Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography

PURPOSE: To compare the ability of optical coherence tomography retinal nerve fiber layer (RNFL), optic nerve head, and macular thickness parameters to differentiate between healthy eyes and eyes with glaucomatous visual field loss. DESIGN: Observational case-control study. METHODS: Eighty-eight patients with glaucoma and 78 healthy subjects were included. All patients underwent ONH, RNFL thickness, and macular thickness scans with Stratus OCT during the same visit. ROC curves and sensitivities at fixed specificities were calculated for each parameter. A discriminant analysis was performed to develop a linear discriminant function designed to identify and combine the best parameters. This LDF was subsequently tested on an independent sample consisting of 63 eyes of 63 subjects (27 glaucomatous and 36 healthy individuals) from a different geographic area. RESULTS: No statistically significant difference was found between the areas under the ROC curves (AUC) for the RNFL thickness parameter with the largest AUC (inferior thickness, AUC = 0.91) and the ONH parameter with largest AUC (cup/disk area ratio, AUC = 0.88) (P = .28). The RNFL parameter inferior thickness had a significantly larger AUC than the macular thickness parameter with largest AUC (inferior outer macular thickness, AUC = 0.81) (P = .004). A combination of selected RNFL and ONH parameters resulted in the best classification function for glaucoma detection with an AUC of 0.97 when applied to the independent sample. CONCLUSIONS: RNFL and ONH measurements had the best discriminating performance among the several Stratus OCT parameters. A combination of ONH and RNFL parameters improved the diagnostic accuracy for glaucoma detection using this instrument.     

Discriminating performance of macular ganglion cell-inner plexiform layer thicknesses at different stages of glaucoma

AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer (GC-IPL) parameters between all the consecutive stages of glaucoma (from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer (RNFL) parameters and optic nerve head (ONH) parameters. METHODS: Totally 147 eyes (40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography (OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve (AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients (P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio (AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the best GC-IPL parameters being minimum and inferotemporal (AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area (AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients. CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other (from glaucoma suspect to moderate-to-severe glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.     

Correlation between retinal nerve fiber layer thickness and central corneal thickness in patients with ocular hypertension: an optical coherence tomography study

PURPOSE: To correlate the retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters measured by optical coherence tomography (OCT) with central corneal thickness (CCT) measurements in patients with ocular hypertension (OHT). DESIGN: Observational cross-sectional study. METHODS: setting: Tertiary care referral teaching institute. study population: Fifty-one eyes of 51 patients with OHT and 35 eyes of 35 normal subjects. Both groups were stratified into thin (CCT < or =555 microm) and thick (CCT >555 microm) cornea subsets. Ocular hypertensives were further stratified by CCT into < or =555 microm, 556 to 588 microm, and >588 microm subsets. observation procedure: RNFL thickness (average, superior average, and inferior average) and ONH parameters were measured by OCT. CCT was measured by ultrasonic pachymetry. main outcome measures: Correlation between CCT and OCT measurements of RNFL and ONH parameters. RESULTS: In the OHT group, CCT correlated significantly with all three RNFL measurements (Pearson's coefficient r = 0.412, 0.484, and 0.380, respectively) but with only four ONH parameters (cup-to-disk area ratio, cup area, rim area, and horizontally integrated rim width; r = -0.459, -0.283, 0.421, and 0.436, respectively). The RNFL in ocular hypertensives with CCT < or =555 microm was significantly thinner than in those with thick corneas (analysis of variance, post hoc Bonferroni comparisons, P < .001). RNFL thickness of normal subjects and ocular hypertensives with CCT >555 microm were similar. CONCLUSIONS: Ocular hypertensives with CCT < or =555 microm may represent patients who have either very early undetected glaucoma or an inherent structural predisposition to glaucomatous damage. This may in part explain the higher risk of these patients for progression to glaucoma.     

