Serial Combined Wide-Field Optical Coherence Tomography Maps for Detection of Early Glaucomatous Structural Progression

Abstract

IMPORTANCE Both parapapillary and macular areas are important in determining the progression of early glaucoma. However, no attempt has been made to assess the progression of glaucoma in images that combine the 2 areas. OBJECTIVE To evaluate the potential usefulness of serial analysis of combined wide-field optical coherence tomography (OCT) maps for detection of structural progression in patients with early glaucoma. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study. Patients with early primary open-angle glaucoma with a minimum of 3-year follow-up involving serial spectral-domain OCT measurement were analyzed. Patients were divided into a nonprogressor group (n = 47) and a progressor group (n = 47) on the basis of serial stereo disc photography and red-free photography. Serial combined wide-field OCT maps integrating parapapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) maps were generated with the embedded software of serial spectral-domain OCT. Glaucoma specialists then assessed the structural progression detection ability of those serial wide-field OCT maps for early glaucomatous eyes and compared their sensitivity with those of RNFL and GCIPL guided progression analyses (GPAs). MAIN OUTCOMES AND MEASURES The diagnostic ability of the serial wide-field OCT maps for early glaucomatous structural progression. RESULTS Ninety-four patients (mean [SD] age, 51.4 [12.3] years; 48 [51.1%] women; all Korean) were included. The serial wide-field OCT map analysis showed good agreement for detection of structural progression between the 2 glaucoma graders (wide-field OCT thickness map: κ = 0.649; wide-field OCT deviation map: κ = 0.833). These maps showed early glaucomatous structural progression detection abilities comparable with those of RNFL and GCIPL GPAs (sensitivities of wide-field OCT thickness map, wide-field OCT deviation map, RNFL GPA, and GCIPL GPA = 63.8%, 83.0%, 83.0%, and 66.0%, respectively, all P > .05; specificities of wide-field OCT thickness map, wide-field OCT deviation map, RNFL GPA, and GCIPL GPA = 93.6%, 95.7%, 84.8%, and 93.6%, respectively, all P > .05). CONCLUSIONS AND RELEVANCE The serial combined wide-field OCT maps integrating RNFL and GCIPL maps performed well in detecting structural progression in early glaucomatous eyes. Confirmation in an independent prospective study might provide greater confidence in this conclusion.

A Wide-Field Optical Coherence Tomography Normative Database Considering the Fovea-Disc Relationship for Glaucoma Detection

“…Our group has reported the advantages of the wide-field RNFL thickness map and also reported the advantage of the wide-field SuperPixel map (DRI-OCT), 12 , 13 or PanoMap (Cirrus OCT). 8 However, these two deviation maps used the normative database of narrow areas based on a uniform size and angle.…”

“…In addition to the classical observation of the retinal nerve fiber layer (RNFL) around the optic disc head (peripapillary), the macular inner retinal structure has received attention in the field of glaucoma. 5 – 7 Recently, studies on the temporal sequences and spatial relations between the peripapillary and macular areas 8 – 11 have been published. Some studies have suggested that it may be useful to diagnose glaucoma to integrate these two areas using advanced hardware (i.e.…”

Comprehensive Glaucoma Imaging

“…This one-page report was shown to be very helpful in discriminating healthy and glaucomatous eyes when used by a non-glaucoma specialist [59]. Furthermore, SS-OCT single widefield scan was able to distinguish between pre-perimetric and early perimetric glaucoma patients from healthy controls and to detect progression successfully [60][61][62]. Albeit some OCT parameters have been shown to detect glaucoma better than others, it is recommended to consider a combination of parameters in the diagnostic process.…”

Vulnerability Zone of Glaucoma Progression in Combined Wide-field Optical Coherence Tomography Event-based Progression Analysis

“…[10][11][12][13][14] Some reports introduced that integrating these two areas together using hardware (wide-field scan with swept source technology) or software (scan individually and combine each area together) is useful for diagnosing glaucoma or its progression and can provide more complementary information than using each separately. 11,12,[15][16][17][18][19] Our group reported that a serial analysis of PanoMaps, which integrates the deviation map of the peripapillary and macular areas, performed well in detecting structural progression in early glaucomatous eyes. 18 Furthermore, our group introduced a combination method, which integrates the peripapillary RNFL and macular GCIPL Guided Progression Analysis (GPA) progression maps, which were derived from glaucoma progression evaluation software (Cirrus HD-OCT GPA software 2,20 ), into a single image and helps to evaluate the temporal sequence of the glaucomatous structural progression.…”

“…11,12,[15][16][17][18][19] Our group reported that a serial analysis of PanoMaps, which integrates the deviation map of the peripapillary and macular areas, performed well in detecting structural progression in early glaucomatous eyes. 18 Furthermore, our group introduced a combination method, which integrates the peripapillary RNFL and macular GCIPL Guided Progression Analysis (GPA) progression maps, which were derived from glaucoma progression evaluation software (Cirrus HD-OCT GPA software 2,20 ), into a single image and helps to evaluate the temporal sequence of the glaucomatous structural progression. 17 However, no studies using a combined wide-field GPA map (GPA PanoMap) to determine spatial characteristics and patterns of glaucomatous structural progression have been reported to date.…”