Central Glaucomatous Damage of the Macula Can Be Overlooked by Conventional OCT Retinal Nerve Fiber Layer Thickness Analyses

Wang, Diane L.; Raza, Ali; Moraes, Carlos Gustavo De; Chen, Monica; Alhadeff, Paula; Jarukatsetphorn, Ravivarn; Ritch, Robert; Hood, Donald C.

doi:10.1167/tvst.4.6.4

Cited by 65 publications

(68 citation statements)

References 28 publications

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“…First, in addition to retinal nerve fiber layer (RNFL) damage, macular damage is common in early/mild glaucoma, 3–7 and to detect this damage with OCT a macular cube scan should be obtained. 8,9 Retinal ganglion cell plus inner plexiform layer (RGC+) thickness and probability maps derived from macular cube scans should be analyzed, in addition to the RNFL thickness and probability maps typically obtained from disc cube scans. Second, the RGC+ and RNFL probability maps should be topographically compared with visual field (VF) information.…”

Section: Introductionmentioning

confidence: 99%

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

Hood

Cuir

Blumberg

et al. 2016

Trans. Vis. Sci. Tech.

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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.

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Section: Introductionmentioning

confidence: 99%

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

Hood

Cuir

Blumberg

et al. 2016

Trans. Vis. Sci. Tech.

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“…However, glaucomatous damage to the macula will be missed in clinical practice if only 24-2 visual fields and peripapillary optical coherence tomography (OCT) scans are performed, 16, 17 as is often the case. In particular, studies have shown that macular damage is prevalent among patients with early glaucoma if one employs the appropriate tools to assess it, namely 10-2 visual fields 4–6, 16 and OCT cube scans of the macula.…”

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confidence: 99%

“…In particular, studies have shown that macular damage is prevalent among patients with early glaucoma if one employs the appropriate tools to assess it, namely 10-2 visual fields 4–6, 16 and OCT cube scans of the macula. 1, 17–19 …”

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24-2 Visual Fields Miss Central Defects Shown on 10-2 Tests in Glaucoma Suspects, Ocular Hypertensives, and Early Glaucoma

et al. 2017

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Purpose To investigate the prevalence of visual field defects in glaucomatous eyes, glaucoma suspects, and ocular hypertensives with 24-2 and 10-2 visual fields. Design Prospective, cross-sectional study. Participants Patients with or suspected glaucoma. Testing 24-2 and 10-2 visual fields. Patients were classified into 3 groups based upon the presence of glaucomatous optic neuropathy (GON) and 24-2 visual field abnormalities: early glaucoma (GON and abnormal visual field, mean deviation >−6 dB), glaucoma suspects (GON and normal visual field), and ocular hypertensives (normal disc, normal visual field, and intraocular pressure >22 mmHg). For the classification of visual field abnormalities, 24-2 and 10-2 tests performed on the same visit were analyzed. Main outcome measure Comparison of the prevalence of abnormal 24-2 versus 10-2 visual field results based upon cluster criteria in each diagnostic group. Results 775 eyes (497 patients) were evaluated. 364 eyes had early glaucoma, 303 were glaucoma suspects, and 108 were ocular hypertensives. In the glaucoma group, 16 of the 26 (61.5%) eyes classified as normal based upon cluster criteria on 24-2 tests were classified as abnormal on 10-2 visual fields. In eyes with suspected glaucoma, 79 of the 200 (39.5%) eyes classified as normal on 24-2 were classified as abnormal on 10-2 visual fields. In ocular hypertensive eyes, 28 of the 79 (35.4%) eyes classified as normal on the 24-2 were abnormal on the 10-2. Patients of African descent were more likely to have an abnormal 10-2 result (67.3 vs. 56.8%, P=0.009). Conclusions Central visual field damage seen on 10-2 is often missed with 24-2 strategy in all groups. This finding has implications for the diagnosis of glaucoma and classification of severity.

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“…38-40 Evidence to date suggests that it provides better diagnostic performance than OCT assessment of the macula in glaucoma, 5,6 though it will sometimes miss highly localized damage that can be detected by macular OCT analysis. 41 Average peripapillary RNFLT is highly repeatable; in a study using the Cirrus OCT (Carl-Zeiss Meditec Inc.) it was reported to have a 1.9% intra-visit coefficient of variation. 42 It also correlates reasonably well with function.…”

Section: Discussionmentioning

confidence: 99%

Localized Changes in Retinal Nerve Fiber Layer Thickness as a Predictor of Localized Functional Change in Glaucoma

Gardiner

Fortune

Demirel

2016

American Journal of Ophthalmology

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Purpose To determine how well rates of localized retinal nerve fiber layer thickness (RNFLT) change correlate with rates of sensitivity change at corresponding locations in the visual field in glaucoma. Design Retrospective Cohort Study Methods 364 eyes of 191 participants, with suspected or confirmed glaucoma as judged by experienced clinicians, were tested every six months with perimetry and optical coherence tomography (OCT). For each 24-2 visual field location, the corresponding sectoral peripapillary RNFLT was defined using a 30° sector, centered on the angle of nerve fiber entry into the optic nerve head. Rates of change of pointwise sensitivity and sectoral RNFLT were calculated over the last 8 visits at which reliable data were obtained. Passing-Bablok regression was used to predict the rate of pointwise sensitivity change from the rate of sectoral RNFLT change, for each location. Results Rates of sectoral RNFLT change were significantly predictive of rates of pointwise sensitivity change at all locations in the field. Correlations were modest, averaging 0.15, ranging from 0.03 to 0.25 depending on the location. A 1μm/y more rapid thinning in corresponding sectors was associated with 0.3dB/y more rapid loss in the superior visual field, but less than 0.1dB more rapid loss at many locations in the inferior visual field. Conclusions Localized RNFL thinning is associated with sensitivity loss at corresponding locations in the visual field, and their rates of change are significantly correlated. Peripapillary RNFLT may be used to monitor localized changes caused by glaucoma that have measurable consequences for a patient's vision.

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Central Glaucomatous Damage of the Macula Can Be Overlooked by Conventional OCT Retinal Nerve Fiber Layer Thickness Analyses

Cited by 65 publications

References 28 publications

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

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

24-2 Visual Fields Miss Central Defects Shown on 10-2 Tests in Glaucoma Suspects, Ocular Hypertensives, and Early Glaucoma

Localized Changes in Retinal Nerve Fiber Layer Thickness as a Predictor of Localized Functional Change in Glaucoma

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