Identifying early glaucoma with optical coherence tomography

Nouri‐Mahdavi, Kouros; Hoffman, Douglas; Tannenbaum, Dana P.; Law, Simon K.; Caprioli, Joseph

doi:10.1016/j.ajo.2003.09.004

Cited by 158 publications

(91 citation statements)

References 19 publications

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“…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 nerve damage seems to begin in the inferotemporal or superotemporal area. [22][23][24] It is logical that optimal glaucoma detection might best employ a combination of several parameters.…”

supporting

confidence: 75%

“…It will also be used in comparative studies with parameters generated by other instruments, such as scanning laser topography and scanning laser polarimetry. Previous comparative studies used only the best single parameter to evaluate the diagnostic performance of OCT. 10,11,13,14,16,17,[19][20][21] This underestimates the diagnostic power of OCT. The OSI combination will significantly improve OCT's diagnostic performance in both clinical studies and clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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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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supporting

confidence: 75%

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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“…[5][6][7][8] Most of this research was based on the peripapillary thickness of the RNFL. New scanning areas for detecting glaucoma with OCT have been studied recently, especially the ONH and the macula.…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL), the morphology of the optic nerve head (ONH), or both can be measured with several instruments such as confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography (OCT). [4][5][6] Macular RGCs are thought to be another target for scanning to detect early glaucomatous damage; however, in the present time it fails to detect early glaucomatous changes. 7,8 Ophthalmoscopic estimation of the vertical cup-to-disc ratio (VCDR) of the optic nerve head is important in the management and follow-up of patients with glaucoma or glaucoma suspects, and has been found to correlate with global visual field indices.…”

Section: Introductionmentioning

confidence: 99%

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Arnalich‐Montiel¹,

Muñoz-Negrete²,

Rebolleda³

et al. 2006

Eye

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Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement AbstractPurpose To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs). Methods Twenty-five ocular hypertensive subjects and 56 patients with primary openangle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cupto-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference. Results The mean VCDR and HCDR was significantly higher (Po0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher (Po0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland-Altman method, as the cupping increased, the agreement also increased. Conclusions There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.

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“…14,18,28,29 NouriMahdavi et al 29 described that in early glaucoma, with their group average MD of -2.9 dB, no correlation was found between MD/PSD and RNFL average thickness using the OCT 2000 (Carl Zeiss Meditec). Ajtony et al 14 reported that no structure-function correlation was detected in POAG eyes with PSD o1.9 dB and RNFL average thickness above 70 mm.…”

Section: Eyementioning

confidence: 99%

Correlation of localized glaucomatous visual field defects and spectral domain optical coherence tomography retinal nerve fiber layer thinning using a modified structure–function map for OCT

Boer

Chen

et al. 2015

Eye

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Purpose To study the correlation between glaucomatous visual field (VF) defects assessed by standard automated perimetry (SAP) and peripapillary retinal nerve fiber layer (RNFL) thinning measured by spectral domain optical coherence tomography (OCT) using a modified OCT-based peripapillary RNFL structure-function map. Patients and methods Perimetric glaucoma patients and age-matched normal control subjects were recruited from a university hospital clinic. All eyes underwent testing with the Spectralis spectral domain OCT and SAP on the same day. An OCT-based correspondence map, which correlated VF areas with peripapillary RNFL sectors was created to evaluate the relationship between glaucomatous RNFL thinning and VF loss in six nerve fiber layer bundle areas. Correlations of RNFL thinning with corresponding VF defects were examined using Spearman rankorder correlations. To demonstrate the association between localized VF defects and RNFL thickness, the theoretical curves were made according to an established log-linear model. The measured RNFL thickness values and VF defects were presented in the same scatterplot for each sector. Results Fifty-six glaucoma patients and 85 normal subjects were included in the study.Significant association between localized VF loss and RNFL thinning was found in corresponding areas. Data from the current study fit well with established log-linear models, which compare RNFL thickness values with VF defects. Conclusion Analysis of RNFL thinning in eyes with localized glaucomatous VF defects showed good structure-function correlation in a new OCT-based structure-function correspondence map.

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Identifying early glaucoma with optical coherence tomography

Cited by 158 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

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Correlation of localized glaucomatous visual field defects and spectral domain optical coherence tomography retinal nerve fiber layer thinning using a modified structure–function map for OCT

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