Comparison of glaucomatous parameters in normal, ocular hypertensive and glaucomatous eyes using optical coherence tomography 3000

This study was performed to evaluate optic disc appearance, retinal nerve fiber layer (RNFL) thickness, and macular thickness in normal, ocular hypertensive (OHT) and glaucomatous eyes using optical coherence tomography (OCT) 3000. One hundred fifty-eight eyes of 167 consecutive subjects were enrolled: 60 normal, 53 OHT, and 54 glaucomatous. OCT topographic parameters of cup diameter, cup area, rim area, and cup/disc area ratio were significantly less in OHT eyes than in normal eyes and were significantly less in glaucomatous eyes than in normal and OHT eyes. RNFL was significantly thinner in OHT eyes than in normal eyes in the inferior quadrant, and in glaucomatous eyes than in OHT and normal eyes in the mean and for all four quadrants. Macular thickness was significantly thinner in glaucomatous eyes than in OHT and normal eyes throughout all subdivisions. Optic disc parameters, and RNFL and macular thickness measurements made with OCT may be useful in the clinical assessment of glaucoma.     

Usefulness of optical coherence tomography parameters of the optic disc and the retinal nerve fiber layer to differentiate glaucomatous, ocular hypertensive, and normal eyes

PURPOSE: To assess Stratus optical coherence tomography (OCT) original parameters for identifying glaucomatous damage and to evaluate differences among glaucomatous, ocular hypertensive, and normal eyes. DESIGN: Cross-sectional prospective study. SUBJECTS AND METHODS: The study was conducted at 2 centers. The study population consisted of 55 normal individuals, 95 patients with ocular hypertension (OHT), and 79 patients with glaucoma. Retinal nerve fiber layer (RNFL) and optic nerve head OCT protocols were used to evaluate all study participants. Measurements taken were RNFL thickness, several ratios, RNFL asymmetry between both eyes, rim volume, rim width, disc area, cup area, rim area, cup/disc (C/D) area ratio, and horizontal and vertical C/D ratios. The main outcome measures were the differences in OCT parameters among groups and the areas under the receiver operating characteristic curves (AROC). RESULTS: Mean RNFL thickness around the disc, and superior and inferior RNFL thickness, were significantly thinner in glaucomatous eyes than in OHT or normal eyes (P<0.001). Rim parameters were significantly smaller in glaucomatous eyes than in normal (P<0.001) and OHT eyes (P=0.01). C/D ratios were significantly greater in glaucomatous eyes than in OHT (P<0.001) and normal (P<0.001) eyes. Significant differences were found between normal and OHT eyes in 7 disc parameters. No difference was found among groups in parameters describing RNFL asymmetry between both eyes. The AROC curves of the other RNFL and disk parameters ranged from 0.741 to 0.85. CONCLUSIONS: Almost all RNFL and disc parameters showed significant differences and discriminated between glaucomatous and normal eyes. There were significant differences in some optic nerve parameters, but no RNFL parameters, between normal and OHT eyes.     

Analysis of retinal nerve fiber layer and optic nerve head in glaucoma with different reference plane offsets, using optical coherence tomography

PURPOSE: To evaluate the performance of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters analyzed with different offsets of reference plane in detecting early glaucomatous changes and in correlation with visual function using optical coherence tomography (OCT). METHODS: This was a cross-sectional study consisting of 41 normal subjects and 30 with early and 40 with advanced glaucoma. RNFL thickness and ONH parameters were measured with reference planes positioned at 95, 150, and 205 microm above the level of retinal pigment epithelium (RPE). Discriminating power for early glaucoma detection and correlation with visual field MD for each parameter at different levels of reference plane were compared by using the analyses of area under the receiver operating characteristic curves (AUCs) and linear regression, respectively. RESULTS: All ONH measurements were significantly different between normal and glaucoma groups, irrespective of the level of reference plane. In normal eyes, changing the reference plane position resulted in significant differences in ONH measurements. Among all the parameters examined, integrated rim volume and RNFL thickness measured at 150 microm above the RPE showed the largest AUC (0.966) for early glaucoma detection, and the strongest correlation with visual function (r = 0.793), respectively. CONCLUSIONS: OCT analysis of the ONH and RNFL is useful for early glaucoma detection. Among the three reference planes examined in this study, measurements analyzed at 150 microm above the RPE demonstrated the best performance for glaucoma detection and correlation with visual function. Compared with ONH measurements, RNFL thickness may be a better indicator, reflecting retinal ganglion cell function and monitoring disease progression.     

