Retinal Nerve Fiber Layer Imaging with Spectral-domain Optical Coherence Tomography

Leung, Christopher Kai-Shun; Yu, Marco; Weinreb, Robert N.; Lai, Gilda; Xu, Guihua; Lam, Dennis S C

doi:10.1016/j.ophtha.2012.03.044

Cited by 173 publications

(125 citation statements)

References 24 publications

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“…13,22 Imaging-based quantitative measurements have diagnostic utility [23][24][25][26][27][28][29] and numerous publications support the ability of imaging-based measurements to identify glaucoma deterioration. [30][31][32][33][34][35][36][37][38][39][40] Progressive structural change has been shown to be useful as a predictor of subsequent VF loss. 41,42 The ability of imaging to detect deterioration has been compared with that of VF testing, controlling for the false-positive rate of the chosen progression criteria.…”

Section: Trial Registrationmentioning

confidence: 99%

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

Garway-Heath

Zhu

Qian

et al. 2018

Health Technol Assess

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Background Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision (‘progression’) challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT). Objective To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials. Design Method ‘hit rate’ (related to sensitivity) was evaluated in subsets of the United Kingdom Glaucoma Treatment Study (UKGTS) and specificity was evaluated in 72 stable glaucoma patients who had 11 VF and OCT tests within 3 months (the RAPID data set). The reference progression detection method was based on Guided Progression Analysis™ (GPA) Software (Carl Zeiss Meditec Inc., Dublin, CA, USA). Index methods were based on previously described approaches [Analysis with Non-Stationary Weibull Error Regression and Spatial enhancement (ANSWERS), Permutation analyses Of Pointwise Linear Regression (PoPLR) and structure-guided ANSWERS (sANSWERS)] or newly developed methods based on Permutation Test (PERM), multivariate hierarchical models with multiple imputation for censored values (MaHMIC) and multivariate generalised estimating equations with multiple imputation for censored values (MaGIC). Setting Ten university and general ophthalmology units (UKGTS) and a single university ophthalmology unit (RAPID). Participants UKGTS participants were newly diagnosed glaucoma patients randomised to intraocular pressure-lowering drops or placebo. RAPID participants had glaucomatous VF loss, were on treatment and were clinically stable. Interventions 24-2 VF tests with the Humphrey Field Analyzer and optic nerve imaging with time-domain (TD) Stratus OCT™ (Carl Zeiss Meditec Inc., Dublin, CA, USA). Main outcome measures Criterion hit rate and specificity, time to progression, future VF prediction error, proportion progressing in UKGTS treatment groups, hazard ratios (HRs) and study sample size. Results Criterion specificity was 95% for all tests; the hit rate was 22.2% for GPA, 41.6% for PoPLR, 53.8% for ANSWERS and 61.3% for sANSWERS (all comparisons p ≤ 0.042). Mean survival time (weeks) was 93.6 for GPA, 82.5 for PoPLR, 72.0 for ANSWERS and 69.1 for sANSWERS. The median prediction errors (decibels) when the initial trend was used to predict the final VF were 3.8 (5th to 95th percentile 1.7 to 7.6) for PoPLR, 3.0 (5th to 95th percentile 1.5 to 5.7) for ANSWERS and 2.3 (5th to 95th percentile 1.3 to 4.5) for sANSWERS. HRs were 0.57 [95% confidence interval (CI) 0.34 to 0.90; p = 0.016] for GPA, 0.59 (95% CI 0.42 to 0.83; p = 0.002) for PoPLR, 0.76 (95% CI 0.56 to 1.02; p = 0.065) for ANSWERS and 0.70 (95% CI 0.53 to 0.93; p = 0.012) for sANSWERS. Sample size estimates were not reduced using methods including OCT data. PERM hit rates were between 8.3% and 17.4%. Treatment effects were non-significant in MaHMIC and MaGIC analyses; statistical significance was altered little by incorporating imaging. Limitations TD OCT is less precise than current imaging technology; current OCT technology would likely perform better. The size of the RAPID data set limited the precision of criterion specificity estimates. Conclusions The sANSWERS method combining VF and OCT data had a higher hit rate and identified progression more quickly than the reference and other VF-only methods, and produced more accurate estimates of the progression rate, but did not increase treatment effect statistical significance. Similar studies with current OCT technology need to be undertaken and the statistical methods need refinement. Trial registration Current Controlled Trials ISRCTN96423140. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 4. See the NIHR Journals Library website for further project information. Data analysed in the study were from the UKGTS. Funding for the UKGTS was provided through an unrestricted investigator-initiated research grant from Pfizer Inc. (New York, NY, USA), with supplementary funding from the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. Imaging equipment loans were made by Heidelberg Engineering, Carl Zeiss Meditec and Optovue (Fremont, CA, USA). Pfizer, Heidelberg Engineering, Carl Zeiss Meditec and Optovue had no input into the design, conduct, analysis or reporting of any of the UKGTS findings or this work. The sponsor for both the UKGTS and RAPID data collection was Moorfields Eye Hospital NHS Foundation Trust. David F Garway-Heath, Tuan-Anh Ho and Haogang Zhu are partly funded by the NIHR Biomedical Research Centre based at Moorfields Eye Hospital and UCL Institute of Ophthalmology. David F Garway-Heath’s chair at University College London (UCL) is supported by funding from the International Glaucoma Association.

