A Diagnostic Calculator for Detecting Glaucoma on the Basis of Retinal Nerve Fiber Layer, Optic Disc, and Retinal Ganglion Cell Analysis by Optical Coherence Tomography

Abstract

Citation: Larrosa JM, Moreno-Montañés J, Martinez-de-la-Casa JM, et al. A diagnostic calculator for detecting glaucoma on the basis of retinal nerve fiber layer, optic disc, and retinal ganglion cell analysis by optical coherence tomography. Invest Ophthalmol Vis Sci. 2015;56:6788-6795. DOI:10.1167/iovs.15-17176 PURPOSE. The purpose of this study was to develop and validate a multivariate predictive model to detect glaucoma by using a combination of retinal nerve fiber layer (RNFL), retinal ganglion cell-inner plexiform (GCIPL), and optic disc parameters measured using spectraldomain optical coherence tomography (OCT). METHODS.Five hundred eyes from 500 participants and 187 eyes of another 187 participants were included in the study and validation groups, respectively. Patients with glaucoma were classified in five groups based on visual field damage. Sensitivity and specificity of all glaucoma OCT parameters were analyzed. Receiver operating characteristic curves (ROC) and areas under the ROC (AUC) were compared. Three predictive multivariate models (quantitative, qualitative, and combined) that used a combination of the best OCT parameters were constructed. A diagnostic calculator was created using the combined multivariate model. RESULTS.The best AUC parameters were: inferior RNFL, average RNFL, vertical cup/disc ratio, minimal GCIPL, and inferior-temporal GCIPL. Comparisons among the parameters did not show that the GCIPL parameters were better than those of the RNFL in early and advanced glaucoma. The highest AUC was in the combined predictive model (0.937; 95% confidence interval, 0.911-0.957) and was significantly (P ¼ 0.0001) higher than the other isolated parameters considered in early and advanced glaucoma. The validation group displayed similar results to those of the study group.CONCLUSIONS. Best GCIPL, RNFL, and optic disc parameters showed a similar ability to detect glaucoma. The combined predictive formula improved the glaucoma detection compared to the best isolated parameters evaluated. The diagnostic calculator obtained good classification from participants in both the study and validation groups.

Diagnostic performance of isolated-check visual evoked potential versus retinal ganglion cell-inner plexiform layer analysis in early primary open-angle glaucoma

“…One is optical coherence tomography (OCT), which facilitates the quantitative and qualitative analyses of the structures of the retinal ganglion cell-inner plexiform layer (GCIPL) [4, 5]. Another is isolated-check visual evoked potential (icVEP), which is designed to detect the transmission function of the magnocellular pathway, a neural pathway that is mainly managed by the RGCs [6].…”

A Diagnostic Calculator for Detecting Glaucoma and False Positive Using Cirrus OCT

“…Only one case has a quantitative probability of 24.3% in an eye with a yellow color code in the GCIPL and a red color code in the cup-to-disc ratio average color. These results suggest that the Larrosa et al 1 quantitative predictive formula could be useful in cases with red color code in patients with normal visual field and suspicion of FP. In cases where FP is suspected, currently it is recommended that the patient undergoes another OCT device analysis such as Spectralis.…”

“…The recent article by Larrosa et al 1 describes the use of a new predictive formula for glaucoma detection, especially in early glaucoma, using Cirrus optical coherence tomography (OCT) parameters. The authors combined in this predictive formula the parameters that resulted in the best areas under the receiver operating characteristic curves (AUC) from the retinal nerve fiber layer (RNFL), the retinal ganglion cell-inner plexiform layer (GCIPL), and the optic head nerve (OHN).…”

“…To understand if the predictive formula from Larrosa et al 1 can decrease the percentage of FP in normal eyes, we used this formula to analyze the same sample of 100 eyes, which found 39% to be FP using Cirrus OCT. The application of this formula obtains a low glaucoma probability in the 100 eyes, and finds no cases with intermediate or high glaucoma probability.…”

“…However, a second OCT is not always available and when it is, it is time-consuming. In contrast, the analysis of the glaucoma probability using the Larrosa et al 1 formula is efficient in that it only takes 1 minute to apply. According to our results, we recommend that this formula be applied in isolated Cirrus OCT with altered color code to detect if it is glaucoma or a FP.…”