Diagnostic Ability of Wide-field Retinal Nerve Fiber Layer Maps Using Swept-Source Optical Coherence Tomography for Detection of Preperimetric and Early Perimetric Glaucoma

Diagnostic ability of macular nerve fiber layer thickness measured by swept-source optical coherence tomography in preperimetric glaucoma

BACKGROUND

We evaluated the diagnostic ability of macula retinal nerve fiber layer (mRNFL) thickness in preperimetric glaucoma (PPG) patients.

METHODS

This prospective study included 83 patients with PPG and 83 age- and refractive error-matched normal control subjects. PPG was defined as a localized RNFL defect corresponding to glaucomatous optic disc changes with a normal visual field test. We used spectral-domain (SD) optical coherence tomography (OCT) to measure the circumpapillary RNFL (cpRNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Swept-source (SS) OCT was used to measure cpRNFL thickness, macular ganglion cell layer + inner plexiform layer (IPL) thickness (GCL+), and macular ganglion cell layer + IPL+ mRNFL thickness (GCL++). The mRNFL thickness was defined as GCL++ minus GCL+. To evaluate the diagnostic power of each parameter, the area under the receiver operating characteristics curve (AUROC) was analyzed to differentiate PPG from the normal groups.

RESULTS

Using SD-OCT, all GCIPL parameters and most cpRNFL parameters, except at the nasal and temporal quadrant, were significantly lower in PPG versus normal controls. PPG eyes had significantly smaller values than normal controls for all cpRNFL and GCL parameters measured by SS-OCT, except mRNFL at the superonasal area. The inferotemporal GCL++ had the largest AUROC value (0.904), followed by inferotemporal GCL+ (0.882), inferotemporal GCIPL thickness (0.871), inferior GCL++ (0.866), inferior cpRNFL thickness by SS-OCT (0.846), inferior cpRNFL thickness by SD-OCT (0.841), and inferotemporal mRNFL thickness (0.840). The diagnostic performance was comparable between inferotemporal mRNFL thickness and the best measures of GCL (inferotemporal GCL++, p = 0.098) and cpRNFL (inferior cpRNFL thickness by SS-OCT, p = 0.546).

CONCLUSION

The diagnostic ability of mRNFL thickness was comparable to that of the best measures of cpRNFL and GCL analysis for eyes with PPG. Therefore, mRNFL thickness could be a new parameter to detect early structural changes in PPG.

Wide-Field Optical Coherence Tomography Imaging Improves Rate of Change Detection in Progressing Glaucomatous Eyes Compared With Standard-Field Imaging

Purpose

To compare rates of retinal nerve fiber layer change over time in healthy, eyes with nonprogressing glaucoma and eyes with progressing glaucoma using single wide-field (SWF) and optic nerve head (ONH) cube scan optical coherence tomography (OCT) images.

Methods

Forty-five eyes of 25 healthy individuals and 263 eyes of 161 glaucoma patients from the Diagnostic Innovations in Glaucoma Study were included. All eyes underwent 24-2 visual field testing and OCT (Spectralis SD-OCT) ONH and macular imaging. SWF images (up to 43° × 28°) were created by stitching together ONH cube scans centered on the optic disc and macular cube scans centered on the fovea. Visual field progression was defined as guided progression analysis likely progression and/or a significant (P < 0.01) mean deviation slope of less than -1.0 dB/year. Mixed effects models were used to compare rates of change. Highly myopic eyes were included.

Results

Thirty glaucomatous eyes were classified as progressing. In eyes with glaucoma, mean global rate of change was -1.22 µm/year (P < 0.001) using SWF images and -0.83 µm/year (P = 0.003) using ONH cube scans. Rate of change was significantly greater in eyes with progressing glaucoma compared with eyes with nonprogressing glaucoma (-1.51 µm/year vs. -1.24 µm/year; P = 0.002) using SWF images and was similar using ONH cube scans (P = 0.27).

Conclusions

In this cohort that includes eyes with and without high axial myopia, the mean rate of retinal nerve fiber layer thinning measured using SWF images was faster in eyes with progressing glaucoma than in eyes with nonprogressing glaucoma. Wide-field OCT images including the ONH and macula can be effective for monitoring glaucomatous progression in patients with and without high myopia.

Unveiling Novel Structural Biomarkers for the Diagnosis of Glaucoma

Glaucoma, a leading cause of irreversible blindness, poses a significant global health burden. Early detection is crucial for effective management and prevention of vision loss. This study presents a collection of novel structural biomarkers in glaucoma diagnosis. By employing advanced imaging techniques and data analysis algorithms, we now can recognize indicators of glaucomatous progression. Many research studies have revealed a correlation between the structural changes in the eye or brain, particularly in the optic nerve head and retinal nerve fiber layer, and the progression of glaucoma. These biomarkers demonstrate value in distinguishing glaucomatous eyes from healthy ones, even in the early stages of the disease. By facilitating timely detection and monitoring, they hold the potential to mitigate vision impairment and improve patient outcomes. This study marks an advancement in the field of glaucoma, offering a promising avenue for enhancing the diagnosis and possible management.

Individual vs simultaneous macular and optic disc measurements with spectral domain optical coherence tomography in glaucoma and healthy eyes

We assessed the repeatability and agreement of ganglion cell complex (GCC) in the macular area and the peripapillary retinal nerve fiber layer (ppRNFL) with individual and combined macula and disc scans. The macular GCC and ppRNFL thicknesses from 34 control eyes and 43 eyes with glaucoma were measured with the Canon Optical Coherence Tomography (OCT) HS-100. Two repeated measurements were performed with both scan modes. The repeatability limit (Rlim) and agreement analysis were performed. The individual scan showed better repeatability than the combined scan in both groups. However, the differences in the Rlim for the GCC in most sectors were lower than 3 μm (axial resolution of the OCT), and this was larger than 3 μm for most of the ppRNFL sectors. The mean differences in the thickness between both scan modes for the GCC and ppRNFL measurements were less than 3 and 6 μm, respectively. The interval of the limits of agreement was about 10 μm in some sectors for the GCC, and about 40 and 60 μm in some sectors in controls and glaucoma eyes, respectively. Both scan modes showed good repeatability in both groups. The agreement results suggest that the scan modes cannot be used interchangeably.

Diagnostic performance of wide-field optical coherence tomography angiography for high myopic glaucoma

Diagnosing and monitoring glaucoma in high myopic (HM) eyes are becoming very important; however, it is challenging to diagnose this condition. This study aimed to evaluate the diagnostic ability of wide-field optical coherence tomography angiography (WF-OCTA) maps for the detection of glaucomatous damage in eyes with HM and to compare the diagnostic ability of WF-OCTA maps with that of conventional imaging approaches, including swept-source optical coherence tomography (SS-OCT) wide-field maps. In this retrospective observational study, a total 62 HM-healthy eyes and 140 HM eyes with open-angle glaucoma were included. Patients underwent a comprehensive ocular examination, including SS-OCT wide-field and 12 × 12 WF-OCTA scans. The WF-OCTA map represents the peripapillary and macular superficial vascular density maps. Glaucoma specialists determined the presence of glaucomatous damage in HM eyes by reading the WF-OCTA map and comparing its sensitivity and specificity with those of conventional SS-OCT images. The sensitivity and specificity of 12 × 12 WF-OCTA scans for HM-glaucoma diagnosis were 87.28% and 86.94%, respectively, while, the sensitivity and specificity of SS-OCT wide-field maps for HM-glaucoma diagnosis were 87.49% and 80.51%, respectively. The specificity of the WF-OCTA map was significantly higher than that of the SS-OCT wide-field map (p < 0.05). The sensitivity of the WF-OCTA map was comparable with that of the SS-OCT wide-field map (p = 0.078). The WF-OCTA map showed good diagnostic ability for discriminating HM-glaucomatous eyes from HM-healthy eyes. As a complementary method to an alternative imaging modality, WF-OCTA mapping can be a useful tool for the detection of HM glaucoma.

