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Clinical science
Combined structure–function analysis in glaucoma screening
  1. Elina Karvonen1,2,3,
  2. Katri Stoor1,2,
  3. Marja Luodonpää1,2,
  4. Pasi Hägg1,2,
  5. Ilmari Leiviskä1,2,
  6. Johanna Liinamaa1,2,
  7. Anja Tuulonen4,
  8. Ville Saarela1,2
  1. 1 Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
  2. 2 PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
  3. 3 Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  4. 4 Tays Eye Centre, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Elina Karvonen, Department of Ophthalmology, Oulu University Hospital, Oulu, Finland; elina.karvonen{at}fimnet.fi

Abstract

Aim To assess the applicability of a structure–function (S-F) analysis combining spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in glaucoma screening in a middle-aged population.

Methods A randomised sample of 3001 Caucasian participants aged 45–49 years of the Northern Finland Birth Cohort Eye Study was examined. We performed an eye examination, including 24–2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive ‘2 out of 3’ rule based on the clinician’s evaluation of ONH and RNFL photographs and visual fields (VFs).

Results At a specificity of 97.5%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones.

Conclusion SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.

  • diagnostic tests/investigation
  • epidemiology
  • glaucoma
  • imaging

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bjophthalmol-2021-319178

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors EK was the corresponding author. EK, KS, ML, PH and AT were involved in the diagnostic protocol. IL assisted in data management and analyses. JL and VS supervise the Northern Finland Birth Cohort Eye Study. AT and VS designed the study and contributed to editing the manuscript.

    • Funding The Oulu University Hospital grant number 24301140, Oulu, Finland; The University of Oulu grant number 24000692, Oulu, Finland; ERDF European Regional Development Fund grant number 539/2010 A31592, Brussels, Belgium; Competitive State Research Funding of Tampere University Hospital, Tampere, Finland (no grant number available); Glaukooma Tukisäätiö (Glaucoma Support) Lux Foundation, Helsinki, Finland (no grant number available); Sokeain Ystävät (Friends of Blind Persons) Foundation, Helsinki, Finland (no grant number available); Silmäsäätiö (Eye) Foundation, Helsinki, Finland (no grant number available); Association of the Finnish Ophthalmologists, Helsinki, Finland (no grant number available); The sponsor or funding organisation had no role in the design or conduct of this research. No conflicting relationship exists for any author.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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