Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography.
ABSTRACT To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection.
Cross-sectional comparative study.
Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included.
Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection.
The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1.
The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC.
The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.
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ABSTRACT: The Moorfields Motion Displacement Test (MMDT; Enhanced Standard Threshold Algorithm [ESTA] version 1, London, UK) is a new 31-point suprathreshold test for visual field assessment using moving line stimuli displayed on a standard laptop computer. This study evaluated the diagnostic performance of the MMDT for discriminating between healthy eyes and eyes with glaucoma. Evaluation of diagnostic technology. Seventy-eight subjects with glaucoma and 348 healthy subjects. All participants underwent a standardized ophthalmologic examination, including the MMDT and Heidelberg Retina Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany) scanning of the optic disc. The diagnosis of glaucoma was based on clinical examination with glaucomatous optic neuropathy defined by the presence of neuroretinal rim thinning, notching or excavation of the cup, cup-to-disc asymmetry between eyes of 0.25 or more, nerve fiber layer thinning (focal or diffuse), or a combination thereof; and HRT-based Moorfields Regression Analysis (MRA) results of outside normal limits in any sector. Normal eyes were defined as clinically having healthy neuroretinal rims and an MRA analysis of within normal limits in all sectors. The MMDT used a Pandora response version of the ESTA without optical correction. Subjects with a false-positive response of 15% or more in MMDT were excluded. The performance of the global probability of true damage (global PTD) for diagnosing glaucoma was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The global PTD was calculated as a sum of individual PTD values, ranging from 0% to 100% for all 31 visual locations, and was expressed as a quotient of 100. Seventy-eight subjects with glaucoma (mean age, 66.6±13.1 years; male gender, 55.1%) and 348 healthy subjects (mean age, 55.2±9.2 years; male gender, 35.3%) were analyzed. The AUC for the global PTD was 0.930 (95% confidence interval, 0.893-0.967) for diagnosing glaucoma. At 85% specificity, the MMDT demonstrated a sensitivity of 88.5%. This decreased to 83.3% at 95% specificity. At the global PTD cutoff point value of 2.0, the sensitivity was 85.9% and the specificity was 94.5%. The suprathreshold MMDT showed good diagnostic performance for diagnosing glaucoma when glaucoma was defined by a structural criterion. The author(s) have no proprietary or commercial interest in any materials discussed in this article.Ophthalmology 10/2013; · 5.56 Impact Factor
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ABSTRACT: Evaluate the diagnostic performance of spectral-domain optical coherence tomography (OCT) parameters to distinguish between healthy, glaucoma suspect, and glaucomatous eyes. Forty-eight eyes of glaucoma, 48 glaucoma suspect eyes, and 35 healthy eyes were included. The circumpapillary and macular retinal nerve fiber layer (RNFL) thickness were measured using the Cirrus OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA). One-way analysis of variance was used to compare the different parameters among groups. Calculating areas under receiver operating characteristic (AROC) curves evaluated the discriminating power of each parameter The average circumpapillary RNFL thickness in normal, glaucoma suspects, and glaucomatous eyes were 100.31 +/- 7.69 microm, 90.27 +/- 9.22 microm, and 71.40 +/- 13.08 microm, respectively (p < 0.001). The largest AROC curve among the circumpapillary parameters was the inferior quadrant thickness (0.974, p < 0.001). The macular volume had the largest AROC curves (0.898, p < 0.001) of all macular parameters. For glaucoma suspect eyes versus early glaucomatous eyes, the best value of circumpapillary parameters was inferior quadrant thickness (0.835, p < 0.001). Among the macular parameters, the best value was the macular cube volume (0.766, p < 0.001). Circumpapillary parameters have better diagnostic performance than macular parameters especially the inferior quadrant thickness that has the best discriminating powerJournal of the Medical Association of Thailand = Chotmaihet thangphaet 06/2013; 96(6):689-95.
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ABSTRACT: Though a newly developed spectral domain OCT is at the center of interests for many ophthalmologic researchers and clinicians, its own characteristics are not fully evaluated yet. The main purpose of this study was to establish the adjusted color probability codes for peripapillary retinal nerve fiber layer (RNFL) thickness in healthy Koreans and to compare them with original color codes provided by spectral domain optical coherence tomography (OCT). Two hundred ninety-five healthy Korean eyes were enrolled and their peripapillary RNFL thickness was measured by Cirrus OCT. For each decade of age, the normal thickness reference was determined on the basis of z-scores and the adjusted color probability codes were established. Then the agreements between adjusted and original color codes were calculated using weighted Kappa (Kw) coefficient. On the basis of Kw coefficient, the overall agreement between the adjusted and original probability color codes was not excellent (Kw range of 0.500 to 0.806). If the adjusted probability codes were assumed as a standard of comparison, the original color codes showed the false-negative in 11% of eyes and the false-positive in 0.3% of eyes for average RNFL thickness. Adjusted color probability codes judged by the Korean normative data showed a discrepancy with original codes. It implies that normal reference and adjusted probability codes for each ethnicity might be needed to determine whether a certain RNFL thickness is within normal range or not.BMC Ophthalmology 03/2014; 14(1):38. · 1.44 Impact Factor