Clinical usefulness of layer-by-layer deviation maps of Spectralis OCT: comparison with Cirrus OCT

BACKGROUND/AIMS

To compare the diagnostic abilities of Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, California, USA) spectral domain-optical coherence tomography (OCT) for retinal nerve fibre layer (RNFL) defect detection among patients with preperimetric glaucoma (PPG) and early glaucoma (EG).

METHODS

In this cross-sectional study, a total of 144 eyes (47 healthy, 43 PPG, 54 EG; MD≥-6 dB) of 144 participants underwent Spectralis and Cirrus OCT on the same day. The presence of RNFL defect on red-free RNFL photography and the respective deviation maps of Spectralis and Cirrus OCT was rated. Areas under the receiver operating characteristic curves (AUCs), sensitivities and specificities were analysed for each deviation layer to discriminate healthy eyes from PPG and EG eyes.

RESULTS

The RNFL, ganglion cell layer (GCL) and retinal layers of Spectralis OCT and the RNFL and macular ganglion cell-inner plexiform layer of Cirrus OCT showed high diagnostic performance (all AUCs >0.8) in discriminating PPG and EG eyes from healthy eyes. Among them, RNFL layer of Cirrus OCT had the largest AUC (0.840 for PPG, 0.959 for EG) but showed no statistical differences from RNFL and retinal layers of Spectralis OCT. The inner plexiform layer (IPL) of Spectralis OCT had the smallest AUC (0.563 for PPG, 0.799 for EG).

CONCLUSIONS

The Spectralis and Cirrus OCT deviation maps showed good diagnostic abilities except for the IPL layer of Spectralis. In the clinical setting, both Spectralis and Cirrus OCT can be useful for detection of RNFL defects in PPG and EG eyes.

Agreement and precision of wide and cube scan measurements between swept-source and spectral-domain OCT in normal and glaucoma eyes

This study aimed to evaluate agreement of Wide scan measurements from swept-source optical coherence tomography (SS-OCT) Triton and spectral-domain OCT (SD-OCT) Maestro in normal/glaucoma eyes, and to assess the precision of measurements from Wide and Cube scans of both devices. Three Triton and three Maestro operator/device configurations were created by pairing three operators, with study eye and testing order randomized. Three scans were captured for Wide (12 mm × 9 mm), Macular Cube (7 mm × 7 mm-Triton; 6 mm × 6 mm-Maestro), and Optic Disc Cube (6 mm × 6 mm) scans for 25 normal eyes and 25 glaucoma eyes. Parameter measurements included circumpapillary retinal nerve fiber layer(cpRNFL), ganglion cell layer + inner plexiform layer (GCL+), and ganglion cell complex (GCL++). A two-way random effect analysis of variance model was used to estimate the repeatability and reproducibility; agreement was evaluated by Bland-Altman analysis and Deming regression. The precision estimates were low, indicating high precision, for all thickness measurements with the majority of the limits < 5 µm for the macula and < 10 µm for the optic disc. Precision of the Wide and Cube scans were comparable. Excellent agreement between the two devices was found for Wide scans, with the mean difference < 3 µm across all measurements (cpRNFL < 3 µm, GCL+  < 2 µm, GCL ++  < 1 µm), indicating interoperability. A single Wide scan covering the peripapillary and macular regions may be useful for glaucoma diagnosis and management.

Optical Coherence Tomography and Optical Coherence Tomography Angiography: Essential Tools for Detecting Glaucoma and Disease Progression

Early diagnosis and detection of disease progression are critical to successful therapeutic intervention in glaucoma, the leading cause of irreversible blindness worldwide. Optical coherence tomography (OCT) is a non-invasive imaging technique that allows objective quantification in vivo of key glaucomatous structural changes in the retina and the optic nerve head (ONH). Advances in OCT technology have increased the scan speed and enhanced image quality, contributing to early glaucoma diagnosis and monitoring, as well as the visualization of critically important structures deep within the ONH, such as the lamina cribrosa. OCT angiography (OCTA) is a dye-free technique for noninvasively assessing ocular microvasculature, including capillaries within each plexus serving the macula, peripapillary retina and ONH regions, as well as the deeper vessels of the choroid. This layer-specific assessment of the microvasculature has provided evidence that retinal and choroidal vascular impairments can occur during early stages of glaucoma, suggesting that OCTA-derived measurements could be used as biomarkers for enhancing detection of glaucoma and its progression, as well as to reveal novel insights about pathophysiology. Moreover, these innovations have demonstrated that damage to the macula, a critical region for the vision-related quality of life, can be observed in the early stages of glaucomatous eyes, leading to a paradigm shift in glaucoma monitoring. Other advances in software and hardware, such as artificial intelligence-based algorithms, adaptive optics, and visible-light OCT, may further benefit clinical management of glaucoma in the future. This article reviews the utility of OCT and OCTA for glaucoma diagnosis and disease progression detection, emphasizes the importance of detecting macula damage in glaucoma, and highlights the future perspective of OCT and OCTA. We conclude that the OCT and OCTA are essential glaucoma detection and monitoring tools, leading to clinical and economic benefits for patients and society.

Agreement and Precision of Wide and Cube Scan Measurements between Swept-source and Spectral-domain OCT in Normal and Glaucoma Eyes

This study aimed to evaluate agreement of Wide scan measurements from swept-source optical coherence tomography(SS-OCT) Triton and spectral-domain OCT(SD-OCT) Maestro in normal/glaucoma eyes, and to assess the precision of measurements from Wide and Cube scans of both devices. Three Triton and three Maestro operator/device configurations were created by pairing three operators, with study eye and testing order randomized. Three scans were captured for Wide (12mm×9mm), Macular Cube (7mmx7mm-Triton; 6mmx6mm-Maestro), and Optic Disc Cube (6mmx6mm) scans for 25 normal eyes and 25 glaucoma eyes. Thickness of circumpapillary retinal nerve fiber layer(cpRNFL), ganglion cell layer+inner plexiform layer(GCL+), and ganglion cell complex(GCL++) was obtained from each scan. A two-way random effect analysis of variance model was used to estimate the repeatability and reproducibility; agreement was evaluated by Bland-Altman analysis and Deming regression. Precision limit estimates were low: <5µm for macular and <10µm for optic disc parameters. Precision for Wide and Cube scans of both devices were comparablein both groups. Excellent agreement between the two devices was found for Wide scans, with the mean difference<3µm across all measurements (cpRNFL<3µm, GCL+<2µm, GCL++<1µm), indicating interoperability. A single Wide scan covering the peripapillary and macular regions may be useful for glaucoma management.