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Section: Trial Registrationmentioning

confidence: 99%

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

Garway-Heath

Zhu

Qian

et al. 2018

Health Technol Assess

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“…Therefore, the results of the present study suggest that changes of depth are more marked than those of area, especially for localized defects of mild-to-earlymoderate severity. Additionally, these results can provide hints to the explanation of the fact that deepening is less often detected than widening in clinical practice [3,4]. The data suggests that change of the depth develops mostly in localized mild RNFL defects, thus it is less noticeable than the change of the area.…”

Section: Discussionmentioning

confidence: 74%

“…The data suggests that change of the depth develops mostly in localized mild RNFL defects, thus it is less noticeable than the change of the area. Since previous studies had offered only little information in this regard [3,4], further longitudinal studies on RNFL defect progression patterns according to baseline depth and area may confirm this speculation.…”

Section: Discussionmentioning

confidence: 90%

“…As a three-dimensional (3-D) structure, the RNFL can be characterized by both depth (the vertical element on the z-axis) and area (the horizontal elemental on the x-y axis) [2]. Correlation between the two parameters is of clinical importance, since this approach can facilitate understanding of the predominant pattern of the RNFL change along various stages of the disease [3,4]. Despite a recent study showing that the area of defect is a sensitive parameter for determination of RNFL progression in moderate-toadvanced glaucoma [5], little is known about change of depth.…”

Section: Introductionmentioning

confidence: 99%

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Correlation between depth and area of retinal nerve fiber layer defect as measured by spectral domain optical coherence tomography

Suh

Yoo

Park

et al. 2015

Graefes Arch Clin Exp Ophthalmol

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“…Recently, a number of studies [2][3][4] have demonstrated the ability of spectral domain (SD OCT) in detecting progressive disease using the trend analysis of the guided progression analysis on the Cirrus Ò OCT. Most of these studies have been done prospectively over 2-3 years, and demonstrate that the rate of RNFL thickness loss is more in progressors on visual fields compared to nonprogressors, albeit with poor agreement between structural and functional progression.…”

Section: Introductionmentioning

confidence: 99%

Comparison of event-based analysis of glaucoma progression assessed subjectively on visual fields and retinal nerve fibre layer attenuation measured by optical coherence tomography

et al. 2014

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The purpose is to study the ability of an event-based analysis of retinal nerve fibre layer (RNFL) attenuation measured by Stratus(®) optical coherence tomography (OCT) and to detect progression across the spectrum of glaucoma. Adult glaucoma suspects, ocular hypertensives and glaucoma patients who had undergone baseline RNFL thickness measurement on Stratus OCT and reliable automated visual field examination by Humphrey's visual field analyser prior to March 2007 and had 5-year follow-up data were recruited. Progression on OCT was defined by two criteria: decrease in average RNFL thickness from baseline by at least 10 and 20 µ. Visual field progression was defined by the modified Hodapp-Parrish-Anderson criteria. Absolute and percentage change in RNFL thickness from baseline was compared in progressors and non-progressors on visual fields. Concordance between structural and functional progression was analysed. 318 eyes of 162 patients were analysed. 35 eyes (11 %) progressed by visual fields, 8 (2.5 %) progressed using the 20 µ loss criterion, while 30 eyes (9.4 %) progressed using the 10 µ loss criterion. In glaucoma suspects, mean absolute RNFL attenuation was 8.6 µ (12.1 % of baseline) in those who progressed to glaucoma by visual fields. OCT was more useful to detect progression in early glaucoma, but performed poorly in advanced glaucoma. The 10 µ criterion appears to be closer to visual field progression. However, the ability to detect progression varies considerably between functional and structural tools depending upon the severity of the disease.

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Retinal Nerve Fiber Layer Imaging with Spectral-domain Optical Coherence Tomography

Cited by 173 publications

References 24 publications

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

Correlation between depth and area of retinal nerve fiber layer defect as measured by spectral domain optical coherence tomography

Comparison of event-based analysis of glaucoma progression assessed subjectively on visual fields and retinal nerve fibre layer attenuation measured by optical coherence tomography

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