A Single Wide-Field OCT Protocol Can Provide Compelling Information for the Diagnosis of Early Glaucoma

Abstract

PurposeTo evaluate a report for glaucoma diagnosis based on a single optical coherence tomography (OCT) protocol.MethodsA wide-field (9 × 12 mm) swept-source (SS) OCT scan, encompassing the macula and disc, was obtained on 130 eyes (patients) with or suspected open-angle glaucoma, a mean deviation greater than or equal to −6 dB on a 24-2 visual field (VF), and spherical refractive error between ± 6 diopters (D). The single-page report contained a circumpapillary retinal nerve fiber layer (cpRNFL) thickness plot; retinal ganglion cell layer and retinal nerve fiber layer (RNFL) thickness and probability plots of the macula and optic nerve; and an enface slab image of the optic nerve. A report specialist judged each eye as healthy (H); probably healthy (PH); forced-choice healthy (FC-H); optic neuropathy (ON); probably ON (PON); forced-choice optic neuropathy (FC-ON). Two glaucoma specialists made similar judgments about the presence of glaucomatous damage. The glaucoma specialists had 24-2 and 10-2 VFs, fundus photos, patient chart information, and the single-page report including the report specialist's interpretation.ResultsThe reference standard consisted of 57 eyes judged as glaucomatous (ON or PON) and 45 eyes judged as healthy (H or PH) by both glaucoma specialists. The report specialist identified 56 of the glaucomatous eyes as optic neuropathy (i.e., ON, PON, or FC-ON), and 44 of the healthy eyes as healthy (i.e., H, PH, or FC-H), an accuracy of 98.0%.ConclusionsA single-page report based upon a single, wide-field OCT scan has the information needed to diagnose early glaucoma with excellent sensitivity/specificity.Translational RelevanceIt is possible that screening for glaucoma can be effective with only a single OCT protocol.

Hybrid Deep Learning on Single Wide-field Optical Coherence tomography Scans Accurately Classifies Glaucoma Suspects

“…The 102 eyes were part of a previous study, 1 which started with 130 eyes. In that study, two glaucoma specialists judged each eye as healthy (H); probably healthy (PH); forced-choice healthy (FC-H); glaucomatous (G); probably G (PG); forced-choice G (FC-G) based upon 24-2 and 10-2 VFs, fundus photos, patient chart information, and a single-page OCT report, 2 which included an OCT specialist’s interpretation as indicated in ref 1.…”

“…Note: 28 of the original 130 eyes in ref. 1 were not included in that study or this one. Of these, the two glaucoma specialists did not agree on 23 eyes, while the other 5 had optic neuropathies.…”

“…Of these, the two glaucoma specialists did not agree on 23 eyes, while the other 5 had optic neuropathies. 1 …”

“…We recently argued that a single wide-field optical coherence tomography (OCT) scan has the information needed to distinguish healthy suspect eyes from eyes with early glaucoma. 1 In particular, two glaucoma specialists placed 102 eyes into two groups (glaucoma or probably glaucoma versus healthy or probably healthy) based upon information from the patients’ charts, 24-2 and 10-2 visual fields (VFs), and OCT scans. Using only a single-page report that summarized the results from a single wide-field OCT scan, the senior author (DCH) correctly identified 100 of these eyes for an accuracy of 98%.…”

Screening for glaucoma using intraocular pressure alone

“…Although one preliminary clinic based report showed the high diagnostic accuracy of optical coherence tomography for diagnosing glaucoma, the test has yet to be evaluated for screening 11 …”