Artificial intelligence in glaucoma: posterior segment optical coherence tomography

PURPOSE OF REVIEW

To summarize the recent literature on deep learning (DL) model applications in glaucoma detection and surveillance using posterior segment optical coherence tomography (OCT) imaging.

RECENT FINDINGS

DL models use OCT derived parameters including retinal nerve fiber layer (RNFL) scans, macular scans, and optic nerve head (ONH) scans, as well as a combination of these parameters, to achieve high diagnostic accuracy in detecting glaucomatous optic neuropathy (GON). Although RNFL segmentation is the most widely used OCT parameter for glaucoma detection by ophthalmologists, newer DL models most commonly use a combination of parameters, which provide a more comprehensive approach. Compared to DL models for diagnosing glaucoma, DL models predicting glaucoma progression are less commonly studied but have also been developed.

SUMMARY

DL models offer time-efficient, objective, and potential options in the management of glaucoma. Although artificial intelligence models have already been commercially accepted as diagnostic tools for other ophthalmic diseases, there is no commercially approved DL tool for the diagnosis of glaucoma, most likely in part due to the lack of a universal definition of glaucoma defined by OCT derived parameters alone (see Supplemental Digital Content 1 for video abstract, http://links.lww.com/COOP/A54 ).

Diagnostic ability of macular microvasculature with swept-source OCT angiography for highly myopic glaucoma using deep learning

Macular OCT angiography (OCTA) measurements have been reported to be useful for glaucoma diagnostics. However, research on highly myopic glaucoma is lacking, and the diagnostic value of macular OCTA measurements versus OCT parameters remains inconclusive. We aimed to evaluate the diagnostic ability of the macular microvasculature assessed with OCTA for highly myopic glaucoma and to compare it with that of macular thickness parameters, using deep learning (DL). A DL model was trained, validated and tested using 260 pairs of macular OCTA and OCT images from 260 eyes (203 eyes with highly myopic glaucoma, 57 eyes with healthy high myopia). The DL model achieved an AUC of 0.946 with the OCTA superficial capillary plexus (SCP) images, which was comparable to that with the OCT GCL+ (ganglion cell layer + inner plexiform layer; AUC, 0.982; P = 0.268) or OCT GCL++ (retinal nerve fiber layer + ganglion cell layer + inner plexiform layer) images (AUC, 0.997; P = 0.101), and significantly superior to that with the OCTA deep capillary plexus images (AUC, 0.779; P = 0.028). The DL model with macular OCTA SCP images demonstrated excellent and comparable diagnostic ability to that with macular OCT images in highly myopic glaucoma, which suggests macular OCTA microvasculature could serve as a potential biomarker for glaucoma diagnosis in high myopia.

Wide-field optical coherence tomography deviation map for early glaucoma detection

BACKGROUND/AIMS

This study aimed to establish a wide-field optical coherence tomography (OCT) deviation map obtained from swept-source OCT (SS-OCT) scans. Moreover, it also aimed to compare the diagnostic ability of this wide-field deviation map with that of the peripapillary and macular deviation maps currently being used for the detection of early glaucoma (EG).

METHODS

Four hundred eyes, including 200 healthy eyes and 200 eyes with EG were enrolled in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT (DRI-OCT Triton; Topcon, Tokyo, Japan). The individual wide-field scan was converted into a uniform template using the fovea and optic disc centres as fixed landmarks. Subsequently, the wide-field deviation map was obtained via the comparison between individual wide-field data and a normative wide-field database that had been created by combining images of healthy eyes into a uniform template in a previous study. The ability of the new wide-field deviation map to distinguish between EG and healthy eyes was assessed by comparing it with conventional deviation maps based on the area under the receiver operating characteristic curve (AUC).

RESULTS

The wide-field deviation map obtained using the normative wide-field database showed the highest diagnostic ability for the diagnosis of EG (AUC=0.980 and 961 for colour-coded pixels presenting <5% and <1%, respectively) among various deviation maps. Its AUC was significantly superior to that of most conventional deviation maps (p<0.05). The wide-field deviation map demonstrated early structural glaucomatous damage well over a wider area.

CONCLUSION

The wide-field SS-OCT deviation map exhibited good performance for distinguishing between eyes with EG and healthy eyes. The visualisation of the wider damaged area on the wide-field deviation map could be useful for the diagnosis of EG in clinical settings.

Deep learning approaches to predict 10-2 visual field from wide-field swept-source optical coherence tomography en face images in glaucoma

Close monitoring of central visual field (VF) defects with 10-2 VF helps prevent blindness in glaucoma. We aimed to develop a deep learning model to predict 10-2 VF from wide-field swept-source optical coherence tomography (SS-OCT) images. Macular ganglion cell/inner plexiform layer thickness maps with either wide-field en face images (en face model) or retinal nerve fiber layer thickness maps (RNFLT model) were extracted, combined, and preprocessed. Inception-ResNet-V2 was trained to predict 10-2 VF from combined images. Estimation performance was evaluated using mean absolute error (MAE) between actual and predicted threshold values, and the two models were compared with different input data. The training dataset comprised paired 10-2 VF and SS-OCT images of 3,025 eyes of 1,612 participants and the test dataset of 337 eyes of 186 participants. Global prediction errors (MAE_point-wise) were 3.10 and 3.17 dB for the en face and RNFLT models, respectively. The en face model performed better than the RNFLT model in superonasal and inferonasal sectors (P = 0.011 and P = 0.030). Prediction errors were smaller in the inferior versus superior hemifields for both models. The deep learning model effectively predicted 10-2 VF from wide-field SS-OCT images and might help clinicians efficiently individualize the frequency of 10-2 VF in clinical practice.

Prevalence of Glaucoma and Its Systemic Risk Factors in a General Japanese Population: The Hisayama Study

Purpose

To estimate the prevalence of glaucoma and its risk factors in a Japanese community.

Methods

This study included 3405 Japanese community dwellers who were ≥40 years of age and enrolled in the Hisayama Study. This population-based, cross-sectional study was conducted from 2017 to 2018. A glaucoma screening test was performed using stereo fundus images and swept-source optical coherence tomography. Glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria.

Results

The prevalence of glaucoma was 7.6% (95% confidence interval [CI], 6.7–8.6) overall. The prevalence of primary open-angle glaucoma (POAG) was 5.8% (95% CI, 5.0–6.6); that of primary angle-closure glaucoma (PACG) was 0.7% (95% CI, 0.5–1.1); and that of exfoliation glaucoma was 1.1% (95% CI, 0.7–1.4). In addition to aging, lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.15; 95% CI, 1.02–1.33), higher intraocular pressure (OR = 1.06; 95% CI, 1.01–1.12), longer axial length (OR = 1.44; 95% CI, 1.31–1.59), and thinner central corneal thickness (CCT) (OR = 1.09; 95% CI, 1.04–1.15) were significant risk factors for POAG. Diabetes (OR = 2.81; 95% CI, 1.19–6.62) was a significant risk factor for PACG, and diabetes (OR = 2.15; 95% CI, 1.03–4.47) and thinner CCT (OR = 1.14; 95% CI, 1.02–1.28) were significant risk factors for exfoliation glaucoma.

Conclusions

The prevalence of glaucoma was approximately 8%, probably due to the increase in the Japanese aging population. Not only ocular factors but also lower eGFR for POAG and diabetes for PACG and exfoliation glaucoma were risk factors in a general Japanese population.