Retinal nerve fiber layer thickness in normal, ocular hypertensive, and glaucomatous Indian eyes: an optical coherence tomography study

PURPOSE: To determine retinal nerve fiber layer (RNFL) thickness measurements in normal, ocular hypertensive (OHT), and glaucomatous Asian Indian eyes. METHODS: This prospective observational cross-sectional study included patients with OHT, primary open angle glaucoma (POAG), and age-matched normal controls. The global and 4-quadrant average RNFL thickness was measured using the Stratus OCT. The main outcome measures were differences in RNFL thickness measurements between the 3 groups. The discriminating power of each parameter was evaluated by calculating areas under receiver operating characteristic curves (AROCs). RESULTS: Twenty-three eyes of 23 POAG patients, 24 eyes of 24 OHT, and 48 eyes of 48 normal controls were analyzed. The superior, inferior, and global RNFL measurements were significantly thinner in OHTs compared with normals (P=0.031, 0.019, and 0.022, respectively). All 5 RNFL parameters were significantly thinner in the POAG group compared with OHT group (P<0.001). Parameters with largest AROCs for distinguishing glaucoma from OHT were average and inferior average RNFL measurements (0.989 and 0.979, respectively). Inferior and superior RNFL measurements had largest AROCs (0.717 and 0.700, respectively) to distinguish OHT from normal eyes. CONCLUSIONS: Stratus OCT detected significant quantitative differences in RNFL thickness between normal, OHT, and glaucomatous Asian Indian eyes.     

Discriminating ability of optical coherence tomography data in staging glaucomatous damage

Objective: To evaluate the ability of retinal nerve fibre layer (RNFL) thickness and optic nerve head (ONH) measurements, as determined by optical coherence tomography (OCT), to discriminate between normal eyesight and glaucoma and also among the different stages of glaucoma.Design: Observational cross-sectional study.Participants: Eighty-one controls and 213 glaucoma patients were enrolled in the study.Methods: The discriminating powers of OCT parameters for the detection of glaucoma and subgroups were compared by the area under the receiver operating characteristic (AUROC) curves.Results: The best RNFL thickness parameters for discriminating between early glaucoma and control eyes were inferior (0.74 [SE 0.04] μm), average (0.74 [SD 0.03] μm), and superior (0.68 [SD 0.03] μm). Among the ONH parameters, the best AUROC curve values were cup area (0.83 [SD 0.33]), cup/disc (C/D) area ratio (0.82 [SD 0.03]), and vertical integrated rim area (VIRA) (0.82 [SD 0.03]). The best AUROC values belonged to the RNFL thickness and were inferior (0.80 [SD 0.03]), superior (0.79 [SD 0.03]), and 6 o’clock (0.78 [SD 0.03]). The highest AUROC values were horizontal integrated rim width (HIRW) (0.74 [SD 0.04]), VIRA (0.64 [SD 0.04]), and rim area (0.63 [SD 0.04]) among the ONH parameters for early versus moderate glaucoma. The best AUROC values were inferior (0.81 [SD 0.03]), 6 o’clock (0.79 [SD 0.03]), and superior (0.78 [SD 0.04]) among the RNFL, and the best AUROC values were cup area (0.81 [SD 0.03]),VIRA (0.81 [SD 0.03]), and C/D area ratio (0.80 [SD 0.03]) among the ONH parameters, for moderate versus advanced glaucoma.Conclusions: RNFL and ONH OCT parameters might provide information for determining glaucomatous damage.     

Scanning laser polarimetric analysis of retinal nerve fiber layer thickness in Turkish patients with glaucoma and ocular hypertension

PURPOSE: To assess the thickness of the retinal nerve fiber layer (RNFL) in patients with different stages of glaucoma, in comparison with ocular hypertensive (OHT) and healthy subjects in a Turkish population. METHODS: Scanning laser polarimetry was done with a GDx Nerve Fiber Analyzer (NFA, GDx version, 1.0.08) on 270 eyes with glaucoma, 52 OHT eyes, and 81 normal eyes. The eyes were classified as having early (146 eyes), moderate (66 eyes) and severe (58 eyes) glaucoma based on the Humphrey Visual Field indices. We compared 14 NFA parameters by analysis of variance (ANOVA) and Scheffe multiple comparison analysis. Receiver operator characteristic curves (ROC) and Fisher linear discriminant analysis (LDF) were used to measure the sensitivity and specificity of the NFA parameters. RESULTS: Except for symmetry, all NFA parameters showed significant differences between the groups (p<0.05). The eyes with glaucoma had significantly thinner RNFL than healthy eyes (p<0.01). The RNFL retardation measurements of OHT eyes were lower than controls, but higher than the early glaucoma group. The sensitivity and specificity of the GDx System were 87% and 72.8%, respectively. Applying LDF, the group with the highest sensitivity and specificity (85.9% and 74.1%) was determined as inferior ratio, superior/nasal ratio, superior maximum and the Number. CONCLUSIONS: Assessment of RNFL thickness with scanning laser polarimetry can distinguish glaucoma, OHT and normal subjects with relatively high sensitivity and specificity.     

