Possible Undiagnosed Glaucoma Detected by MultiColor Imaging of Retinal Diseases

Multicolor imaging compared with red-free fundus photography in the detection of glaucomatous retinal nerve fiber layer thinning

BACKGROUND

To compare the ability of multicolor imaging (MCI) with red-free fundus photography (RFP) to detect glaucomatous retinal nerve fiber layer (RNFL) thinning.

METHODS

A total of 127 eyes of 79 patients with glaucoma underwent MCI using blue light, RFP, and circumpapillary optical coherence tomography (OCT) scanning on the same day. Angular location and width of the RNFL defects (RNFLDs) identified on the MCI and RFP were independently measured, and compared with those of RNFL thinning indicated by abnormal color codes on OCT.

RESULTS

The angular location and width of the RNFLDs determined by both MCI and RFP were well correlated with those of RNFL thinning determined by OCT (all P ≤ 0.013). The correlation of angular width with OCT was significantly stronger for MCI than for RFP (R = 0.708 vs. R = 0.616, P = 0.009). The superiority of MCI to RFP in the detection of OCT-determined RNFL thinning was significant in the inferior (P = 0.025) and marginally significant in the superior (P = 0.084) hemisectors. Thinner RNFL and longer axial length were significantly associated with better visualization of RNFLD by MCI than by RFP, respectively in the superior (OR = 0.948, P = 0.048) and inferior (OR = 1.490, P = 0.012) hemisectors.

CONCLUSIONS

RNFLD on MCI correlated well with OCT measurement of RNFL thinning in eyes with glaucoma. MCI performed better than conventional RFP in the detection of OCT-determined RNFL thinning, specifically in eyes with thinner RNFL and those with myopia. MCI may be more useful than conventional RFP in evaluating glaucomatous RNFL thinning.

Clinical application of multicolor imaging in Leber hereditary optic neuropathy

Purpose

To characterize features of retinal never fiber in Leber Hereditary Optic Neuropathy (LHON) using multicolor (MC) imaging and color fundus photography (CFP).

Methods

Ninety-two eyes of patients with LHON underwent MC imaging, optic disc spectral domain optical coherence tomography (SD-OCT), and CFP. Two independent observers graded RNFL visibility scores and two other experts determined never fiber bundle defects from four-quadrant readings. CFP, standard MC, infrared reflectance (IR), green reflectance (GR), blue reflectance (BR), and green-blue-enhanced (BG) imaging were compared.

Results

Agreement on never fiber bundle defects was substantial for CFP, standard MC, GR, BR, and BG images relative to IR. It was shown that BR (2.71 ± 0.55) had the best mean RNFL visibility score, BG (2.69 ± 0.52), GR (2.69 ± 0.56), standard MC (2.04 ± 0.79), CFP (1.80 ± 0.82), and IR (0.45 ± 0.59) followed. Agreement on temporal area defects was relatively improved. Youden's indices for CFP (78.21%), standard MC (84.48%), GR (90.92%), BR (89.64%), and BG (90.99%) indicated good detection of defects in the papillomacular bundle (PMB)/ high suspicion of patients with LHON, particularly for BG and GR. According to the proportion of never fiber bundle defects, standard MC, GR, BR, and BG can roughly determine the LHON clinical stage, especially in subacute and chronic stages, and standard MC is superior for patients with LHON of all stages. The stage judged by MC was consistent with the course inferred by pRNFL thickness.

Conclusion

As an adjunct to SD-OCT, the MC image, particularly the GR and BG can delineate RNFL more effectively than CFP. The MC image may be a useful adjunct to OCT for detecting or monitoring never fiber bundle defects, providing inexpensive and rapid methods that can quickly identify patients with high suspicion of LHON.

Multicolor Imaging for Detection of Retinal Nerve Fiber Layer Defect in Myopic Eyes With Glaucoma

PURPOSE

To investigate the diagnostic performance of multicolor imaging for detection of retinal nerve fiber layer (RNFL) defects in myopic eyes with glaucoma.

DESIGN

Comparative diagnostic analysis.

METHODS

A total of 150 myopic eyes of 138 patients (< -1.00 diopter or axial length >24 mm) underwent multicolor imaging by Spectralis (Heidelberg Engineering GmbH) optical coherence tomography (OCT). Two independent observers graded the RNFL visibility score and determined the location of the RNFL defect on each image. Readings were taken from the superior and inferior areas. The diagnostic performances of multicolor, green-reflectance, and blue-reflectance images for detection of the RNFL defect were compared with those of conventional fundus and red-free RNFL photographs.

RESULTS

The interobserver agreement on the RNFL visibility score was substantial for fundus and RNFL photographs and multicolor and green-reflectance images and was perfect for blue-reflectance images. The interobserver agreement on the location of the RNFL defect was better when using multicolor imaging than when using conventional photography. The green-reflectance image (2.89 ± 0.31) showed the highest RNFL visibility score, followed by blue-reflectance (2.88 ± 0.32) and multicolor (2.57 ± 0.63) images. The sensitivity of multicolor imaging (94.9%, 93.2%, and 91.5% for green-reflectance, blue-reflectance, and multicolor images, respectively) was significantly higher than that of fundus photography (83.1%) for detection of superotemporal RNFL defects (all P < .05). It was significantly higher for inferotemporal defects than those of fundus and RNFL photographs (all P < .05).

CONCLUSIONS

Multicolor imaging can visualize the glaucomatous RNFL defects in myopic eyes that are indistinguishable on conventional photography.