Translational Relevance

Systemic factors such as eGFR and diabetes must also be considered when implementing preventive measures against glaucoma.

The Role of Widefield and Ultra Widefield Optical Coherence Tomography in the Diagnosis and Management of Vitreoretinal Diseases

Background: This study reports on the advantages of wide-field (WF)- and ultra-widefield (UWF)- optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in managing different vitreoretinal diseases in a real-life setting using the new WF—Swept Source (SS)—OCT Xephilio S1 (Canon, Tokyo, Japan). Methods: We conducted an observational retrospective case series study involving 1472 eyes that underwent retinal scans with Canon Xephilio^® OCT-S1 between 1 March 2021 and 1 December 2021 at Eyecare Clinic (Brescia, Italy). All patients underwent routine ophthalmologic examinations along with WF and UWF color fundus retinography with Clarus 500™ (Carl Zeiss Meditec, Inc., Dublin, CA, USA) and Xephilio^® OCT-S1. WF SS-OCT, UWF-OCT, WF-OCTA, and UWF-OCTA were taken by using Xephilio^® OCT-S1. Results: We analyzed 122 peripheral retinal lesions, 144 retinal detachment, 329 high myopic eyes, 37 pediatric cases, 60 vascular retinopathies, 15 choroidal lesions, and 90 eyes as follow-up post vitreoretinal surgery. The OCT-S1 was the only reliable and diagnostic exam for peripheral lesions, pediatric and high myopic cases, and significantly influenced the management in 10% of cases and the postoperative follow-up. Conclusions: WF and UWF OCT and OCTA imaging may help in the management of several vitreoretinal diseases, becoming an indispensable tool for the high-quality management of patients.

Comparison of Diagnostic Ability Between Wide-Field Swept-Source Optical Coherence Tomography Imaging Maps and Heidelberg Retina Tomograph 3 Optic Nerve Head Assessment to Discriminate Glaucomatous and Non-glaucomatous Eyes

Background

In this study, we aimed to determine the diagnostic performance of optic nerve head (ONH), macular, and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements of wide-field maps (12 × 9 mm) using swept-source optical coherence tomography (SS-OCT) compared to measurements of the ONH and RNFL parameters measured by Heidelberg Retina Tomograph (HRT3).

Methodology

This case-control study included 39 eyes of 39 glaucoma patients and 36 eyes of 36 normal subjects (control group). All participants underwent standard automated perimetry (SAP) as well as structural measurements by SS-OCT (DRI-OCT, Triton; Topcon Inc., Tokyo, Japan) and HRT3 (Heidelberg Engineering, Heidelberg, Germany). The abilities of the continuous parameters to discriminate between glaucoma and control groups were assessed using areas under the receiver operating characteristic curves (AUCs). To assess the glaucoma diagnostic abilities of each of the categorical variables, sensitivity, specificity, positive predictive value, and negative predictive value were tested.

Results

The highest sensitivities were achieved by the DRI-OCT categorical parameters of Superpixel-200 map and cpRNFL (12 sectors) thickness analysis. The best performing HRT3 continuous parameter was rim volume (AUC = 0.829, 95% confidence interval (CI) = 0.735-0.922), and the best continuous parameter for DRI-OCT wide-field was vertical cdr (AUC = 0.883, 95% CI = 0.805-0.951), followed by total cpRNFL thickness (AUC = 0.862, 95% CI = 0.774-0.951). AUCs for disc area, rim area, linear cdr, and RNFL thickness were not significantly different between the two technologies. Using either the most or the least specific criteria, SuperPixel-200 map always showed the highest sensitivity among the categorical parameters of both technologies (82.1% and 89.7%, respectively). The highest sensitivity among HRT3 classification parameters was shown by MRA and GPS classification algorithms.

Conclusions

Both wide-field DRI-OCT maps and HRT3 showed good diagnostic performance in discriminating glaucoma. Although DRI-OCT thickness values and normative diagnostic classification showed the best performance, more studies are required to determine the clinical role of wide-field DRI-OCT scan in glaucoma diagnosis.

Discrimination Between Healthy Eyes and Those With Mild Glaucoma Damage Using Hemoglobin Measurements of the Optic Nerve Head

PRCIS

The Laguna ONhE, a software that measures the hemoglobin (Hb) concentration of the optic nerve head (ONH) from fundus photographs, demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma.

PURPOSE

The aim was to evaluate Hb concentration of the optic nerve to distinguish between healthy eyes and eyes with mild glaucoma.

METHODS

Eyes from patients with mild primary open angle glaucoma (MD > -6 dB) (n=58) and from healthy subjects (n=64) were selected. Retinal nerve fiber layer thickness measurements of all eyes were acquired with optical coherence tomography. Optic disc photographs were also obtained, and the images were analyzed using the Laguna ONhE software, which measures the amount of Hb in 24 sectors of the ONH. The software also calculates the Glaucoma Discriminant Function (GDF), an index that expresses the chance of the ONH being compatible with glaucoma. Areas under the receiver operating characteristic curve and sensitivities at fixed specificities of 90% and 95% of each Laguna ONhE parameter were calculated.

RESULTS

The mean retinal nerve fiber layer thickness and vertical cup/disc ratio of the control and glaucoma groups were 90.0±10.6 μm versus 66.28±9.85 μm ( P <0.001) and 0.5±0.09 versus 0.65±0.09 ( P <0.001), respectively. Total Hb (67.9±4.45 vs. 62.89±4.89, P <0.001) and GDF (11.57±15.34 vs. -27.67±20.94, P <0.001) were significantly higher in the control group. The Hb concentration was also significantly higher in 21 of the 24 sectors in the control group compared with the glaucoma group ( P <0.05). The GDF had the largest areas under the receiver operating characteristic curve (0.93), with 79.3% sensitivity at a fixed specificity of 95%.

CONCLUSION

Measurements of optic nerve Hb concentration using a colorimetry photographic device demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. Further studies are need to understand vascular factors implicated in the development of glaucoma.

Screening for Glaucoma in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Two 2013 systematic reviews to inform the US Preventive Services Task Force (USPSTF) found insufficient evidence to assess benefits and harms of screening for primary open-angle glaucoma (OAG) in adults.

OBJECTIVE

To update the 2013 reviews on screening for glaucoma, to inform the USPSTF.

DATA SOURCES

Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews (to February 2021); surveillance through January 21, 2022.

STUDY SELECTION

Randomized clinical trials (RCTs) of screening, referral, and treatment; and studies of screening test diagnostic accuracy.

DATA EXTRACTION AND SYNTHESIS

One investigator abstracted data and a second checked accuracy. Two investigators independently assessed study quality.

