Effectiveness of a Qualitative Approach Toward Evaluating OCT Imaging for Detecting Glaucomatous Damage

Abstract

PurposeThe purpose of this study was to determine whether a qualitative approach toward evaluating optical coherence tomography (OCT) imaging improves the ability to detect glaucomatous damage compared to a conventional metric of global circumpapillary retinal nerve fiber layer (cpRNFL) thickness.MethodsA total of 394 healthy eyes and 272 glaucoma eyes were evaluated. Glaucoma eyes were categorized as perimetric (156 eyes) based on a history of three or more consecutive abnormal 24-2 visual field tests or suspected glaucoma if they did not (116 eyes). Customized one-page reports derived using OCT volume scans of the optic disc and macula from these eyes were qualitatively graded for the probability of optic neuropathy affecting the eye.ResultsThe sensitivity of detecting perimetric glaucoma eyes with the global circumpapillary RNFL thickness metric and qualitative evaluation of the OCT imaging results were 86.5% and 95.5% at a specificity of 95%, being significantly higher for the latter (P < 0.001). There were seven eyes with perimetric glaucoma missed by the qualitative evaluation. Based upon examination of all available visual fields, at least four of these seven eyes had visual fields that either improved or had abnormalities that were inconsistent over time or with patterns of glaucomatous damage.ConclusionsQualitative evaluation of OCT imaging results allows glaucoma eyes with repeatable visual field abnormalities to be detected with a high level of accuracy, performing better than a conventional summary metric of global cpRNFL thickness.Translational RelevanceClinical detection of glaucomatous damage with OCT imaging can be optimized through a qualitative evaluation of its results.

Retinal Function in Patients with Adalimumab Treatment: Long-term Follow-up with Microperimetry

“…9,10,12,13 As previously shown, it provides information concerning the light sensitivity of several macular points with a very good repeatability. 11,16 The present results show no retinal impairment associated to adalimumab therapy.…”

“…Previously, an improvement of the macular sensitivity in a second examination in healthy subjects was reported and also in AMD patients. 11,16 On the other hand, Wong et al reported no learning effect on the mean sensitivity in glaucoma patients by using MAIA microperimetry. 21 In our previous study, a learning effect was seen in fixation stability in the better eye of AMD patients, but there was no learning effect in their worse eye by microperimetry 16 or nor in any eye concerning the other parameters, like sensitivity or macular integrity.…”

“…As shown in earlier studies, the regional analysis, rather than the average macular sensitivity, would be more reliable and more sensitive to establish whether there is or not a sensitivity change. 11 In order to verify if the similarities of the global parameters (average threshold and macular integrity) found during the six-month or twelve-month consecutive examinations would be reproduced for a more detailed regional and local analysis. Then each macular point was analyzed separately.…”

“…Therefore, fixation stability (P1 and P2) were evaluated. 11 Data are expressed as means ± one standard deviation. Two-way ANOVA tests (SPSS, Statistical Package for the Social Sciences, Hong Kong, China) for repeated measure and paired comparisons using Bonferroni post-hoc analyses were performed.…”

Reasons why OCT Global Circumpapillary Retinal Nerve Fiber Layer Thickness is a Poor Measure of Glaucomatous Progression

“…There is also evidence that the cpRNFL thickness measured from circle b-scans, on which the ΔG metric is based, is affected by segmentation and alignment errors 14 – 18 and that reports based on this metric can miss local defects. 19 – 21 Our purpose here was to provide evidence that links these findings. That is, we tested the hypothesis that local defects, segmentation errors, and alignment are major contributing factors to the relatively poor performance of the commonly used method to detect progression, that is, the ΔG metric.…”