Optic nerve head topographic measurements and retinal nerve fiber layer thickness in physiologic large cups

PURPOSE: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. METHODS: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. RESULTS: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. CONCLUSIONS: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.     

傅立叶OCT和海德堡激光眼底扫描仪在开角型青光眼早期诊断中的应用

背景研究表明,视网膜神经纤维层（RNFL）缺损是青光眼早期损害的重要表现,如何准确地定量检测RNFL的厚度变化是青光眼早期诊断及监测青光眼病情进展的关键步骤之一。目的对傅立叶OCT、海德堡激光眼底扫描仪（HRT—Ⅲ）测量青光眼患者的RNFL厚度以及视盘的各项参数进行分析,对二者在青光眼早期诊断中的作用进行临床评价。方法收集可疑开角型青光眼（SOAG）患者26例40眼、原发性开角型青光眼（POAG）患者29例48眼以及正常对照组27例48眼。应用傅立叶OCT、HRT—Ⅲ、Humphrey 750-i型全自动视野计对所有研究对象分别进行视盘面积,视杯面积,杯盘面积比,盘沿面积,盘沿容积,视盘上方、下方、颞侧、鼻侧象限的RNFL厚度等参数测定和视野检查,对不同受检者测得的各项参数进行分析和比较,分别与视野平均缺损值做相关分析,评价不同参数对于青光眼RNFL损伤的诊断价值。结果傅立叶OCT和HTR—Ⅲ检测对正常对照组检查结果均证实RNFL从厚到薄依次为视盘下方、上方、颞侧、鼻侧象限,SOAG组和POAG组RNFL厚度变薄的顺序依次为视盘下方、上方、颞侧、鼻侧象限,各部位厚度改变的差异均有统计学意义（P〈0．05）,SOAG组和POAG组患者盘沿面积、杯盘面积比、视杯面积、盘沿容积与正常对照组比较,差异均有统计学意义（P〈0．05）。对3组患者的检测表明,傅立叶OCT与HTR-Ⅲ检测视盘上方象限、下方象限的测定之间存在着正相关关系（r=0．362、r=0．441、r=0．395,P〈0．05）;2种检查方法所测得3个组视杯容积、视杯面积、盘沿容积、杯盘面积比呈正相关（P〈0．05）。在POAG组中,傅立叶OCT测得视盘参数中的盘沿面积、盘沿容积、视杯容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．284、0．286、0．340、0．371（P〈0．05）;HRT-Ⅲ测得视盘参数中的盘沿面积、盘沿容积、杯盘面积比与视野的平均缺损值间的相关系数分别为0．339、0．859、0．422（P〈0．05）。结论傅立叶OCT和HRT-Ⅲ检测的视盘参数结果接近,且均与视野的平均缺损值有较好的相关性;所检测杯盘面积比、盘沿面积和视盘上方象限、下方象限的RNFL厚度的改变在青光眼早期诊断中均有重要价值。     

Pattern electroretinogram optimized for glaucoma screening (PERGLA) and retinal nerve fiber thickness in suspected glaucoma and ocular hypertension