RESULTS

Eighty-three studies (N = 75 887) were included (30 trials and 53 diagnostic accuracy studies). One RCT (n = 616) found screening of frail elderly persons associated with no difference in vision outcomes vs no screening but with significantly greater falls risk (relative risk [RR], 1.31 [95% CI, 1.13-1.50]). No study evaluated referral to an eye health professional. For glaucoma diagnosis, spectral domain optical coherence tomography (providing high-resolution cross-sectional imaging; 15 studies, n = 4242) was associated with sensitivity of 0.79 (95% CI, 0.75-0.83) and specificity of 0.92 (95% CI, 0.87-0.96) and the Humphrey Visual Field Analyzer (for perimetry, or measurement of visual fields; 6 studies, n = 11 244) with sensitivity of 0.87 (95% CI, 0.69-0.95) and specificity 0.82 (95% CI, 0.66-0.92); tonometry (for measurement of intraocular pressure; 13 studies, n = 32 892) had low sensitivity (0.48 [95% CI, 0.31-0.66]). Medical therapy for ocular hypertension and untreated glaucoma was significantly associated with decreased intraocular pressure and decreased likelihood of glaucoma progression (7 trials, n = 3771; RR, 0.68 [95% CI, 0.49-0.96]; absolute risk difference -4.2%) vs placebo, but 1 trial (n = 461) found no differences in visual acuity, quality of life, or function. Selective laser trabeculoplasty and medical therapy had similar outcomes (4 trials, n = 957).

CONCLUSIONS AND RELEVANCE

This review found limited direct evidence on glaucoma screening, showing no association with benefits. Screening tests can identify persons with glaucoma and treatment was associated with a lower risk of glaucoma progression, but evidence of improvement in visual outcomes, quality of life, and function remains lacking.

Effects of Axial Lengths in High Myopia on the Significance Maps of Optical Coherence Tomography

Purpose: We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications.Methods: Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software.Results: At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively.Conclusions: Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.

The OCT RNFL Probability Map and Artifacts Resembling Glaucomatous Damage

Purpose

The purpose of this study was to improve the diagnostic ability of the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) probability (p-) map by understanding the frequency and pattern of artifacts seen on the p-maps of healthy control (HC) eyes resembling glaucomatous damage.

Methods

RNFL p-maps were generated from wide-field OCT cube scans of 2 groups of HC eyes, 200 from a commercial normative group (HC-norm) and 54 from a prospective study group, as well as from 62 patient eyes, which included 32 with early glaucoma (EG). These 32 EG eyes had 24-2 mean deviation (MD) better than -6 dB and perimetric glaucoma as defined by 24-2 and 10-2 criteria. For the HC groups, "glaucoma-like" arcuates were defined as any red region near the temporal half of the disc.

Results

Seven percent of the 200 HC-norm and 11% of the 54 HC RNFL p-maps satisfied the definition of "glaucoma-like," as did all the patients' p-maps. The HC p-maps showed two general patterns of abnormal regions, "arcuate" and "temporal quadrant," and these patterns resembled those seen on some of the RNFL p-maps of the EG eyes. A "vertical midline" rule, which required the abnormal region to cross the vertical midline through the fovea, had a specificity of >99%, and a sensitivity of 75% for EG and 93% for moderate to advanced eyes.

Conclusions

Glaucoma-like artifacts on RNFL p-maps are relatively common and can masquerade as arcuate and/or widespread/temporal damage.

Translational Relevance

A vertical midline rule had excellent specificity. However, other OCT information is necessary to obtain high sensitivity, especially in eyes with early glaucoma.

Protein Biomarkers in Glaucoma: A Review

Glaucoma is a multifactorial disease. Early diagnosis of this disease can support treatment and reduce the effects of pathophysiological processes. A significant problem in the diagnosis of glaucoma is limited access to the tested material. Therefore, intensive research is underway to develop biomarkers for fast, noninvasive, and reliable testing. Biomarkers indicated in the formation of glaucoma include chemical compounds from different chemical groups, such as proteins, sugars, and lipids. This review summarizes our knowledge about protein and/or their protein-like derived biomarkers used for glaucoma diagnosis since 2000. The described possibilities resulting from a biomarker search may contribute to identifying a group of compounds strongly correlated with glaucoma development. Such a find would be of great importance in the diagnosis and treatment of this disorder, as current screening techniques have low sensitivity and are unable to diagnose early primary open-angle glaucoma.

Combined wide-field optical coherence tomography angiography density map for high myopic glaucoma detection

The present study aimed to evaluate the diagnostic ability of wide-field optical coherence tomography angiography (OCTA) density map for detection of glaucomatous damage in high myopic (HM) eyes and to further compare the diagnostic ability of OCTA with that of conventional imaging approaches including red-free photography and swept-source OCT (SS-OCT) wide-field maps. A total of 77 healthy HM eyes and 72 HM eyes with open angle glaucoma (OAG) participated in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT scan and peripapillary area and macular OCTA scans. An integrated OCTA density map thereafter was merged by vascular landmark-guided superimposition of peripapillary and macular superficial vascular density maps onto the red-free photography (resulting in the OCTA-PanoMap). Glaucoma specialists then determined the presence of glaucomatous damage in HM eyes by reading the OCTA-PanoMap and compared its sensitivity and specificity with those of conventional images. Sensitivity and specificity of OCTA-PanoMap for HM-OAG diagnosis was 94.4% and 96.1%, respectively. Compared with other imaging methods, the sensitivity of OCTA-PanoMap was significantly higher than that of red-free photography (P = 0.022) and comparable to that of wide-field SS-OCT maps. Specificity of OCTA-PanoMap was significantly higher than those of other conventional imaging methods (except for wide-field thickness map). The OCTA-PanoMap showed good diagnostic ability for discrimination of HM-OAG eyes from healthy HM eyes. As a complementary method of an alternative imaging modality, OCTA-PanoMap can be a useful tool for detection of HM-OAG.

Deep Learning-based Diagnosis of Glaucoma Using Wide-field Optical Coherence Tomography Images

PURPOSE

(1) To evaluate the performance of deep learning (DL) classifier in detecting glaucoma, based on wide-field swept-source optical coherence tomography (SS-OCT) images. (2) To assess the performance of DL-based fusion methods in diagnosing glaucoma using a variety of wide-field SS-OCT images and compare their diagnostic abilities with that of conventional parameter-based methods.

METHODS

Overall, 675 eyes, including 258 healthy eyes and 417 eyes with glaucoma were enrolled in this retrospective observational study. Each single-page wide-field report (12×9 mm) of wide-field SS-OCT imaging provides different types of images that reflect the state of the eyes. A DL-based automated diagnosis system was proposed to detect glaucoma and identify its stage based on such images. We applied the convolutional neural network to each type of image to detect glaucoma. In addition, 2 fusion strategies, fusion by convolution network (FCN) and fusion by fully connected network (FFC) were developed; they differ in terms of the level of fusion of features derived from convolutional neural networks. The diagnostic models were trained using 382 and 293 images in the training and test data sets, respectively. The diagnostic ability of this method was compared with conventional parameters of the thickness of the retinal nerve fiber layer and ganglion cell complex.

RESULTS

FCN achieved an area under the receiver operating characteristic curve (AUC) of 0.987 (95% confidence interval, CI: 0.968-0.996) and an accuracy of 95.22%. In contrast, FFC achieved an AUC of 0.987 (95% CI, 0.971-0.998) and an accuracy of 95.90%. Both FCN and FFC outperformed the conventional method (P<0.001). In detecting early glaucoma, both FCN and FFC achieved significantly higher AUC and accuracy than the conventional approach (P<0.001). In addition, the classification performance of the DL-based fusion methods in identifying the 5 stages of glaucoma is presented via a confusion matrix.

CONCLUSION

DL protocol based on wide-field OCT images outperformed the conventional method in terms of both AUC and accuracy. Therefore, DL-based diagnostic methods using wide-field OCT images are promising in diagnosing glaucoma in clinical practice.

