Early Glaucoma Detection Using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and Retinal Nerve Fiber Layer Photography
The Institute of Vision Research, Yonsei University, Sŏul, Seoul, South Korea Ophthalmology
(Impact Factor: 6.14).
03/2007; 114(2):210-5. DOI: 10.1016/j.ophtha.2006.09.021
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.
Available from: onlinelibrary.wiley.com
- "The evaluation of glaucomatous progression in the optic nerve head should not rely solely on HRT parameters (Saarela et al. 2010, 2012). The diagnostic accuracy for detecting glaucomatous damage with the OCT is relatively good (Hong et al. 2007; Pueyo et al. 2007). Progression rates have been reported to be higher when using OCT compared with visual fields (Wollstein et al. 2005). "
[Show abstract] [Hide abstract]
Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma.
Objective and methods:
This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score.
When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently.
Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument.
Available from: Nagahisa Yoshimura
- "Because morphological changes in the optic disc and the RNFL often precede observable visual field loss in glaucoma , early diagnosis of glaucoma requires an intimate knowledge of the configuration of the optic disc and the distribution of the RNFL in normal subjects. Many previous studies have analyzed RNFL thickness in normal subjects using various imaging techniques, such as confocal SLO (Heidelberg Retina Tomography [HRT]; Heidelberg Engineering, Germany) , scanning laser polarimetry (GDx Nerve Fiber Analyzer; Laser Diagnostic Technologies, Inc, San Diego, CA), – and OCT , , , , –. In these reports, RNFL thickness was measured at the optic disc using HRT, at a diameter of 3.2 mm or a diameter of 1.5–1.75 "
[Show abstract] [Hide abstract]
ABSTRACT: To conduct high-resolution imaging of the retinal nerve fiber layer (RNFL) in normal eyes using adaptive optics scanning laser ophthalmoscopy (AO-SLO).
AO-SLO images were obtained in 20 normal eyes at multiple locations in the posterior polar area and a circular path with a 3-4-mm diameter around the optic disc. For each eye, images focused on the RNFL were recorded and a montage of AO-SLO images was created.
AO-SLO images for all eyes showed many hyperreflective bundles in the RNFL. Hyperreflective bundles above or below the fovea were seen in an arch from the temporal periphery on either side of a horizontal dividing line to the optic disc. The dark lines among the hyperreflective bundles were narrower around the optic disc compared with those in the temporal raphe. The hyperreflective bundles corresponded with the direction of the striations on SLO red-free images. The resolution and contrast of the bundles were much higher in AO-SLO images than in red-free fundus photography or SLO red-free images. The mean hyperreflective bundle width around the optic disc had a double-humped shape; the bundles at the temporal and nasal sides of the optic disc were narrower than those above and below the optic disc (P<0.001). RNFL thickness obtained by optical coherence tomography correlated with the hyperreflective bundle widths on AO-SLO (P<0.001)
AO-SLO revealed hyperreflective bundles and dark lines in the RNFL, believed to be retinal nerve fiber bundles and Müller cell septa. The widths of the nerve fiber bundles appear to be proportional to the RNFL thickness at equivalent distances from the optic disc.
Available from: Young Jae Hong
- "J. Hong & G. J. Seong) were asked to interpret it. Table 1 showed the scoring methods to assess the RNFL photo.9 The RNFL defect score I was a summation of each score, and the RNFL defect score II was the product of each score - RNFL defect, darkness, width, and location. "
[Show abstract] [Hide abstract]
ABSTRACT: To evaluate retinal nerve fiber layer (RNFL) defect by a new scoring system for RNFL photography using the Heidelberg Retina Angiograph 1 (HRA1).
This retrospective study included 128 healthy eyes and 836 primary open-angle glaucoma eyes. The RNFL photography using HRA1 was interpreted using a new scoring system, and correlated with visual field indices of standard automated perimetry (SAP). Using the presence of RNFL defect, darkness, width, and location, we established the new scoring system of RNFL photos.
The mean RNFL defect score I in the early, moderate, severe, and control groups were 7.3, 9.2, 10.4, and 3.6, respectively. The mean RNFL defect score II in the early, moderate, severe, and control groups were 14.5, 28.5, 43.4, and 3.4, respectively. Correlations between the RNFL defect score II and the mean deviation of SAP was the strongest of the various combinations (r=-0.675, P<.001).
Using a new scoring system, we propose a method for semi-quantitative interpretation of RNFL photographs. This scoring system may be helpful to distinguish between normal and glaucomatous eyes, and the score is associated with the severity of visual field loss.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.