3D morphometry of the human optic nerve head.

Human optic nerve head (ONH) anatomy is of interest in glaucoma. Our goal was to carry out a morphometric study of the human ONH based on 3D reconstructions from histologic sections. A set of 10 human ONHs (from four pairs of eyes plus two singles) were reconstructed in an iterative procedure that required the resulting geometries to satisfy a set of quality control criteria. Five models corresponded to eyes fixed at 5 mmHg and the other five models to eyes fixed at 50 mmHg. Several aspects of ONH morphology were measured based on surface and point landmarks: the thicknesses of the lamina cribrosa (LC), the peripapillary sclera and the pre-laminar neural tissue (peripapillary and within the cup); the minimum distance between the anterior surface of the LC and the subarachnoid space; the surface area of the anterior and posterior surfaces of the LC; and the diameter of the scleral canal opening. Our results showed that about one third of the anterior LC surface was obscured from view from the front by the sclera. In all eyes the LC inserted into the pia mater, and not only into the sclera. The variations in ONH morphology between eyes of a pair exceeded, or were of the same order as, changes in morphology due to acute changes in IOP. The reconstruction and morphometry techniques introduced are suitable for application to the ONH. Comparison of measurements in eyes fixed at different pressures suggested small effects on geometry of the increase in IOP. A large variability in ONH morphology, even between contralateral eyes of different IOP, was observed. We conclude that reconstruction of human ONH anatomy from 3D histology is possible, but that large inter-individual anatomic variations make morphometric analysis of the ONH very difficult in the absence of large sample numbers. The insertion of the pia mater into the LC may have biomechanical implications and should be further investigated. Emerging clinical imaging techniques such as deep-scanning OCT will be limited to investigation of the central and mid-peripheral regions of the LC due to optical "occluding" by the peripapillary sclera.