The Future of Imaging in Detecting Glaucoma Progression

Lavinsky, Fábio; Wollstein, Gadi; Tauber, Jenna; Schuman, Joel S.

doi:10.1016/j.ophtha.2017.10.011

Cited by 21 publications

(16 citation statements)

References 100 publications

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“…Visual field and OCT measurements are both commonly used for the diagnosis and monitoring of glaucoma 13–15 . Unfortunately, VF parameters and OCT-based NFL thickness parameters do not correlate well with each other 16–18 .…”

Section: Discussionmentioning

confidence: 99%

Estimating Visual Field Mean Deviation using Optical Coherence Tomographic Nerve Fiber Layer Measurements in Glaucoma Patients

Tan

Greenfield

Francis

et al. 2019

Sci Rep

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To construct an optical coherence tomography (OCT) nerve fiber layer (NFL) parameter that has maximal correlation and agreement with visual field (VF) mean deviation (MD). The NFL_MD parameter in dB scale was calculated from the peripapillary NFL thickness profile nonlinear transformation and VF area-weighted averaging. From the Advanced Imaging for Glaucoma study, 245 normal, 420 pre-perimetric glaucoma (PPG), and 289 perimetric glaucoma (PG) eyes were selected. NFL_MD had significantly higher correlation (Pearson R: 0.68 vs 0.55, p < 0.001) with VF_MD than the overall NFL thickness. NFL_MD also had significantly higher sensitivity in detecting PPG (0.14 vs 0.08) and PG (0.60 vs 0.43) at the 99% specificity level. NFL_MD had better reproducibility than VF_MD (0.35 vs 0.69 dB, p < 0.001). The differences between NFL_MD and VF_MD were −0.34 ± 1.71 dB, −0.01 ± 2.08 dB and 3.54 ± 3.18 dB and 7.17 ± 2.68 dB for PPG, early PG, moderate PG, and severe PG subgroups, respectively. In summary, OCT-based NFL_MD has better correlation with VF_MD and greater diagnostic sensitivity than the average NFL thickness. It has better reproducibility than VF_MD, which may be advantageous in detecting progression. It agrees well with VF_MD in early glaucoma but underestimates damage in moderate~advanced stages.

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Section: Discussionmentioning

confidence: 99%

Estimating Visual Field Mean Deviation using Optical Coherence Tomographic Nerve Fiber Layer Measurements in Glaucoma Patients

Tan

Greenfield

Francis

et al. 2019

Sci Rep

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“…8 NFL thickness is useful for confirming the diagnosis of glaucoma and monitoring the progression, at least in the early stage. [9][10][11][12][13][14] However, its diagnostic sensitivity is not sufficient to be used alone for mass screening. 10,15 At the 99% specificity diagnostic cutoff needed for screening applications, the best single NFL thickness parameters have sensitivity of only 7% to 30% for preperimetric glaucoma (PPG) and 20% to 60% for perimetric glaucoma (PG).…”

Section: Introductionmentioning

confidence: 99%

Focal Loss Analysis of Nerve Fiber Layer Reflectance for Glaucoma Diagnosis

Tan

Liu

You

et al. 2021

Trans. Vis. Sci. Tech.

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To evaluate nerve fiber layer (NFL) reflectance for glaucoma diagnosis.Methods: Participants were imaged with 4.5 × 4.5 mm volumetric disc scans using spectral-domain optical coherence tomography. The normalized NFL reflectance map was processed by an azimuthal filter to reduce directional reflectance bias caused by variation of beam incidence angle. The peripapillary area of the map was divided into 160 superpixels. Average reflectance was the mean of superpixel reflectance. Lowreflectance superpixels were identified as those with NFL reflectance below the fifth percentile normative cutoff. Focal reflectance loss was measured by summing loss in low-reflectance superpixels.Results: Thirty-five normal, 30 preperimetric, and 35 perimetric glaucoma participants were enrolled. Azimuthal filtering improved the repeatability of the normalized NFL reflectance, as measured by the pooled superpixel standard deviation (SD), from 0.73 to 0.57 dB (P < 0.001, paired t-test) and reduced the population SD from 2.14 to 1.78 dB (P < 0.001, t-test). Most glaucomatous reflectance maps showed characteristic patterns of contiguous wedge or diffuse defects. Focal NFL reflectance loss had significantly higher diagnostic sensitivity than the best NFL thickness parameter (from map or profile): 77% versus 55% (P < 0.001) in glaucoma eyes with the specificity fixed at 99%. Conclusions:Azimuthal filtering reduces the variability of NFL reflectance measurements. Focal NFL reflectance loss has excellent glaucoma diagnostic accuracy compared to the standard NFL thickness parameters. The reflectance map may be useful for localizing NFL defects.Translational Relevance: The high diagnostic accuracy of NFL reflectance may make population-based screening feasible.

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“…2016; Lavinsky et al. 2017), defined as a lower limit below which structural changes cannot be measured, and SAP test–retest variability is higher (Heijl et al. 1989; Gardiner et al.…”

Section: Introductionmentioning

confidence: 99%

Measuring optic nerve head perfusion to monitor glaucoma: a study on structure–function relationships using laser speckle flowgraphy

Calzetti

Mursch‐Edlmayr

Bata

et al. 2021

Acta Ophthalmologica

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Purpose We aimed to describe the global and localized correlations among visual field (VF) sensitivity, optic nerve head (ONH) perfusion measured by laser speckle flowgraphy (LSFG) and neural structure measured by optical coherence tomography (OCT) in open‐angle glaucoma (OAG) and to compare the floor effect for LSFG and OCT. Methods Cross‐sectional, multicenter study including one eye each from fifty OAG patients (mean age 69.3 years; average VF mean deviation, MD, −8.5 dB, range −25.17 to 0.85 dB) and fifty‐one controls. Patients underwent SITA standard 24‐2 automated perimetry and measurement of ONH perfusion, peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell‐inner plexiform layer thickness (GCIPLT). We tested the presence of a significant change (breakpoint) in the correlation slope with VF sensitivity to assess floor effect. Results The correlation between the LSFG parameter Mean All (MA) of the global disc area and MD (r = 0.56, p < 0.001) did not show a breakpoint, in contrast to the correlations between MD and OCT global parameters, which showed breakpoints at −8.53 and −4.05 dB for RNFLT and GCIPLT, respectively. Global and localized correlations with VF sensitivity were stronger for LSFG compared to OCT. In particular, LSFG outperformed OCT in the correlation with the central VF sector (r = 0.50, p < 0.001 and r = 0.06, p = 0.67 for MA and RNFLT, respectively). Conclusion The global and sectoral correlations with VF sensitivity and the favourable floor effect compared to OCT indicate LSFG as a promising tool to monitor progression particularly in late‐stage glaucoma. Further longitudinal studies are warranted.

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The Future of Imaging in Detecting Glaucoma Progression

Cited by 21 publications

References 100 publications

Estimating Visual Field Mean Deviation using Optical Coherence Tomographic Nerve Fiber Layer Measurements in Glaucoma Patients

Estimating Visual Field Mean Deviation using Optical Coherence Tomographic Nerve Fiber Layer Measurements in Glaucoma Patients

Focal Loss Analysis of Nerve Fiber Layer Reflectance for Glaucoma Diagnosis

Measuring optic nerve head perfusion to monitor glaucoma: a study on structure–function relationships using laser speckle flowgraphy

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