Clinical Use of PanoMap for Glaucoma: Frequently Damaged Areas in Early Glaucoma

PRCIS

Recognizing the shortcomings of poor consistency of the fovea-disc relationship at different time points and comparing PanoMaps may well facilitate the understanding of the spatial relationship between parapapillary and macular areas in glaucoma.

PURPOSE

The aims of this study are to analyze the spatial distribution of the frequently damaged areas in early glaucoma, compare the patterns between nonprogressors and progressors using the combined wide-field parapapillary and macular deviation maps (PanoMap), and to evaluate the consistency of the fovea-disc relationship in PanoMap. The fovea-disc distance (FDD) and fovea-disc axis (FDA) were compared at baseline and at the last follow-up.

MATERIALS AND METHODS

In total, 118 patients with early glaucoma and a minimum follow-up period of 3 years were included in this retrospective observational study. The pattern of structural changes was evaluated by averaging the PanoMaps of the enrolled patients at baseline and last follow-up. Longitudinal comparison of the FDD and FDA was performed at baseline and the last follow-up. Patients were divided into nonprogressor (n=44) and progressor (n=74), and the patterns of glaucoma progression in PanoMaps were compared between them.

RESULTS

At baseline, the glaucomatous damage was found more frequently in the macular compared with the parapapillary area. The spatial distribution of frequently damaged areas was similar between the nonprogressor and progressor. At the last follow-up, compared with the baseline structural change on the PanoMap, the progressive structural changes extended toward the fovea at both the parapapillary and macular areas in the progressor. The FDD and FDA were significantly different between the baseline and the last follow-up.

CONCLUSIONS

The PanoMaps showed a clear spatial distribution of early glaucomatous changes, indicating that the damaged area was frequently observed in the macular area. As the consistency of the fovea-disc relationship in PanoMaps was not excellent, this aspect should be considered when interpreting the PanoMap.

A Wide-Field Optical Coherence Tomography Normative Database Considering the Fovea-Disc Relationship for Glaucoma Detection

Purpose

One purpose of this study was to collect wide-field swept-source optical coherence tomography (SS-OCT) data from healthy eyes and build a wide-filed normative database. Another purpose was to compare the glaucoma diagnostic ability of new parameters based on this normative database to the parameters that are currently in use, such as the peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell-inner plexiform layer, and ganglion cell complex (GCC) thickness.

Methods

This study had 220 healthy eyes and 292 eyes with early-stage glaucoma (EG) and moderate-stage glaucoma (MG) enrolled. Using the wide-field SS-OCT images (12 × 9 mm) of healthy eyes, a wide-field normative database was constructed by transforming and combining the individual images into a uniform template using the fovea and optic disc centers as fixed landmarks. Adjustment for the disc size was conducted. With this normative database, new parameters based on the ratio of the fovea-disc distance (FDD) consisting of the fovea-disc relationship were evaluated. The glaucoma diagnostic ability was assessed based on the area under the receiver operating characteristic curve (AUC).

Results

Among the new peripapillary parameters, the RNFL of the circumference of the circle with diameter 0.8 FDD showed the highest AUC value for EG and MG, but the value was not significantly superior to that of the initial RNFL (AUC = 0.940 vs. 0.937, P = 0.631). Among the macular parameters, the GCC of the area of the circle of 1.5 FDD showed the highest AUC value for EG and MG, and the value was significantly superior to that of initial GCC (AUC = 0.929 vs. 0.919, P = 0.033). However, there was no significant difference between the initial and adjusted GCC thickness in patients included in the EG or MG groups separately.

Conclusions

A wide-field normative database was built to consider the relationship between the fovea and the optic disc. Considering this aspect, we found that the GCC analysis using a broader area presented a significantly greater glaucoma diagnostic performance for EG and MG in the macula than the initial parameter for the GCC.

Translational Relevance

Based on this wide-field normative database, the clinical use of a wide-field deviation map may help diagnose the patients with EG and MG in the future.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of preperimetric glaucoma and comparison to retinal nerve fiber layer

Purpose:

The aim of this study was to evaluate the diagnostic ability of optic nerve head (ONH), RNFL, and GC-IPL parameters in differentiating eyes with PPG from normals.

Methods:

This was a retrospective, cross-sectional, observational study. We studied 73 eyes of 41 patients and compared them to 65 eyes of 34 normal persons. Each patient underwent detailed ocular examination, standard automated perimetry, GC-IPL, ONH, and RNFL analysis. PPG was defined as eyes with normal visual field results and one or more localized RNFL defects that were associated with a glaucomatous disc appearance (e.g., notching or thinning of neuroretinal rim) and IOP more than 21 mm Hg. Diagnostic abilities of GC-IPL, ONH, and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity and specificity, and likelihood ratios (LRs).

Results:

All GC-IPL parameters differed significantly from normal. The ONH, RNFL, and GC-IPL parameters with best area under curves (AUCs) to differentiate PPG were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.79), and inferotemporal quadrant GC-IPL thickness (0.73), respectively. Similarly, best LRs were found for clock hour 5, 6, and 12 thicknesses among RNFL; inferior sector and inferotemporal sector thicknesses among GC-IPL parameters.

Conclusion:

Diagnostic abilities of GC-IPL parameters were comparable to RNFL parameters in differentiating PPG patients from normals. The likelihood of ruling in a disease was greater with GC-IPL parameters.

Macular imaging with optical coherence tomography in glaucoma

With the advent of spectral-domain optical coherence tomography, imaging of the posterior segment of the eye can be carried out rapidly at multiple anatomical locations, including the optic nerve head, circumpapillary retinal nerve fiber layer, and macula. There is now ample evidence to support the role of spectral-domain optical coherence tomography imaging of the macula for detection of early glaucoma. Macular spectral-domain optical coherence tomography measurements demonstrate high reproducibility, and evidence on its utility for detection of glaucoma progression is accumulating. We present a comprehensive review of macular spectral-domain optical coherence tomography imaging emerging as an essential diagnostic tool in glaucoma.

Diagnostic Accuracy of Wide-Field Map from Swept-Source Optical Coherence Tomography for Primary Open-Angle Glaucoma in Myopic Eyes

PURPOSE

To compare the accuracy of glaucomatous defects and diagnostic power for primary open-angle glaucoma (POAG) between swept-source optical coherence tomography (SS-OCT) and spectral-domain OCT (SD-OCT) in myopic eyes.

DESIGN

Prospective, case-control study.

METHODS

A total of 150 myopic POAG eyes and 100 healthy myopic eyes underwent SD-OCT and SS-OCT in random order on the same day. The locations of glaucomatous defects on SD-OCT thickness and deviation maps and SS-OCT wide-field thickness (thickness surfaces) and SuperPixel maps were rated, and the maps' accuracies were compared. The area under receiver operating characteristic (AUROC) of the peripapillary retinal nerve fiber layer (RNFL) and the macular parameters (GCL++: equivalent to ganglion cell-inner plexiform layer [GCIPL] + RNFL; GCL+: equivalent to GCIPL) from each of the devices for myopic POAG were calculated and compared.

