects on OCT parameters. Although it is difficult to demonstrate definite clinical significance, we confirmed that the BMP affected the auto-segmentation of the ILM in OCT scans. BMP, a remnant of the hyaloid tissue, might be a pitfall, and it is necessary to be careful when interpreting OCT data related to cup volume and nasal RNFL thickness when diagnosing and discriminating the progression of an optic nerve disease such as glaucoma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement and Funding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Chung-Ang University Research Grants in 2022. (20220283)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYSC was responsible for collecting the data and writing the paper. NJM was responsible for collecting data. USK was responsible for contributing the data and analysis tools. JHY was responsible for performing the analysis. JHJ was responsible for conceiving and designing the analysis. All authors discussed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflict of interest.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLloyd RI. Variations in the Development and Regression of Bergmeister's Papilla and the Hyaloid Artery. Trans Am Ophthalmol Soc. 1940;38:326\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetersen HP. Persistence of the Bergmeister papilla with glial overgrowth. Various diagnostic problems. Acta Ophthalmol (Copenh). 1968;46(3):430\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaffe GJ, Caprioli J. Optical coherence tomography to detect and manage retinal disease and glaucoma. 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Curr Opin Ophthalmol. 2012;23(2):79\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehrens A, Doyle JJ, Stern L, Chuck RS, McDonnell PJ, Azar DT, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. 2006;25(8):900\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavini G, Carbonelli M, Barboni P. Spectral-domain optical coherence tomography for the diagnosis and follow-up of glaucoma. Curr Opin Ophthalmol. 2011;22(2):115\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergin C, Guber I, Hashemi K, Majo F. Tolerance and Relative Utility: Two Proposed Indices for Comparing Change in Clinical Measurement Noise Between Different Populations (Repeatability) or Measurement Methods (Agreement). Invest Ophthalmol Vis Sci. 2015;56(9):5543\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones HE. Hyaloid Remnants in the Eyes of Premature Babies. Br J Ophthalmol. 1963;47:39\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin Q, Deng J, Ohno-Matsui K, He X, Xu X. The Existence and Regression of Persistent Bergmeister's Papilla in Myopic Children Are Associated With Axial Length. Transl Vis Sci Technol. 2021;10(13):4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakino S. Prevalence of Bergmeister Papilla. Scholars Journal of Applied Medical Sciences. 2015;3(2C):682\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassi ST, George R, Sen S, Asokan R, Lingam V. Prevalence of the optic disc anomalies in the adult South Indian population. Br J Ophthalmol. 2019;103(1):94\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu JJ, Witkin AJ, Adhi M, Grulkowski I, Kraus MF, Dhalla AH, et al. Enhanced vitreous imaging in healthy eyes using swept source optical coherence tomography. PLoS One. 2014;9(7):e102950.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoth AM, Foos RY. Surface structure of the optic nerve head. 1. Epipapillary membranes. Am J Ophthalmol. 1972;74(5):977\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBedell AJ, Jokl A. Epipapillary tissues. Trans Am Ophthalmol Soc. 1954;52:291\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkateswaran N, Moster SJ, Goldhagen BE. Bergmeister Papilla With Overlying Traction. JAMA Ophthalmol. 2019;137(9):e185915.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpry PG, Henson DB, Sparrow JM, North RV. Quantitative comparison of static perimetric strategies in early glaucoma: test-retest variability. J Glaucoma. 2000;9(3):247\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2414786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2414786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e To demonstrate the morphological characteristics of Bergmeister papilla (BMP), a persistent hyaloid remnant tissue, and its effects on the measurements and repeatability of spectral domain optical coherence tomography (OCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A prospective cross-sectional study was used to collect 83 patients with BMP and 76 age-matched unaffected individuals from a tertiary care institution. Imaging including 5-line raster and 3 consecutive optic disc cube scans centered on the optic disc were acquired using the Cirrus HD-OCT. Structural characteristics of BMP were classified according to the images of raster scans, and the repeatability of optic nerve head and retinal nerve fiber layer parameters was analyzed by calculating the test-retest standard deviation, coefficient of variance, and intraclass correlation coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBMP was categorized into lifting edge (LE) type where does not cover the entire optic nerve head, but partially covers the corners, and covering disc (CD) type in which covers the entire cupping area like a cap. Among the BMP of 83 eyes, 58 (63.9%) were lifting edge type and 33 (36.1%) were CD type, and some of the optic nerve head parameters in OCT showed significant differences between the CD and LE types and normal control eyes. The analysis of repeatability showed that eyes with LE types affected cup volume and nasal retinal nerve fiber layer parameters and correlated with BMP location.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Because BMP might be a pitfall in OCT imaging, it is necessary to be careful when interpreting OCT in an eye with BMP.\u003c/p\u003e","manuscriptTitle":"Effect of Bergmeister papilla on disc parameters in spectral domain optical coherence tomography","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-30 22:30:38","doi":"10.21203/rs.3.rs-2414786/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2023-02-20T09:43:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2023-02-13T12:26:58+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2023-01-27T15:26:16+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2023-01-26T16:55:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-23T15:21:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-01-05T12:47:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Eye","date":"2022-12-26T06:29:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3ff5f678-bd94-4bfc-bd99-b82f2440274a","owner":[],"postedDate":"January 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":18725152,"name":"Health sciences/Signs and symptoms/Eye manifestations"},{"id":18725153,"name":"Health sciences/Diseases/Eye diseases"}],"tags":[],"updatedAt":"2023-11-19T08:19:17+00:00","versionOfRecord":{"articleIdentity":"rs-2414786","link":"https://doi.org/10.1038/s41433-023-02818-z","journal":{"identity":"eye","isVorOnly":false,"title":"Eye"},"publishedOn":"2023-11-18 05:00:00","publishedOnDateReadable":"November 18th, 2023"},"versionCreatedAt":"2023-01-30 22:30:38","video":"","vorDoi":"10.1038/s41433-023-02818-z","vorDoiUrl":"https://doi.org/10.1038/s41433-023-02818-z","workflowStages":[]},"version":"v1","identity":"rs-2414786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2414786","identity":"rs-2414786","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}