Comparison of data analysis tools for detection of glaucoma with the heidelberg retina tomograph

Ford, Bryce; Artes, Paul H.; McCormick, Terry A.; Nicolela, Marcelo T.; LeBlanc, Raymond P.; Chauhan, Balwantray C.

doi:10.1016/s0161-6420(03)00230-6

Cited by 110 publications

(79 citation statements)

References 19 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Lu¹,

Wang²,

Varma³

et al. 2008

Ophthalmology

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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.Glaucoma is an optic neuropathy characterized by irreversible loss of neural tissue and visual field (VF). Currently, definitive glaucoma diagnosis is based on VF testing. However, between 30% and 50% of the ganglion cells may be lost before abnormalities appear in perimetric Optical coherence tomography, first described by Huang et al, 4 is the only imaging modality with sufficiently fine depth resolution to measure the RNFL thickness directly. Measurements of the circumpapillary RNFL are reproducible 7-9 and useful in the early diagnosis of glaucoma. [10][11][12][13][14][15][16][17][18][19] Stratus (Carl Zeiss Meditec, Inc., Dublin, CA) is the most widely used OCT system for glaucoma diagnosis. Stratus measures the RNFL thickness profile along a 3.4-mm-diameter circle around the optic disc. Based on the profile, the averages of overall, quadrant, and clockhour RNFL thickness are computed and displayed. At present, the clinician has no clear guideline on whether one, several, or all of these diagnostic parameters should be used in the clinical diagnosis of glaucoma. Based on the area under the receiver operating characteristic curve (AROC), some studies have shown the overall RNFL thickness average to be the best diagnostic parameter. 11,13,14,16,19 Other studies have shown the inferior 10,17,20 or superior 21 quadrant RNFL thickness average to be the best, in agreement with clinical observation that glaucomatous optic...

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Section: Discussionmentioning

confidence: 99%

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

Lu¹,

Wang²,

Varma³

et al. 2008

Ophthalmology

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“…Finally, the research of Ford et al (17) shows a sensitivity of 58% and specificity of 96% when comparing normal subjects and those suspect of suffering glaucoma with glaucomatous subjects, and a sensitivity of 78% and specificity of 81% when comparing normal subjects with suspect and glaucomatous subjects.…”

Section: Discussionmentioning

confidence: 94%

Análisis de la distribución de anillo neurorretiniano por sectores mediante láser confocal de barrido en el diagnóstico del glaucoma

Pueyo

Larrosa

Polo

et al. 2006

Arch Soc Esp Oftalmol

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Purpose: To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser. Methods: 200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects -MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector. Results: The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity ORIGINAL ARTICLE RESUMEN Objetivos: Valorar la capacidad diagnóstica del análisis de la distribución de anillo neurorretiniano por sectores (regresión de Moorfields, MRA), medido mediante láser confocal de barrido. Material y métodos: Se estudiaron 200 ojos, de los cuales 101 eran normales y 99 glaucomas clasificados por una perimetría automatizada convencional con defectos glaucomatosos (DM o DSPC con p<2% o grupo de 3 puntos con p<5% o 2 con p<1% o Glaucoma Hemifield Test alterado). A todos ellos se les realizó exploración oftalmológica completa, PA Humphrey 24-2 umbral completo y una topografía papilar con HRT-II. Se calculó la especificidad y la sensibilidad de los resultados de la clasificación MRA para cada uno de los sectores. Resultados: Se observó mayor sensibilidad para detectar defectos estructurales basados en MRA (p<0,05) en los sectores nasal superior (48%) y nasal inferior (45%), mientras que la mayor especificidad se encontró en los sectores temporal superior (98%) e inferior (98%

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“…Other studies have suggested that when the same strategy is applied to a new population, the diagnostic precision is not as good. 40,41 HRT descriminating precision is influenced by disc size, with larger discs more precisely discriminated than smaller discs. 37,41 HRT performance has been compared to stereo optic disc photography.…”

Section: Hrtmentioning

confidence: 99%

Image analysis of optic nerve disease

Burgoyne¹

2004

Eye

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Existing methodologies for imaging the optic nerve head surface topography and measuring the retinal nerve fibre layer thickness include confocal scanning laser ophthalmoscopy (Heidelberg retinal tomograph), optical coherence tomography, and scanning laser polarimetry. For cross-sectional screening of patient populations, all three approaches have achieved sensitivities and specificities within the 60-80th percentile in various studies, with occasional specificities greater than 90% in select populations. Nevertheless, these methods are not likely to provide useful assistance for the experienced examiner at their present level of performance. For longitudinal change detection in individual patients, strategies for clinically specific change detection have been rigorously evaluated for confocal scanning laser tomography only. While these initial studies are encouraging, applying these algorithms in larger numbers of patients is now necessary. Future directions for these technologies are likely to include ultrahigh resolution optical coherence tomography, the use of neural network/machine learning classifiers to improve clinical decision-making, and the ability to evaluate the susceptibility of individual optic nerve heads to potential damage from a given level of intraocular pressure or systemic blood pressure. Definition of termsThere are at present two principal tasks for these imaging systems. First, cross-sectional screening, in which an eye is imaged initially with the intention of detecting the presence of glaucomatous optic nerve damage. Second, longitudinal change detection, in which an eye that is already known to be at risk is imaged on multiple occasions over time with the intention of detecting change or progressive damage. Current instruments Heidelberg retinal tomographThe Heidelberg retinal tomograph (HRT) is a confocal scanning laser ophthalmoscope (CSLO) that uses a 670 nm diode laser to obtain a series of two-dimensional optical section images of the ONH and peripapillary retina. A threedimensional topographic image of the ONH surface is then built from the series of 16-64 serial optical sections, when algorithms are used to find the surface at each of 256 Â 256 (HRT I) or 384 Â 384 (HRT II) pixels over a 10 or 151 field of view. The HRT II automatically captures three consecutive 151 images and from these generates a mean topographic image.To process images, the optic disc margin (anterior scleral canal opening) is defined by a contour line placed around the inner margin of the peripapillary scleral ring. The standard reference plane for volumetric parameter calculation is then automatically determined as 50 mm posterior to the mean peripapillary retinal height along the contour line between 350 and 3561; however, the reference plane

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Comparison of data analysis tools for detection of glaucoma with the heidelberg retina tomograph

Cited by 110 publications

References 19 publications

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

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

Análisis de la distribución de anillo neurorretiniano por sectores mediante láser confocal de barrido en el diagnóstico del glaucoma

Image analysis of optic nerve disease

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