RESULTS

The wide-field RNFL thickness (thickness surface) map showed the best accuracy for glaucomatous defects in the inferotemporal (96.4%) and superotemporal (92.4%) regions. The RNFL/GCL++/GCL+ wide-field thickness (thickness surface) map showed better accuracy for glaucomatous defects in both the superotemporal and inferotemporal regions than with the SD-OCT thickness map (all P values <.05). The average GCL++ (87.6%) and GCL+ (87.5%) thicknesses showed significantly greater AUROC for myopic POAG than GCIPL thickness from SD-OCT (83.8%, all P values <.05).

CONCLUSIONS

In myopic eyes, the SS-OCT wide-field map exhibited better accuracy for glaucomatous defect and greater diagnostic power for POAG than SD-OCT outcomes. This result might have been due to SS-OCT's wider scan and measurement area.

Vulnerability Zone of Glaucoma Progression in Combined Wide-field Optical Coherence Tomography Event-based Progression Analysis

Purpose

To investigate the spatial characteristics and patterns of structural progression using the combined retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer event-based progression analysis feature provided by the Guided Progression Analysis (GPA) software of spectral-domain optical coherence tomography.

Methods

In this retrospective observational study, we evaluated 89 patients with open-angle glaucoma showing clinically confirmed structural progression within a minimum follow-up period of 3 years. For each eye, the RNFL and ganglion cell–inner plexiform layer GPA data were extracted from serial spectral-domain optical coherence tomography (HD-OCT 4000, Carl Zeiss Meditec, Inc., Dublin, CA) data from 2012 to 2017 (available in commercial report). A combined wide-field GPA map was merged using vascular landmark-guided superimposition of RNFL and ganglion cell–inner plexiform layer GPA event-based progression maps onto the RNFL image (resulting in the GPA PanoMaps: proposed in this study). The pattern of progressive structural changes was evaluated by comparing the baseline combined wide-field OCT deviation maps (PanoMap deviation maps: available in commercial report) and GPA PanoMaps at the time the first progression was detected and the GPA PanoMaps at the last follow-up. Spatial characteristics and patterns of glaucoma structural progression on GPA PanoMaps were evaluated.

Results

Progressive structural progression was detected most frequently at the macular vulnerability zone (MVZ), with the peripapillary and macular progression being well-correlated spatially. Compared with the baseline structural change on PanoMap, the progressive structural changes extended toward the fovea at both the peripapillary and macular areas. A spatial difference was observed between the areas where structural damage was frequently found on PanoMap (peripapillary inferoinferior sector and macular MVZ) and areas where progression was frequently found on GPA PanoMap (peripapillary and macular MVZ).

Conclusions

The patterns of progressive glaucomatous structural changes in both the peripapillary and macular areas were confirmed on the combined wide-field GPA map (GPA PanoMap). An analysis of the progression pattern using the GPA PanoMap facilitates the understanding of the spatial relation between the peripapillary and macular areas in glaucoma.

Traumatic optic neuropathy-associated progressive thinning of the retinal nerve fiber layer and ganglion cell complex: two case reports

Background

Traumatic optic neuropathy (TON) is a form of optic nerve injury that occurs secondary to trauma and is etiologically associated with acute axonal loss with severe vision loss. Here, we reported longitudinal changes in the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) using wide-field swept source optical coherence tomography (SS-OCT) in two cases of TON and identified the source of the damage.

Case presentation

(Case 1) A 65-year-old man was admitted to the hospital due to an injury in the right eye (OD) and was subsequently diagnosed with indirect TON. He was then treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 day, 2 days, 1 week, 1 month, and 4 months. The wide-field deviation map detected thinning earlier in the macular GCC than in the peripapillary RNFL. (Case 2) A 63-year-old man was admitted to the hospital with a fractured left maxilla-zygomatic complex attributed to blunt-force trauma to the head and loss of vision in his left eye (OS). He was diagnosed with indirect TON and treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 week, 2 weeks, 2 months 5 months, and 7 months. The wide-field deviation map detected thinning earlier in the peripapillary RNFL than in the macular GCC.

Conclusions

Wide-field SS-OCT facilitated the identification of various sequential progression patterns in patients with TON. Furthermore, the area in which the structural damage was first detected was seen differently in the peripapillary and macular deviation maps for each case. Thus, wide-field imaging, which includes the macular and peripapillary areas, are useful in monitoring TON.

Serial Combined Wide-Field Optical Coherence Tomography Maps for Detection of Early Glaucomatous Structural Progression

Importance

Both parapapillary and macular areas are important in determining the progression of early glaucoma. However, no attempt has been made to assess the progression of glaucoma in images that combine the 2 areas.

Objective

To evaluate the potential usefulness of serial analysis of combined wide-field optical coherence tomography (OCT) maps for detection of structural progression in patients with early glaucoma.

Design, Setting, and Participants

Retrospective observational study. Patients with early primary open-angle glaucoma with a minimum of 3-year follow-up involving serial spectral-domain OCT measurement were analyzed. Patients were divided into a nonprogressor group (n = 47) and a progressor group (n = 47) on the basis of serial stereo disc photography and red-free photography. Serial combined wide-field OCT maps integrating parapapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) maps were generated with the embedded software of serial spectral-domain OCT. Glaucoma specialists then assessed the structural progression detection ability of those serial wide-field OCT maps for early glaucomatous eyes and compared their sensitivity with those of RNFL and GCIPL guided progression analyses (GPAs).

Main Outcomes and Measures

The diagnostic ability of the serial wide-field OCT maps for early glaucomatous structural progression.

Results

Ninety-four patients (mean [SD] age, 51.4 [12.3] years; 48 [51.1%] women; all Korean) were included. The serial wide-field OCT map analysis showed good agreement for detection of structural progression between the 2 glaucoma graders (wide-field OCT thickness map: κ = 0.649; wide-field OCT deviation map: κ = 0.833). These maps showed early glaucomatous structural progression detection abilities comparable with those of RNFL and GCIPL GPAs (sensitivities of wide-field OCT thickness map, wide-field OCT deviation map, RNFL GPA, and GCIPL GPA = 63.8%, 83.0%, 83.0%, and 66.0%, respectively, all P > .05; specificities of wide-field OCT thickness map, wide-field OCT deviation map, RNFL GPA, and GCIPL GPA = 93.6%, 95.7%, 84.8%, and 93.6%, respectively, all P > .05).

Conclusions and Relevance

The serial combined wide-field OCT maps integrating RNFL and GCIPL maps performed well in detecting structural progression in early glaucomatous eyes. Confirmation in an independent prospective study might provide greater confidence in this conclusion.

Combined Use of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Event-based Progression Analysis

PURPOSE

To evaluate patterns of glaucomatous structural progression using the combined retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) event-based progression analysis feature provided by spectral-domain optical coherence tomography (SD-OCT)'s - (GPA) software.

DESIGN

Retrospective observational case series.