The purpose of this study is to evaluate pattern electroretinogram optimized for glaucoma screening (PERGLA) and retinal nerve fiber layer (RNFL) at spectral optical coherence tomography (OCT) in eyes with suspected glaucoma (GS) and in eyes with ocular hypertension (OHT). This is a cross-sectional, observational study. Twenty-four patients with GS (BCVA 20/20, normal visual field, intraocular pressure, IOP, less than 21 mmHg, and glaucomatous optic neuropathy, GON) and 14 patients with OHT (BCVA 20/20, intraocular pressure 25 mmHg, absence of glaucomatous optic neuropathy and normal visual field) were considered in this study. GON was intended as vertical cup-disk ratio of 0.5 or more; asymmetry of greater than 0.2, disk notching, disk splinter hemorrhages. PERGLA amplitude and phase were measured, while thickness of the RNFL was obtained with spectral OCT. A control group of 50 age-matched healthy patients was added. In the GS group, 16 eyes (66.7%) showed normal average RNFL analysis and normal PERGLA, 3 eyes (12.5%) showed abnormal average RNFL analysis and abnormal PERGLA, 5 eyes (20.8%) presented with normal average RNFL analysis and abnormal PERGLA. In the OHT group, 11 eyes (78.6%) showed an average normal RNFL and normal PERGLA, while 3 eyes (21.4%) presented with an average normal RNFL and abnormal PERGLA. PERGLA is a non-invasive, fast, and fully automatic version of the pattern ERG. In eyes with OHT and in eyes with GS, PERGLA abnormalities in presence of a normal RNFL could suggest an early functional damage of viable retinal ganglion cells.     

频域OCT检测视乳头形态及视网膜神经纤维层厚度在青光眼诊断中的作用

目的 探讨频域相干光断层扫描(OCT)检测视乳头形态及视网膜神经纤维层(RNFL)厚度在青光眼诊断中的作用.方法 为非干预性、观察性研究.应用RTVue OCT检测60例正常人和97例青光眼患者的视乳头各参数,以及平均和各个区域的RNFL厚度.采用单因素方差分析对以上各参数组间进行比较.用受试者工作特性曲线下面积(AUC)和特异性≥80%的敏感性来评价每一个检测参数区分正常与各期青光眼的能力大小.结果 除视乳头面积外,正常人和各期青光眼患者各参数测量值之间差异均有统计学意义(F=1.024,P=0.596;F=36.519,54.464,27.659,36.176,20.562,63.833,30.031, 54.652,98.146,78.705,99.839,43.728,75.720,45.709,39.380, 33.590,66.887,78.335,45.485;P=0.000).其中,平均RNFL厚度正常人为109.950μm,早期青光眼患者为93.313 μm,中期青光眼患者为80.374μm,晚期青光眼患者为65.570 μm.在视乳头周围8个RNFL区域中,正常人最厚的为颞下150.066μm和颞上146.285μm.各期青光眼患者最厚的均为颞上,分别为早期108.569 μm,中期103.420μm,晚期88.708μm,其次为颞下,分别为早期108.201μm,中期102.830 μm,晚期86.369 μm.而鼻侧(NU+NL)和颞侧(TU+TL)无论在正常人还是青光眼患者中均较薄.在视乳头形态各参数中,各期青光眼诊断效能最高的均为垂直杯盘比,其AUC值在早、中、晚期青光眼患者中分别为0.762,0.946和0.988,它们特异性在80%时的敏感性分别为62.2%,76.5%和99.2%.在RNFL厚度参数中,早期青光眼诊断效能最高的是颞上区域RNFL厚度,其AUC值为0.915,特异性在80%时的敏感性为89.5%;中期青光眼诊断效能最高的是下方平均RNFL厚度,其AUC值为0.967,特异性在80%时的敏感性为94.1%;晚期青光眼诊断效能最高的是平均RNFL厚度,其AUC值为0.985,特异性在80%时的敏感性为99.2%.在视乳头周围8个RNFL区域中,诊断效能最高的是颞上区域(ST),其AUC值在早、中、晚期青光眼患者中分别为0.915,0.926和0.966,它们特异性在80%时的敏感性分别为89.5%,88.2%和92.9%.诊断效能较低的是颞侧(TU+TL)和鼻侧(NU+NL).结论 RTVue OCT具有较好的区别正常人和各期青光眼患者的能力,在青光眼诊断方面是一个有用的工具.     

