Combining Information From 3 Anatomic Regions in the Diagnosis of Glaucoma With Time-Domain Optical Coherence Tomography

Abstract

Purpose To improve the diagnosis of glaucoma by combining time-domain optical coherence tomography (TD-OCT) measurements of the optic disc, circumpapillary retinal nerve fiber layer (RNFL), and macular retinal thickness. Patients and Methods Ninety-six age-matched normal and 96 perimetric glaucoma participants were included in this observational, cross-sectional study. Or-logic, support vector machine (SVM), relevance vector machine (RVM), and linear discrimination function (LDF) were used to analyze the performances of combined TD-OCT diagnostic variables. Results The area under the receiver operating curve (AROC) was used to evaluate the diagnostic accuracy and to compare the diagnostic performance of single and combined anatomic variables. The best RNFL thickness variables were the inferior (AROC=0.900), overall (AROC=0.892), and superior quadrants (AROC=0.850). The best optic disc variables were horizontal integrated rim width (AROC=0.909), vertical integrated rim area (AROC=0.908), and cup/disc vertical ratio (AROC=0.890). All macular retinal thickness variables had AROCs of 0.829 or less. Combining the top 3 RNFL and optic disc variables in optimizing glaucoma diagnosis, SVM had the highest AROC, 0.954, followed by or-logic (AROC=0.946), LDF (AROC=0.946), and RVM (AROC=0.943). All combination diagnostic variables had significantly larger AROCs than any single diagnostic variable. There are no significant differences among the combination diagnostic indices. Conclusions With TD-OCT, RNFL and optic disc variables had better diagnostic accuracy than macular retinal variables. Combining top RNFL and optic disc variables significantly improved diagnostic performance. Clinically, or-logic classification was the most practical analytical tool with sufficient accuracy to diagnose early glaucoma.

Combining Spectral Domain Optical Coherence Tomography Structural Parameters for the Diagnosis of Glaucoma With Early Visual Field Loss

“…Indeed, using a group of patients at all stages of disease severity in the development of the underlying structure would tend to avoid restricting the range in the test measures and therefore attenuating correlations among variables that can result in falsely low estimates of factor loadings. 34 In contrast to our study, most previous studies [9][10][11][12][23][24][25][26]30,31 included patients with all spectra of glaucoma severity, but did not provide the diagnostic performance for early glaucoma. Because the performance of glaucoma diagnostic devices is often dependent on disease severity, the glaucoma performances reported in those studies would have been lower if the analysis was restricted to early glaucoma.…”

Regression Analysis of Optical Coherence Tomography Disc Variables for Glaucoma Diagnosis

“…Analysis of AIG Study data showed that combining RNFL, GCC, and ONH measurements can improve diagnostic accuracy. 37 It is possible that the combined diagnostic index could be further improved by incorporating BMO-MRW.…”

Macular Ganglion Cell/Inner Plexiform Layer Measurements by Spectral Domain Optical Coherence Tomography for Detection of Early Glaucoma and Comparison to Retinal Nerve Fiber Layer Measurements

“…The utility of combining various OCT parameters has been previously explored with both time-domain and spectral-domain OCTs. 33-35 The study by Huang et al used linear discriminant function for combining various OCT parameters. These findings need to be implemented in clinical software on current SD-OCT machines so that the full potential of combining various structural measures can be verified and used.…”