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: To compare the abilities of current commercially available versions of 3 optical imaging techniques: scanning laser polarimetry with variable corneal compensation (GDx VCC), confocal scanning laser ophthalmoscopy (HRT II [Heidelberg Retina Tomograph]), and optical coherence tomography (Stratus OCT) to discriminate between healthy eyes and eyes with glaucomatous visual field loss. We included 107 patients with glaucomatous visual field loss and 76 healthy subjects of a similar age. All individuals underwent imaging with a GDx VCC, HRT II, and fast retinal nerve fiber layer scan with the Stratus OCT as well as visual field testing within a 6-month period. Receiver operating characteristic curves and sensitivities at fixed specificities (80% and 95%) were calculated for parameters reported as continuous variables. Diagnostic categorization (outside normal limits, borderline, or within normal limits) provided by each instrument after comparison with its respective normative database was also evaluated, and likelihood ratios were reported. Agreement on categorization between methods (weighted kappa) was assessed. After the exclusion of subjects with unacceptable images, the final study sample included 141 eyes of 141 subjects (75 with glaucoma and 66 healthy control subjects). Mean +/- SD mean deviation of the visual field test result for patients with glaucoma was -4.87 +/- 3.9 dB, and 70% of these patients had early glaucomatous visual field damage. No statistically significant difference was found between the areas under the receiver operating characteristic curves (AUCs) for the best parameters from the GDx VCC (nerve fiber indicator, AUC = 0.91), Stratus OCT (retinal nerve fiber layer inferior thickness, AUC = 0.92), and HRT II (linear discriminant function, AUC = 0.86). Abnormal results for each of the instruments, after comparison with their normative databases, were associated with strong positive likelihood ratios. Chance-corrected agreement (weighted kappa) among the 3 instruments ranged from moderate to substantial (0.50-0.72). The AUCs and the sensitivities at high specificities were similar among the best parameters from each instrument. Abnormal results (as compared with each instrument's normative database) were associated with high likelihood ratios and large effects on posttest probabilities of having glaucomatous visual field loss. Calculation of likelihood ratios may provide additional information to assist the clinician in diagnosing glaucoma with these instruments.Archives of Ophthalmology 07/2004; 122(6):827-37. · 3.83 Impact Factor
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ABSTRACT: To determine the sensitivity and specificity of measurements of the retinal nerve fiber layer (RNFL) using the StratusOCT in glaucoma subjects with visual field (VF) defects. Prospective cross-sectional study. One hundred nine normal and 63 glaucoma subjects. Fast RNFL scans were performed in one eye of each patient using the StratusOCT. Sensitivity and specificity of different optical coherence tomography (OCT) criteria for identifying glaucoma subjects with glaucomatous VF defects. Areas under the receiver operating characteristic curves (AROCs) for various OCT parameters. Severity of VF defects in the glaucoma group was distributed between mild (18 subjects), moderate (21 subjects), and severe (24 subjects). The average mean deviation of the glaucoma fields was -8.4 decibels (dB), with a standard deviation of 6.0 dB and a range from -0.14 to -28.0 dB. The sensitivity and specificity using a criterion of average RNFL thickness abnormal at the <5% level were 84% and 98%, respectively. The sensitivity and specificity using a criterion of average RNFL thickness abnormal at the <1% level were 68% and 100%. The sensitivity and specificity of using a criterion of >or=1 quadrants abnormal at the <5% level were 89% and 95%. The sensitivity and specificity of using a criterion of >or=1 quadrants abnormal at the <1% level were 83% and 100%. The sensitivity and specificity of using a criterion of >or=1 clock hours abnormal at the <5% level were 89% and 92%. The sensitivity and specificity of using a criterion of >or=1 quadrants abnormal at the <1% level were 83% and 100%. The AROC for mean RNFL thickness was 0.966. Other high AROC values included the superior quadrant (0.952), inferior quadrant (0.971), inferotemporal clock hour at 7-o'clock (right eye) and 5-o'clock (left eye) (0.959), 6-o'clock hour (0.940), superotemporal clock hour at 11-o'clock (right eye) and 1-o'clock (left eye) (0.935), and 12-o'clock hour (0.924). The sensitivity and specificity of RNFL measurements using the new StratusOCT for glaucoma with manifest VF defects are excellent. The best parameters seem to be >or=1 quadrants abnormal at the <or=5% level or >or=1 clock hours abnormal at the <or=5% level. Future studies are needed to determine the sensitivity and specificity of this new technology for glaucoma without VF defects.Ophthalmology 01/2005; 112(1):3-9. · 5.56 Impact Factor
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ABSTRACT: To compare the association between scanning laser polarimetry (SLP) retinal nerve fiber layer (RNFL) measurements and automated perimetry sensitivity using both SLP manufacturer-assumed fixed and subject-specific variable corneal polarization magnitude and corneal polarization axis values. An SLP was modified to enable the measurement of corneal polarization magnitude and corneal polarization axis so that compensation for corneal birefringence could be corrected on a subject-specific variable basis. Seventy-three eyes from the University of California, San Diego, Diagnostic Innovations in Glaucoma Study with early glaucoma or suspected glaucoma (abnormal Swedish Interactive Threshold Algorithm [SITA] or full-threshold automated perimetry results and/or glaucomatous-appearing optic disc by consensus grading of stereoscopic optic disc photographs) (mean [SD] SITA mean deviation, -2.74 [3.71] dB; range, 1.72 to -14.72 dB) were included. Subjects were imaged with SLP using the manufacturer-assumed fixed corneal compensation values and subject-specific variable corneal compensation values and tested with SITA automated perimetry. Scanning laser polarimetry and SITA data were obtained within 3 months of each other. The relationship between regional SLP RNFL measurements (24 parameters) and corresponding regional SITA raw thresholds were evaluated using linear regression for both (fixed corneal compensation and variable corneal compensation) SLP configurations. No fixed corneal compensation SLP measurements were significantly associated with corresponding SITA visual field zone sensitivities after corrections for multiple comparisons. Seven variable corneal compensation RNFL parameters (superior, inferior, or mean RNFL thickness measurements) were significantly associated with their corresponding visual field zones with R2 values ranging from 0.13 (ellipse average) to 0.20 (superior average). Variable corneal compensation to correct for subject-specific corneal polarization magnitude and corneal polarization axis improves the relationship between SLP-measured RNFL thickness and visual function measured by SITA perimetry.Archives of Ophthalmology 08/2003; 121(7):961-6. · 3.83 Impact Factor