Optical Coherence Tomography Measurement of Retinal Nerve Fibre Layer,Optic Nerve Head and Macula in Normal Subjects

The aim of the study was to evaluate the variation in retinal nerve fibre layer (RNFL), optic nerve head (ONH) and macular measurements in healthy Turkish subjects using Stratus optical coherence tomography (OCT). The design is a cross-sectional study of 398 eyes in 199 normal subjects aged between 5 and 70 years. The participants underwent a detailed ophthalmologic examination including imaging with Stratus OCT. RNFL, optic disc and macula fast scan methods were used to obtain the peripapillary RNFL thickness, ONH and macular parameters. The effects on the findings of age, gender and laterality of the eye tested were assessed. The average RNFL thickness and the thickness measured in the superior and temporal quadrants were statistically significantly negatively correlated with age. Similar results were found for mean macular thickness, macular RNFL thickness and for total macular volume. There was no effect of age on ONH measurements. The RNFL thickness in the temporal quadrant was significantly greater in females than in males (p<0.05). The mean macular thickness in 1–3?mm was greater in males than in females (p<0.05). The nasal RNFL thickness was significantly thicker in the right eyes than in the left eyes (p<0.05). We conclude that, in healthy subjects, as age increases there is a significant reduction in peripapillary and macular RNFL thickness and in macular thickness and volume. The hypothesis that RNFL and macular measurements are not symmetrical between the two eyes merits further study.     

Retinal nerve fiber layer and macular inner retina measurements by spectral domain optical coherence tomograph in Indian eyes with early glaucoma

Purpose

To compare the diagnostic abilities of peripapillary retinal nerve fiber layer (RNFL) and macular inner retina (MIR) measurements by spectral domain optical coherence tomography (SD–OCT) in Indian eyes early glaucoma.

Methods

In an observational, cross-sectional study, 125 eyes of 64 normal subjects and 91 eyes of 59 early glaucoma patients underwent RNFL and MIR imaging with SD–OCT. Glaucomatous eyes had characteristic optic nerve and RNFL abnormalities and correlating visual field defects and a mean deviation of better than or equal to -6 dB on standard automated perimetry. Areas under the receiver operating characteristic curves (AUC), sensitivities at a fixed specificity and likelihood ratios (LRs) were estimated for all RNFL and MIR parameters.

Results

The AUCs for the RNFL parameters ranged from 0.537 for the temporal quadrant thickness to 0.821 for the inferior quadrant RNFL thickness. AUCs for the MIR parameters ranged from 0.603 for the superior minus inferior MIR thickness average to 0.908 for ganglion cell complex focal loss volume (GCC–FLV). AUC for the best MIR parameter (GCC–FLV) was significantly better (P<0.001) than that of the best RNFL parameter (inferior quadrant thickness). The sensitivities of these parameters at high specificity of 95%, however, were comparable (52.7% vs58.2%). Evaluation of the LRs showed that outside normal limits results of most of the RNFL and MIR parameters were associated with large effects on the post-test probability of disease.

Conclusion

MIR parameters with RTVue SD–OCT were as good as the RNFL parameters to detect early glaucoma.     

OCT检测视网膜神经纤维层厚度及视盘参数在青光眼早期诊断应用

目的 通过光学相干断层成像术(OCT)检测视网膜神经纤维层(RNFL)厚度及视盘结构参数,结合视野改变,探讨OCT在青光眼早期诊断中的应用价值.方法 采用OCT对34只眼疑似闭角型青光眼(SG)患者、36只眼慢性闭角型青光眼(CACG)早中期患者、10只眼正常人行RNFL及视盘扫描,观察各组的RNFL厚度及视盘结构的图像特征;将各象限RNFL厚度和平均RNFL厚度的均数进行总体比较及任意两组间比较;将视乳头水平、垂直杯盘比及杯/盘面积比的均数进行比较;将平均RNFL厚度与视野指数进行相关分析.结果 三组间各象限RNFL厚度、平均RNFL厚度、视盘参数差异有统计学意义(P<0.05);正常人与SG组下方、上方及平均RNFL厚度差异有统计学意义(P<0.05);正常人与CACG早中期组各象限RNFL厚度及平均RNFL厚度差异均有统计学意义(P<0.05);CACG早中期组与SG组上方、下方、鼻侧及平均RNFL厚度差异有统计学意义(P相似文献   

Comparison of diagnostic capability of macular ganglion cell complex and retinal nerve fiber layer among primary open angle glaucoma,ocular hypertension,and normal population using Fourier-domain optical coherence tomography and determining their functional correlation in Indian population

