Exploring the Heidelberg Retinal Tomograph 3 Diagnostic Accuracy across Disc Sizes and Glaucoma Stages

Oddone, Francesco; Centofanti, Marco; Rossetti, Luca; Iester, Michele; Fogagnolo, Paolo; Capris, Elisabetta; Manni, Gianluca

doi:10.1016/j.ophtha.2008.01.007

Cited by 42 publications

(38 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31,32 Unlike previous studies that largely analyzed sensitivities and specificities only, our study evaluated PPV and NPV performance indices, as PPV and NPV are influenced strongly by disease prevalence. 30 This analysis indicated that the ISNT rule and its variants, determined based on the HRT, have limited value in population-based detection of glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of the ISNT Rule for Glaucoma Based on the Heidelberg Retinal Tomograph

Chan¹,

Liao²,

Foo³

et al. 2013

Trans. Vis. Sci. Tech.

View full text Add to dashboard Cite

Purpose: We determined the accuracy of the inferior . superior . nasal . temporal (ISNT) neuroretinal rim area rule and its variants in adult Asian populations, and evaluated whether disc area impacts its performance characteristics.Methods: Participants in the Singapore Malay Eye Study (SiMES) and Singapore Indian Eye Study (SINDI) underwent standardized ocular examinations, including optic disc imaging with the Heidelberg retinal tomograph (HRT). Glaucoma was defined using the ISGEO criteria. HRT rim areas in the superior, inferior, nasal, and temporal quadrants were quantified. We determined sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of violating the ISNT rule and 4 variants (I . S . T, I . S, I . T, and combined I . T and S . T). The influence of disc area was analyzed with multivariate marginal logistic regression.Results: There were 6112 participants (mean age: 57.6 6 10.3 years). Glaucoma was present in 194 individuals (3.2%). Among 11,840 eyes, 232 (93.2%) of 249 glaucomatous eyes and 9768 (84.3%) of 11,591 nonglaucomatous eyes, violated the ISNT rule. The ISNT rule had highest sensitivity (93.5%), but lowest specificity (15.7%); I . T had highest specificity (98.2%), but low sensitivity (7.4%). For all variants, PPVs were low (2.1%-8.4%) and NPVs were high (97.9-99.1%). Larger disc area was associated with reduced specificity for the ISNT rule (P , 0.001), and reduced sensitivity (P ¼ 0.01) and increased specificity for I . S . T (P , 0.05). PPV increased (P , 0.05) and NPV decreased (P , 0.001) with increasing disc area. Conclusions:The ISNT rule based on HRT has high sensitivity, and the I . T, S . T, and combined I . T and S . T variants have high specificity. Disc area influences sensitivity, specificity, PPV, and NPV of the ISNT rule and its variants.Translational Relevance: The high sensitivity of the ISNT rule, and high specificities of its variants, may have potential utility when used in combination with other HRT algorithms for glaucoma assessment.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of the ISNT Rule for Glaucoma Based on the Heidelberg Retinal Tomograph

Chan¹,

Liao²,

Foo³

et al. 2013

Trans. Vis. Sci. Tech.

View full text Add to dashboard Cite

show abstract

“…The sensitivity of CSM was estimated to be 86% for a fixed specificity of 90% corresponding to a cutoff value of Ϫ0. 15. Complete details are given in Table 4 (available online at http://aaojournal.org).…”

Section: Continuous Parametersmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] The commer-cially available CSLO, the Heidelberg Retinal Tomograph (HRT; Heidelberg Engineering GmbH, Dossenheim, Germany) is the leading device for a 3-dimensional quantitative study and classification of the ONH shape. 9 -14 Despite its good overall diagnostic performance, the accuracy of the discrimination between normality and glaucoma has been shown to be significantly influenced by ONH shape and size; specifically, it has been shown that larger optic discs are associated with lower specificities and smaller discs with lower sensitivities, [15][16][17][18][19][20] thus limiting the role of quantitative ONH assessment in the clinical diagnostic process.…”

mentioning

confidence: 99%

Influence of Disc Size on Optic Nerve Head versus Retinal Nerve Fiber Layer Assessment for Diagnosing Glaucoma

