Evaluation of a Region-of-Interest Approach for Detecting Progressive Glaucomatous Macular Damage on Optical Coherence Tomography

Wu, Zhichao; Weng, Denis S. D.; Thenappan, Abinaya; Ritch, Robert; Hood, Donald C.

doi:10.1167/tvst.7.2.14

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…Importantly, the retest variability for ROI analysis was excellent at ±1.3 µm. (Wu et al 2018b). As in study manual ROI analysis was superior to automated ROI analysis for longitudinal detection of macular inner retinal layer atrophy.…”

Section: Brain 2019mentioning

confidence: 80%

Patterns of retrograde axonal degeneration in the visual system

Vries-Knoppert

Baaijen

Petzold

2019

Brain

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Conclusive evidence for existence of acquired retrograde axonal degeneration that is truly trans-synaptic (RTD) has not yet been provided for the human visual system. Convincing data rely on experimental data of lesions to the posterior visual pathways. This study aimed to overcome the limitations of previous human studies, namely pathology to the anterior visual pathways and neurodegenerative co-morbidity. In this prospective, longitudinal cohort retinal optical coherence tomography scans were acquired before and after elective partial temporal lobe resection in 25 patients for intractable epilepsy. Newly developed region of interest-specific, retinotopic areas substantially improved on conventional reported early treatment diabetic retinopathy study (ETDRS) grid-based optical coherence tomography data. Significant inner retinal layer atrophy separated patients with normal visual fields from those who developed a visual field defect. Acquired RTD affected the retinal nerve fibre layer, ganglion cell and inner plexiform layer and stopped at the level of the inner nuclear layer. There were significant correlations between the resected brain tissue volume and the ganglion cell layer region of interest (R = −0.78, P < 0.0001) and ganglion cell inner plexiform layer region of interest (R = −0.65, P = 0.0007). In one patient, damage to the anterior visual pathway resulted in occurrence of microcystic macular oedema as recognized from experimental data. In the remaining 24 patients with true RTD, atrophy rates in the first 3 months were strongly correlated with time from surgery for the ganglion cell layer region of interest (R = −0.74, P < 0.0001) and the ganglion cell inner plexiform layer region of interest (R = −0.51, P < 0.0001). The different time course of atrophy rates observed relate to brain tissue volume resection and suggest that three distinct patterns of retrograde axonal degeneration exist: (i) direct retrograde axonal degeneration; (ii) rapid and self-terminating RTD; and (iii) prolonged RTD representing a ‘penumbra’, which slowly succumbs to molecularly governed spatial cellular stoichiometric relationships. We speculate that the latter could be a promising target for neuroprotection.

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Section: Brain 2019mentioning

confidence: 80%

Patterns of retrograde axonal degeneration in the visual system

Vries-Knoppert

Baaijen

Petzold

2019

Brain

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“…Further, progressive changes can be better detected by following a region of interest (ROI) than by using summary metrics from OCT printouts, such as average global cpRNFL thickness. 2,34,35…”

Section: When Do You Look At Oct Images?mentioning

confidence: 99%

“…In fact, we can still make use of the segmentation algorithms to define a ROI, but we should follow this region both quantitatively and qualitatively. 34 35 . This ROI can be a small abnormal region in cases of early glaucoma and small regions of preserved cpRNFL in the case of advanced glaucoma (Fig.…”

Section: A Comparison To An Interpretation Of Mri Scans Of the Brainmentioning

confidence: 99%

Four Questions for Every Clinician Diagnosing and Monitoring Glaucoma

Hood

Moraes

2018

Journal of Glaucoma

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We pose 4 questions for the clinician diagnosing and monitoring glaucoma, and supply evidence-based answers. The first question is: "When do you perform a 10-2 (2-degree grid) visual field (VF) test?" We argue the best answer is: anyone you would do, or have done, a 24-2 (6-degree grid) VF on should have both a 24-2 and a 10-2 VF within the first 2 visits. Second, "When do you perform an optical coherence tomography (OCT) scan of the macula?" We argue that, if you are performing an OCT test, then it should include both the macula and disc, either as a single scan or as 2 scans, one centered on the macula and the other on the disc. Third, "How do you know if the VF and OCT tests agree?" The poor answer is, "I use summary statistics such as 24-2 mean deviation and global or quadrant average of retinal nerve fiber layer (RNFL) thickness." It is much better to topographically compare abnormal regions on the OCT to abnormal regions on the VF. Finally, the fourth question is: "When do you look at OCT images?" We argue that, at a minimum, the clinician should be directly examining an image of the circumpapillary RNFL, and this image should be sufficiently large and with sufficient resolution so that local damage can be seen, and the segmentation evaluated.

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“…However, recent studies have revealed how neuroretinal parameters in the macula and posterior pole (outside of the peripapillary region) could also provide important information about disease progression 10–14,22,23 that could be exploited to further improve the power to detect a significant treatment effect. Furthermore, analytical methods that limit the evaluation of progression within regions of established glaucomatous damage (to minimize the contribution of measurement variability from non-damaged regions) could further reduce sample size requirements 23–26 .…”

Section: Discussionmentioning

confidence: 99%

Sample Size Requirements of Glaucoma Clinical Trials When Using Combined Optical Coherence Tomography and Visual Field Endpoints

Medeiros

2019

Sci Rep

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Glaucoma clinical trials using visual field (VF) endpoints currently require large sample sizes because of the slowly-progressive nature of this disease. We sought to examine whether the combined use of VF testing and non-invasive optical coherence tomography (OCT) imaging of the neuroretinal tissue could improve the feasibility of such trials. To examine this, we included 192 eyes of 121 glaucoma participants seen at ≥5 visits over a 2-year period to extract real-world estimates of the rates of change and variability of VF and OCT imaging measurements for computer simulations to obtain sample size estimates. We observed that the combined use of VF and OCT endpoints led to a 31–33% reduction in sample size requirements compared to using VF endpoints alone for various treatment effect sizes. For example, 189 participants would be required per group to detect a 30% treatment effect with 90% power with combined VF and OCT endpoints, whilst 276 and 285 participants would be required when using VF and OCT endpoints alone respectively. The combined use of OCT and VF endpoints thus has the potential to effectively improve the feasibility of future glaucoma clinical trials.

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Evaluation of a Region-of-Interest Approach for Detecting Progressive Glaucomatous Macular Damage on Optical Coherence Tomography

Cited by 15 publications

References 25 publications

Patterns of retrograde axonal degeneration in the visual system

Patterns of retrograde axonal degeneration in the visual system

Four Questions for Every Clinician Diagnosing and Monitoring Glaucoma

Sample Size Requirements of Glaucoma Clinical Trials When Using Combined Optical Coherence Tomography and Visual Field Endpoints

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