Summary of Glaucoma Diagnostic Testing Accuracy: An Evidence-Based Meta-Analysis

Ahmed, Suza; Khan, Zainab; Si, Francie; Mao, Alex; Pan, Irene; Yazdi, Fatemeh; Tsertsvadze, Alexander; Hutnik, Cindy; Moher, David; Tingey, David P.; Trope, Graham E.; Damji, Karim F.; Tarride, Jean‐Éric; Goeree, Ron; Hodge, William

doi:10.14740/jocmr2643w

Cited by 14 publications

(8 citation statements)

References 27 publications

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“…The majority of previous reviews have limited inclusion criteria to those patients who have exclusively undergone standard automated perimetry. Our approach enabled the inclusion of 150 OCT studies, markedly larger than previous meta-analyses; a Cochrane review by Michelessi et al[ 181 ] identified 63 OCT studies, Fallon et al[ 185 ] identified 47 studies, Ahmed et al[ 182 ] identified 84 studies, and Oddone et al[ 183 ] identified 34 studies. The larger number of studies included enabled a more robust meta-analysis and the analyses of several patient subgroups.…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography for glaucoma diagnosis: An evidence based meta-analysis

et al. 2018

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PurposeEarly detection, monitoring and understanding of changes in the retina are central to the diagnosis of glaucomatous optic neuropathy, and vital to reduce visual loss from this progressive condition. The main objective of this investigation was to compare glaucoma diagnostic accuracy of commercially available optical coherence tomography (OCT) devices (Zeiss Stratus, Zeiss Cirrus, Heidelberg Spectralis and Optovue RTVue, and Topcon 3D-OCT).Patients16,104 glaucomatous and 11,543 normal eyes reported in 150 studies.MethodsBetween Jan. 2017 and Feb 2017, MEDLINE®, EMBASE®, CINAHL®, Cochrane Library®, Web of Science®, and BIOSIS® were searched for studies assessing glaucoma diagnostic accuracy of the aforementioned OCT devices. Meta-analysis was performed pooling area under the receiver operating characteristic curve (AUROC) estimates for all devices, stratified by OCT type (RNFL, macula), and area imaged.Results150 studies with 16,104 glaucomatous and 11,543 normal control eyes were included. Key findings: AUROC of glaucoma diagnosis for RNFL average for all glaucoma patients was 0.897 (0.887–0.906, n = 16,782 patient eyes), for macula ganglion cell complex (GCC) was 0.885 (0.869–0.901, n = 4841 eyes), for macula ganglion cell inner plexiform layer (GCIPL) was 0.858 (0.835–0.880, n = 4211 eyes), and for total macular thickness was 0.795 (0.754–0.834, n = 1063 eyes).ConclusionThe classification capability was similar across all 5 OCT devices. More diagnostically favorable AUROCs were demonstrated in patients with increased glaucoma severity. Diagnostic accuracy of RNFL and segmented macular regions (GCIPL, GCC) scans were similar and higher than total macular thickness. This study provides a synthesis of contemporary evidence with features of robust inclusion criteria and large sample size. These findings may provide guidance to clinicians when navigating this rapidly evolving diagnostic area characterized by numerous options.

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Section: Discussionmentioning

confidence: 99%

Optical coherence tomography for glaucoma diagnosis: An evidence based meta-analysis

et al. 2018

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“…Glaucomatous progression can be assessed by structural testing, such as measuring the peripapillary RNFL thickness with spectral domain optical coherence tomography (SD-OCT)5–7 and/or functional testing with perimetry (VF testing). However, the correlation between these two types of measurements generally is poor.…”

Section: Introductionmentioning

confidence: 99%

Contrast-to-Noise Ratios for Assessing the Detection of Progression in the Various Stages of Glaucoma

Majoor

Vermeer

Andrinopoulou

et al. 2019

Trans. Vis. Sci. Tech.

