Optic disk and nerve fiber layer imaging to detect glaucoma

Federico Badalà, Kouros Nouri-Mahdavi, Duna A Raoof, Narakorn Leeprechanon, Simon K Law, Joseph Caprioli
American Journal of Ophthalmology 2007, 144 (5): 724-32

PURPOSE: To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes.

DESIGN: Retrospective, cross-sectional study.

METHODS: In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters.

RESULTS: The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs (+/- standard error) were: average RNFL thickness for StratusOCT (0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area with CART produced a sensitivity of 91% and specificity of 96%.

CONCLUSIONS: StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"