Sector-Based Analysis with the Heidelberg Retinal Tomograph 3 Across Disc Sizes and Glaucoma Stages

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

doi:10.1016/j.ophtha.2009.01.020

Cited by 28 publications

(36 citation statements)

References 28 publications

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“…7 Importantly, the sensitivity of the ISNT rule in our study and the earlier study 7 is higher than other current HRT diagnostic algorithms (i.e., MRA, GPS, and Mikelberg, Burk, and Bathija linear discriminant functions, which have reported sensitivities of ,90% in clinic-and population-based studies). 16,17,19,30,32,33 Thus, the high sensitivity and NPV of the ISNT rule per se revealed in our analysis indicated potential utility in population-based glaucoma evaluation.…”

Section: Discussionmentioning

confidence: 55%

“…In addition, disc size is known to influence the diagnostic performance of HRT classification algorithms, such as the Moorfields regression analysis (MRA), glaucoma probability score (GPS), and linear discriminant functions. [16][17][18][19] Whether the performance of the ISNT rule on the HRT is influenced by the spectrum of optic disc sizes in the population is unclear. Therefore, a second objective of this study was to evaluate the impact of disc area on the performance of the ISNT rule and its variants.…”

Section: Superior (S) Nasal (N)mentioning

confidence: 99%

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

Chan¹,

Liao²,

Foo³

et al. 2013

Trans. Vis. Sci. Tech.

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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.

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Section: Discussionmentioning

confidence: 55%

Section: Superior (S) Nasal (N)mentioning

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.

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“…[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

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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.

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“…In general it was shown that GPS is influenced to a greater extent by the disc size and is therefore outperformed by MRA. 50,51 It was suggested that GPS may be more useful to confirm a normal disc while MRA might be more helpful to confirm glaucoma suspects. 52 SLP (GDx VCC and ECC) has been shown to be influenced only minimally by optic disc size; however, repeatability of the measurements decreased with increasing severity of glaucoma.…”

Section: Imaging Technologies For the Diagnosis Of Glaucomamentioning

confidence: 99%

Imaging Technologies for the Diagnosis of Glaucoma

Bochmann¹,

Azuara‐Blanco²

2009

European Ophthalmic Review

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In this article we describe recent advances in imaging technologies that quantify the topography of the optic nerve head and retinal nerve fibre layer and their role in diagnosing glaucoma. These technologies include optical coherence tomography (OCT), scanning laser polarimetry (SLP, GDx) and confocal scanning laser ophthalmoscopy (CSLO, HRT). A review of recently published literature was carried out.The diagnostic performance of the different imaging devices is comparable and appears to be acceptable for the diagnosis of manifest glaucoma. The benefits of recent technological improvements need to be fully assessed. At the moment it is not clear which of the currently used imaging technologies is the most useful for diagnosis and management of glaucoma. KeywordsOptical coherence tomography, scanning laser polarimetrey, confocal scanning laser ophthalmoscopy ) and optical coherence tomography (OCT) (see Figure 1). They can be used to detect early structural damage by focusing on glaucoma-relevant structures of the ONH and surrounding tissues and using a normative database to determine the probability of glaucoma. Imaging of the ONH and the RNFL for detecting glaucoma progression is another important aspect of glaucoma management. However, in this review we will focus only on the role of imaging technologies in the diagnosis of glaucoma.We will provide a brief description of the recent advances, and review the current literature on the diagnostic performance for glaucoma of these imaging devices. Scanning Laser PolarimetrySLP is designed to provide objective assessment of the RNFL thickness with potential use for diagnosis and follow-up. SLP is based on the principle that polarised light passing through the birefringence RNFL undergoes a detectable phase shift, which is linearly related to RNFL thickness. 7 The result is a 2D map of retardation around the optic disc. The software provides a discriminating classifier of glaucoma/normality named nerve fibre indicator (NFI), which is fully automated. To detect change over time, regression analysis can be performed.The first GDx nerve fibre analyser contained a fixed compensating device to compensate for polarisation effects of cornea and lens.

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Sector-Based Analysis with the Heidelberg Retinal Tomograph 3 Across Disc Sizes and Glaucoma Stages

Cited by 28 publications

References 28 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

Imaging Technologies for the Diagnosis of Glaucoma

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