Combining Nerve Fiber Layer Parameters to Optimize Glaucoma Diagnosis with Optical Coherence Tomography

doi:10.1016/j.ophtha.2008.01.011

Ophthalmology

Volume 115, Issue 8, August 2008, Pages 1352-1357.e2

https://doi.org/10.1016/j.ophtha.2008.01.011 Get rights and content

Purpose

To identify the best combination of Stratus optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness parameters for the detection of glaucoma.

Design

Observational cross-sectional study.

Participants

Eighty-nine age-matched normal and perimetric glaucoma participants enrolled in the Advanced Imaging for Glaucoma Study.

Methods

The Zeiss Stratus OCT system was used to obtain the circumpapillary RNFL thickness in both eyes of each participant. Right and left eye clock-hour data are analyzed together, assuming mirror-image symmetry. The RNFL diagnostic parameters were combined using either or-logic or and-logic approaches.

Main Outcome Measures

Area under the receiver operating characteristic curve (AROC), sensitivity, and specificity are used to evaluate diagnostic performance.

Results

Overall average RNFL thickness has the highest AROC value (0.89) of all single parameters evaluated, followed by the inferior and superior quadrants (0.88 and 0.86, respectively). The clock hours with the best AROC values are in the inferior and superior quadrants. The highest AROC (0.92) was achieved by the or-logic combination of overall, inferior, and superior quadrant RNFL thicknesses. The 3-parameter combination was significantly better than the overall average alone (P = 0.01). The addition of more quadrants or clock hours to the combination reduced diagnostic performance.

Conclusions

The best stand-alone diagnostic strategy for Stratus OCT RNFL data is to classify an eye as glaucomatous if the overall, inferior quadrant, or superior quadrant RNFL thickness average is below normal.

Section snippets

Study Population and Database

This investigation is based on the Advanced Imaging for Glaucoma Study (AIGS), a multicenter bioengineering partnership and clinical study sponsored by the National Eye Institute, part of the National Institutes of Health. All study procedures adhered to the principles outlines in the Declaration of Helsinki for research involving human subjects. Written informed consent was obtained from all participants. Institutional review board/ethics committee approval was obtained from the institutional

Results

Analyses were performed on 89 normal and 89 PG age-matched participants selected from a database of 99 normal (194 eyes) and 132 PG (196 eyes) participants. The characteristics of the selected study populations are listed in Table 1 (available at http://aaojournal.org). There were not significant differences between the normal and PG groups in terms of age and gender. There were more Caucasians in the normal group. However, there was no significant difference between the racial groups in terms

Discussion

Stratus OCT is a valuable aid in differentiating glaucomatous from normal eyes.19, 20, 31, 32, 33, 34, 35, 36, 37, 38, 39 Optical coherence tomography provides objective, quantitative, reproducible measurements of RNFL thickness.11, 19 Compared with VF testing, OCT scanning demands little effort from the patients and thus eliminates subjective performance variations and increases testing reliability and reproducibility. However, Stratus OCT does not provide a single diagnostic parameter that

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Citation Excerpt :
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: Manuscript no. 2007-1048.

: Drs Huang and Schuman receive royalties from the Massachusetts Institute of Technology derived from an optical coherence tomography patent licensed to Carl Zeiss Meditec. Dr Huang has research grants from, stock options in, a consulting relationship with, travel support from, and potential patent royalty interest in Optovue, Inc.

: Supported by the National Institute of Health, Bethesda, Maryland (grant nos. R01 EY013516, P30 EY03040), and a grant from Research to Prevent Blindness, New York, New York.

^⁎: See http://www.AIGStudy.net.

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Original articleCombining Nerve Fiber Layer Parameters to Optimize Glaucoma Diagnosis with Optical Coherence Tomography

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Study Population and Database

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy

Arch Ophthalmol

Optical coherence tomography

Science

Technique for detecting serial topographic changes in the optic disc and peripapillary retina using scanning laser tomography

Invest Ophthalmol Vis Sci

Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes

Invest Ophthalmol Vis Sci

Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using Stratus OCT

Invest Ophthalmol Vis Sci

Optical coherence tomography machine learning classifiers for glaucoma detection: a preliminary study

Invest Ophthalmol Vis Sci

Comparing glaucomatous optic neuropathy in primary open angle and chronic primary angle closure glaucoma eyes by optical coherence tomography

Ophthalmic Physiol Opt

Optical coherence tomography: a new tool for glaucoma diagnosis

Curr Opin Ophthalmol

Original article
Combining Nerve Fiber Layer Parameters to Optimize Glaucoma Diagnosis with Optical Coherence Tomography