METHODS

Seventy-nine (79) patients were identified with open-angle glaucoma (OAG) showing clinically confirmed structural progression within a minimum 3-year follow-up period. For each eye, RNFL and GCIPL GPA data were obtained from serial SD-OCT data from 2012 to 2017. An integrated GPA map thereafter was merged by vascular landmark-guided superimposition of RNFL and GCIPL GPA event-based progression maps onto the RNFL imagery (resulting in what we call the GPA PanoMap). The GPA PanoMap progression patterns were classified as (1) RNFL-only, (2) GCIPL-only, (3) concurrent (both RNFL and GCIPL), (4) GCIPL after RNFL, and (5) RNFL after GCIPL. The locations of structural progression were classified, based on an earlier schematic model, as (1) superior vulnerability zone (SVZ), (2) papillomacular bundle (PM), (3) macular vulnerability zone (MVZ), and (4) inferoinferior portion. Structural progression patterns on the GPA PanoMap were evaluated according to the location of progression. Among the eyes with progression in the inferior hemiretina, structural progression patterns on the GPA PanoMap were evaluated according to the baseline structural damage.

RESULTS

On the GPA PanoMap, when structural progression was located in the SVZ or inferoinferior portion, it was detected only in the RNFL area; when progression was located in the PM or MVZ, various patterns were observed, among which the concurrent pattern was the majority in both areas (43.8% and 45.6% in the PM and MVZ, respectively). Among the eyes with progression in the inferior hemiretina (n = 66), the location of progression varied but did not differ significantly according to the baseline deviation map (P = .440). The progression patterns of MVZ were significantly different among the baseline deviation map patterns (P = .023); however, all of the progression patterns of the inferoinferior portion were RNFL-only.

CONCLUSION

The various progression patterns were confirmed according to the locations and baseline patterns of glaucomatous structural change on the integrated GPA map (GPA PanoMap). Combined use of RNFL and GCIPL GPA or the GPA PanoMap could be useful for determination of structural progression and understanding of its patterns in patients with glaucoma.

Comparison of glaucoma-diagnostic ability between wide-field swept-source OCT retinal nerve fiber layer maps and spectral-domain OCT

PURPOSE

To compare the diagnostic ability of wide-field swept-source optical coherence tomography (SS-OCT) retinal nerve fiber layer (RNFL) maps with spectral-domain OCT (SD-OCT) maps for detection of preperimetric (PPG) and early glaucoma (EG).

PATIENTS AND METHODS

One hundred and forty-six eyes, including 37 healthy eyes, 38 eyes with PPG, and 71 eyes with EG, were analyzed. The patients underwent both SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA) and wide-field SS-OCT scanning (DRI-OCT-1 Atlantis; Topcon, Tokyo, Japan). By SD-OCT, circumpapillary RNFL and macular ganglion cell analyses were performed. SS-OCT provides a wide-field RNFL thickness map and a SuperPixel map, which are composed of an RNFL deviation map of the peripapillary area and a deviation map of the composition of the ganglion cell layer with the inner plexiform layer and RNFL [GC-IPL+RNFL] in the macular area. The ability to discriminate PPG and EG from healthy eyes was assessed according to sensitivity, specificity and area under the receiver operating characteristic curve for parameters and criteria provided by SD-OCT and wide-field SS-OCT scanning.

RESULTS

The wide-field RNFL thickness map obtained by SS-OCT showed the highest sensitivity to PPG and EG (92.1 and 97.2%, respectively) as compared with the other, SD-OCT criteria. The wide-field RNFL thickness map showed PPG-diagnostic performance comparable to the SD-OCT RNFL thickness and GC-IPL deviation maps (p = 0.453 and 0.180), and PPG-diagnostic performance superior to the SD-OCT RNFL deviation and GC-IPL thickness maps (p = 0.003 and 0.039). In EG, the wide-field RNFL thickness and SuperPixel maps showed diagnostic performance comparable to the SD-OCT thickness and deviation maps (p = 0.065 to 0.100), except for the GC-IPL thickness map (p = 0.004).

CONCLUSIONS

The wide-field SS-OCT RNFL thickness maps showed a diagnostic ability for distinguishing PPG and EG from healthy eyes that was similar to that of SD-OCT. In the clinical setting, these maps can be effective for detection of early-glaucomatous changes.

Comparison of Widefield and Circumpapillary Circle Scans for Detecting Glaucomatous Neuroretinal Thinning on Optical Coherence Tomography

PURPOSE

Our purpose was to compare the effectiveness of detecting progressive retinal nerve fiber layer (RNFL) thickness changes using widefield scans compared to circumpapillary circle scans derived from optic disc volume scans when using a manual region-of-interest (ROI) approach.

METHODS

In a prospective observational study, a total of 125 eyes diagnosed clinically with glaucoma or suspected glaucoma that had both widefield (12 × 9 mm) and optic disc (6 × 6 mm) scans obtained at least one year apart were included. Changes in the RNFL thickness between the two visits were evaluated within region(s) of observed or suspected glaucomatous damage, which were manually outlined after reviewing key features from each scan on the second visit (described as a manual ROI approach). Within ROI(s), changes in the widefield and circumpapillary RNFL thickness (wfRNFLROI and cpRNFLROI), as well as in the global circumpapillary RNFL thickness (cpRNFLG), were determined. The performance of these three methods for detecting progressive changes was compared using longitudinal signal-to-noise ratios (SNRs), whereby the rate of change determined by each method was normalized by individualized estimates of measurement variability and age-related change.

RESULTS

On average, the longitudinal SNRs for the wfRNFLROI, cpRNFLROI, and cpRNFLG methods were -0.57, -0.38, and -0.23 y-1, respectively, being significantly more negative for the wfRNFLROI than the latter two methods (P ≤ 0.009).

CONCLUSIONS

Progressive RNFL thickness changes were more effectively detected on widefield optical coherence tomography (OCT) scans using a manual ROI approach compared to conventional derived circumpapillary circle scans.

TRANSLATIONAL RELEVANCE

Widefield OCT scans show promise for improving the detection of glaucomatous progression.

Wide scan imaging with swept-source optical coherent tomography for glaucoma diagnosis

Purpose

To determine glaucoma-discriminating abilities of macular and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements of wide scan (12X9mm) using swept-source optical coherence tomography (SS-OCT) compared to measurements of standard macula and disc scans (6 X 6 mm).

Methods

This retrospective chart review study included 60 glaucomatous and 62 healthy eyes of total 122 subjects who visited a glaucoma clinic and were examined with wide, standard macula, and standard disc scans of SS-OCT (DRI-OCT-1 Atlantis; Topcon Inc., Tokyo, Japan) on the same day. Thickness measurements of the ganglion cell layer plus inner plexiform layer (mGCIPL), mGCIPL plus nerve fiber layer (mGCC), and total retinal layer (TRL) were assessed in wide and standard macula scans. Thickness measurements of cpRNFL were assessed in wide and standard disc scans. The repeatability and agreement of measurements taken in each scan were evaluated using intraclass correlation coefficients (ICCs). The abilities of parameters to discriminate between glaucoma and normal groups were assessed using areas under receiver operating characteristic curves (AUCs).

Results

The repeatability and agreement of all parameters showed high ICC values (all ≥ 0.800). AUCs for mGCIPL thickness were 0.710–0.847 and 0.701–0.836 in standard macula and wide scans, respectively. AUCs for cpRNFL thickness were 0.749–0.902 and 0.726–0.897 in standard disc and wide scans, respectively. There were no significant differences in AUCs between wide and standard scans.

Conclusions

The agreement between SS-OCT wide and standard scans for mGCIPL, mGCC and cpRNFL measurements were excellent. As the glaucoma-discriminating ability of wide scans was comparable to that of standard macula/disc scans, a single wide scan can replace separate standard macula/disc scans for evaluating glaucoma.