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Purpose We determine the contrast-to-noise ratios (CNRs) of structural and functional measurements to assess their sensitivity to detect progression in the various stages of glaucoma. Methods We calculated the CNRs for the mean peripapillary retinal nerve fiber layer (RNFL) thickness measured by spectral domain optical coherence tomography, and the mean deviation (MD) and visual field index (VFI) determined by standard automated perimetry for the transitions between five stages. Longitudinal data from healthy and glaucomatous eyes from a prospective study were used. Contrast was defined as the change in the mean value of the parameter between two successive stages. Noise was defined as the variability of the parameter and calculated from the residuals of linear regression on the data from five subsequent visits per eye. Results We studied 205 eyes from 125 participants (46% men, 54% women). CNRs for different parameters varied considerably across the range of disease severity (0.8–12.2). The RNFL thickness had a higher CNR in the transition from normal to mild glaucoma (12.2) compared to the CNRs of the functional measures (MD 4.1, VFI 4.5). The CNRs for the functional measures were higher in the transition from moderate to advanced (MD 5.2, VFI 5.8) and advanced to severe glaucoma (MD 7.2, VFI 5.8) compared to the RNFL thickness (CNR 0.8 and 3.2, respectively). Conclusions The RNFL thickness is more sensitive for detecting glaucomatous progression at the onset of glaucoma compared to the functional measures, while the latter are more sensitive for detecting progression in the later stages of glaucoma. Translational Relevance The CNR method can be used to determine which measurement is most sensitive for detecting progression in glaucoma, differentiated for the severity of the disease. Furthermore, it creates a basic toolset for determining the most sensitive measurement in detecting progression not only in glaucoma, but other (ophthalmic) diseases as well.

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“…Anti-glaucoma surgery can be classified into two types: Procedures that facilitate the outflow of the aqueous humor, including aqueous humor shunts, and trabecular, goniotomy and iridotomy surgeries; and procedures that reduce aqueous humor secretion by destroying cells of the ciliary body, such as cyclocryotherapy and cyclophotocoagulation (11). However, the former group of procedures is flawed, due to scarring problems and their limited long-term effects, while the latter group lacks precise control and can only be utilized for patients with absolute glaucoma who have already lost their vision (12)(13)(14)(15). Therefore, there is an urgent need to develop more safe and effective therapeutic approaches for glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Study of minimally invasive radiofrequency ablation of the ciliary body for the treatment of glaucoma in rabbits

Hou

Jin

et al. 2019

Mol Med Report

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The aim of the present study was to explore the safety and effectiveness of radiofrequency ablation (rFa) of the ciliary body for the treatment of glaucoma. a glaucoma model was established in new Zealand white rabbits, which were then treated with rFa of the ciliary body, utilizing an Xl-1-type rF meter developed by the chinese Pla General Hospital. after treatment, general ocular investigation, including ocular pressure was carried out, the anterior chamber was imaged via ultrasound biomicroscopy, and the pathological changes were observed via hematoxylin and eosin (H&e) staining. it was determined that the glaucoma model was successfully established in the new Zealand white rabbit by inducing high intraocular pressure (ioP). after rFa treatment, ablation spots were observed but no clear anterior chamber reaction was found. The ablation group showed a steady and continuous decrease of ioP, which was significantly lower than the model group at days 3 and 7 (P<0.05). a sclera pathway was observed in the ablation site 1-day post-treatment, which had mostly recovered by day 7. H&e staining demonstrated shedding of the ciliary epithelium, and an unclear boundary between muscle layer and blood vessel at day 1. This had fully recovered by day 14, with clear ciliary layers and well-arranged muscle structures observed. The present study suggested that treatment with rFa could decrease ioP without substantial side effects in the glaucoma model in the rabbit. Therefore, it could be used as a strategy to control ioP and as a treatment for glaucoma in the clinic.

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Summary of Glaucoma Diagnostic Testing Accuracy: An Evidence-Based Meta-Analysis

Cited by 14 publications

References 27 publications

Optical coherence tomography for glaucoma diagnosis: An evidence based meta-analysis

Optical coherence tomography for glaucoma diagnosis: An evidence based meta-analysis

Contrast-to-Noise Ratios for Assessing the Detection of Progression in the Various Stages of Glaucoma

Study of minimally invasive radiofrequency ablation of the ciliary body for the treatment of glaucoma in rabbits

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