et al. 2011

Self Cite

View full text Add to dashboard Cite

Purpose: To explore and compare the influence of optic disc size on the diagnostic accuracy of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) quantitative assessment.Design: Observational, cross-sectional evaluation of diagnostic tests. Participants: We included 120 eyes from 50 normal subjects and 70 glaucomatous patients classified by the presence of a repeatable visual field defect for the analysis.Testing: The RNFL thickness was measured by scanning laser polarimetry with variable corneal compensator (GDx-VCC, Carl-Zeiss Meditec, Dublin, CA) and spectral-domain optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Inc). We obtained ONH imaging by means of confocal scanning laser ophthalmoscopy (HRT3; Heidelberg Engineering, GmbH, Dossenheim, Germany).Main Outcome Measures: Sensitivity and specificity for normative classifications, sensitivity at fixed specificity and area under the receiver operating characteristics curve (AUC) for continuous parameters. A logistic marginal regression model and coefficients of variation (CoV) have been used to test and quantify the influence of optic disc size on the diagnostic accuracy of the 3 technologies under investigation.Results: Among continuous parameters average RNFL thickness for Cirrus HD-OCT, nerve fiber indicator for GDx-VCC and cup shape measure for the HRT3 showed the best diagnostic accuracy with an AUC of 0.97, 0.94, and 0.94, respectively. Among normative classifications, the highest sensitivity and specificity were found for OCT average RNFL thickness (75.8% and 94.7%), for GDx superior thickness (77.1% and 97.5%), for HRT3 Moorfields regression analysis result (89.4% and 73.7%) and for HRT3 GPS global (92.3% and 76.5%). The diagnostic performance of HRT3 parameters seemed to be significantly influenced by optic disc size, although the same was not true for Cirrus HD-OCT and GDx VCC. The most steady performers for each imaging device across disc size groups were Cirrus HD-OCT average thickness (CoV, 1.6%), GDx-VCC inferior thickness (CoV, 2.5%), and HRT3 GPS temporal and nasal (CoV, 21.4%).Conclusions: The diagnostic accuracy of quantitative RNFL assessment as performed by Cirrus HD-OCT and GDx-VCC is high and virtually unaffected or only minimally affected by the size of the optic disc and may provide more consistent diagnostic outcomes across small and large discs than ONH assessment as performed by HRT3. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

show abstract

“…Numerous studies [5][6][7][8][9]26 have been performed to determine the best HRT parameters for discriminating between healthy and glaucoma subjects. Others studies [18][19][20]27 have focused on developing discriminant functions to improve the diagnostic ability of HRT parameters.…”

Section: Discussionmentioning

confidence: 99%

Optic nerve head changes in early glaucoma: a comparison between stereophotography and Heidelberg retina tomography

Pablo

Ferreras

Fogagnolo

et al. 2009

Eye

View full text Add to dashboard Cite

Objective To evaluate and compare the diagnostic accuracy of the Heidelberg retina tomograph (HRT) version 3 with that of glaucoma specialists using stereophotography in discriminating between normal eyes and patients with early glaucomatous visual field loss. Methods A total of 105 eyes of 105 individuals were prospectively and consecutively recruited. The sample comprised 51 normal and 54 early glaucomatous eyes, as defined by intraocular pressure and standard automated perimetry results, regardless of optic disc appearance. Receiver operating characteristic (ROC) curves were plotted for the HRT3 parameters and a linear discriminant function (LDF) developed in our hospital. Best sensitivity-specificity pairs were compared between the HRT3 parameters, with the highest areas under the ROC curve (AUCs) and evaluation of optic disc stereophotographs. Agreement between methods for measuring vertical cup-to-disc ratio was evaluated with the Bland-Altman plot. Results The average visual field mean deviation was -2.90 dB. The HRT3 parameters with the largest AUCs were our LDF (0.900), rim volume (0.883), and vertical cup/disk ratio (0.880), with no significant differences between these parameters. Sensitivity-specificity pairs were 79.6-100% (clinical evaluation), 83.3-86.3% (our LDF), 64.8-96.1% (final glaucoma probability score), and 68.5-90.2% (global Moorfields regression analysis). ConclusionsThe diagnostic accuracy for differentiating normal eyes from those with early visual field defects was similar between clinical evaluation of the optic disc and evaluation with the HRT3. The use of our LDF increased the sensitivity-specificity balance with respect to the HRT-provided parameters. The diagnostic accuracy of the HRT classifications was comparable to that of an experienced glaucoma specialist.

show abstract

Exploring the Heidelberg Retinal Tomograph 3 Diagnostic Accuracy across Disc Sizes and Glaucoma Stages

Cited by 42 publications

References 21 publications

Diagnostic Performance of the ISNT Rule for Glaucoma Based on the Heidelberg Retinal Tomograph

Diagnostic Performance of the ISNT Rule for Glaucoma Based on the Heidelberg Retinal Tomograph

Influence of Disc Size on Optic Nerve Head versus Retinal Nerve Fiber Layer Assessment for Diagnosing Glaucoma

Optic nerve head changes in early glaucoma: a comparison between stereophotography and Heidelberg retina tomography

Contact Info

Product

Resources

About