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

Eguia, Melvi Del Valle; Tsamis, Emmanouil; Zemborain, Zane; Sun, Ashley; Percival, Joseph; Moraes, Carlos Gustavo De; Ritch, Robert; Hood, Donald C.

doi:10.1167/tvst.9.11.22

Cited by 14 publications

(25 citation statements)

References 28 publications

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“…Formal testing of various OCT thickness measures with regard to the detection of glaucoma in such eyes showed lower performance for most such OCT measures, including macular thickness measures. 12 , 37 The lower performance of GCL as compared with GCIPL could also be explained by segmentation and alignment errors in the inner macular layer, 38 , 39 as well as concurrent changes within the IPL in early glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

Nezhad¹,

Mohammadzadeh²,

Martinyan³

et al. 2023

Ophthalmology Glaucoma

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Section: Discussionmentioning

confidence: 99%

Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

Nezhad¹,

Mohammadzadeh²,

Martinyan³

et al. 2023

Ophthalmology Glaucoma

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“…In fact, we and others have shown that subtle segmentation errors, which are difficult to detect, are common, and can lead to false diagnoses from the OCT summary metrics. 41 – 43 Second, if the scan is not placed properly on the disc or foveal center it can too lead to false diagnoses. 44 Third, early glaucomatous damage often involves relatively local defects that are missed by summary statistics, which include regions larger than these defects.…”

Section: Discussionmentioning

confidence: 99%

Detection of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry

Tsamis

Bruna

Leshno

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose To evaluate the diagnostic performance of optical coherence tomography (OCT) and visual field (VF) summary statistics (metrics) that are available in OCT and VF reports. Methods OCT disc and macular scans and 24-2 and 10-2 VFs were obtained from 56 healthy control (HC) eyes/participants and 61 eyes/patients with 24-2 mean deviation of better than –6 dB. All metrics were obtained from OCT radial, circle, and posterior pole cube scans and 24-2 and 10-2 VFs. Their diagnostic performances were evaluated, in isolation and in combinations. For specificity, the 56 HC eyes were used. For sensitivity, 40 of the 61 patient eyes were deemed likely glaucomatous based on an automated topographic method that evaluates structure–function (S–F) agreement. Any 1 of these 40 eyes not judged as abnormal by any given metric was considered a false negative. Results All single OCT and VF metrics misclassified HCs as glaucomatous and missed likely glaucomatous eyes. The best performing single metric was the temporal inferior thickness of the 3.5-mm circle scan, with 96% specificity and 83% sensitivity. Combinations of OCT–OCT and OCT–VF metrics markedly improved specificity. A newly proposed metric that evaluates structure–structure (S–S) agreement at a hemifield level had the highest accuracy. This S–S metric had 98% specificity and 80% sensitivity. Conclusions OCT and VF metrics, single or in combinations, have only moderate sensitivity for eyes with early glaucoma. Translational Relevance OCT and VF metrics combinations evaluating S–S or S–F agreement can be highly specific, which is an important implication for clinical and research purposes.

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“…Similarly for OCT, it has been suggested as a general rule of thumb that a loss of 5 µm on the global cpRNFL between two OCT scans constitutes strong evidence of progressive glaucomatous loss, 11 , 12 although this measure has been questioned. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Progression of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry

Tsamis

Bruna

Rai

et al. 2023

Trans. Vis. Sci. Tech.

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Purpose Performance comparison of optical coherence tomography (OCT) and visual field (VF) summary metrics for detecting glaucomatous progression. Methods Thirty healthy control eyes (mean deviation [MD], −1.25 ± 2.03; pattern standard deviation [PSD], 1.78 ± 0.77) and 91 patient eyes comprised of 54 glaucoma patients and 37 glaucoma suspects (MD, −1.58 ± 1.96; PSD, 2.82 ± 1.92) with a follow-up of at least 1 year formed a group to evaluate progression with event analyses (P-Event). A subset of eyes with an additional criterion of a minimum of four tests was used for trend analyses (P-Trend) (30 healthy controls and 73 patients). For P-Event analysis, test–retest variability thresholds (lower 5th percentile) were estimated with repeat tests within a 4-month period. A P-Event eye was considered a “progressor” if the difference between follow-up and baseline tests exceeded the variability thresholds. For the P-Trend analysis, rates of change were calculated based on least-squares regression. Negative rates with significant ( P < 0.05) values were considered progressing. For a reference standard, 17 patient eyes were classified as definitely progressing based on clear evidence of structural and corresponding functional progression. Results Isolated OCT and VF summary metrics were either inadequately sensitive or not too specific. Combinations of OCT–OCT and OCT–VF metrics markedly improved specificity to nearly 100%. A novel combination of OCT metrics (circumpapillary retinal nerve fiber layer and ganglion cell layer) showed high precision, with 13 of the 15 statistical progressors confirmed as true positives. Conclusions Although relying solely on metrics is not recommended for clinical purposes, in situations requiring very high specificity and precision, combinations of OCT–OCT metrics can be used. Translational Relevance All available OCT and VF metrics can miss eyes with progressive glaucomatous damage and/or can falsely identify progression in stable eyes.

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

Cited by 14 publications

References 28 publications

Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

Detection of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry

Progression of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry

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