Context:Analysis of diagnostic ability of macular ganglionic cell complex and retinal nerve fiber layer (RNFL) in glaucoma.Aim:To correlate functional and structural parameters and comparing predictive value of each of the structural parameters using Fourier-domain (FD) optical coherence tomography (OCT) among primary open angle glaucoma (POAG) and ocular hypertension (OHT) versus normal population.Results:All parameters showed strong correlation with visual field (P < 0.001). Inferior GCC had highest area under curve (AUC) for detecting glaucoma (0.827) in POAG from normal population. However, the difference was not statistically significant (P > 0.5) when compared with other parameters. None of the parameters showed significant diagnostic capability to detect OHT from normal population. In diagnosing early glaucoma from OHT and normal population, only inferior GCC had statistically significant AUC value (0.715).Conclusion:In this study, GCC and RNFL parameters showed equal predictive capability in perimetric versus normal group. In early stage, inferior GCC was the best parameter. In OHT population, single day cross-sectional imaging was not valuable.     

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of preperimetric glaucoma and comparison to retinal nerve fiber layer

Purpose:The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals.Methods:This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs).Results:All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters.Conclusion:Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.     

Detecting optic nerve head deformation and retinal nerve fiber layer thinning in glaucoma progression

The application of digital imaging technologies including confocal scanning laser ophthalmoscopy (CSLO), optical coherence tomography (OCT), and scanning laser polarimetry (SLP) has significantly improved the detection of optic nerve head (ONH) deformation and progressive retinal nerve fiber layer (RNFL) thinning for assessment of glaucoma progression. Algorithms for change analysis such as topographic change analysis and guided progression analysis perform event analysis of serial ONH surface height topology maps and RNFL thickness/RNFL retardance maps, respectively, providing a topographical display of the location of significant change. With spectral-domain OCT, it is feasible to delineate and measure the lamina cribrosa surface depth in addition to ONH surface depth and RNFL thickness. Growing evidence from experimental and clinical studies indicates that ONH and lamina cribrosa deformation can be observed prior to detectable RNFL thinning and functional loss in glaucoma. These findings lend support to the notion that upon detection of ONH/lamina cribrosa deformation, a time window for therapeutic intervention for better outcomes may exist. The ONH and the lamina cribrosa are therefore important targets for monitoring glaucoma progression. This review summarizes the latest findings comparing the performance of OCT, CSLO, and SLP for detection of progressive ONH and RNFL damages in glaucoma patients and the clinical implication and limitations of studying the morphological alteration of the ONH, lamina cribrosa, and RNFL in the assessment of glaucoma progression.     

Diagnostic accuracy of posterior pole asymmetry analysis parameters of spectralis optical coherence tomography in detecting early unilateral glaucoma

Purpose:

To report the diagnostic ability of posterior pole asymmetry analysis (PPAA) parameters of spectralis optical coherence tomography (OCT) in detecting early unilateral glaucoma.

Methods:

A prospective, cross-sectional study which included 80 eyes of 80 normal subjects and 76 eyes of 76 patients with unilateral early primary open-angle glaucoma by Hodapp-Anderson-Parrish classification. All subjects were of age more than 18 years, best-corrected visual acuity 20/40 or better, and a refractive error within ± 5 diopter (D) sphere and ± 3 D cylinder. Control subjects had a normal ocular examination, intraocular pressure (IOP) <22 mmHg, no past history of high IOP, no family history of glaucoma, normal optic disc morphology, and visual field in both eyes. One eye of the control subject was randomly included. All eyes underwent OCT for retinal nerve fiber layer (RNFL) analysis and PPAA. The number of continuous black squares was noted in the asymmetry analysis (right-left + hemisphere asymmetry). The area under curve (AUC) was calculated for all OCT parameters.

Results:

The best value for AUC for RNFL analysis was 0.858 for the inferotemporal quadrant thickness. This was similar to the best value for AUC for PPAA which was 0.833 for the inferior macular thickness parameter (P = 0.5). The AUC for the right-left and the hemisphere asymmetry part of PPAA was 0.427 and 0.499, respectively.

Conclusion:

The macular thickness PPAA parameters were equally good as the RNFL parameters. However, the asymmetry analysis parameters performed poorly and need further refinement before its use in early unilateral glaucoma diagnosis.