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Venkata Srinivasan V, Carter-Dawson L, Patel NB. Retinal Ganglion Cell Content Underlying Standard Automated Perimetry Size I to V Visual Sensitivities in the Non-Human Primate Experimental Glaucoma Model. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38995114 PMCID: PMC11246096 DOI: 10.1167/iovs.65.8.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Purpose To determine the relationship between visual sensitivities from white-on-white Goldmann size I to V stimuli and the underlying retinal ganglion cell (RGC) content in the non-human primate (NHP) experimental glaucoma model. Methods Normative data were collected from 13 NHPs. Unilateral experimental glaucoma was induced in seven animals with the least variable fields who were monitored using optical coherence tomography and 30-2 full-threshold standard automated perimetry (SAP). At varying endpoints, animals were euthanized followed by perfusion fixation, and 1-mm retinal punches were obtained from 34 corresponding SAP locations. RGCs were immunolabeled with an antibody against an RNA-binding protein (RBPMS) marker and imaged using confocal microscopy. RGC counts from each location were then related to visual sensitivities for each stimulus size, after accounting for ocular magnification. Results At the endpoint, the circumpapillary retinal nerve fiber layer thickness for experimental glaucoma eyes ranged from 47 to 113 µm. RGC density in control eyes was greatest for the 4.24° sample (18,024 ± 6869 cells/mm2) and decreased with eccentricity. Visual sensitivity at each tested location followed that predicted by spatial summation, with the critical area increasing with eccentricity (slope = 0.0036, R2 = 0.44). The relationship between RGC counts and visual sensitivity was described using a two-line fit, where the intercept of the first segment and hinge points were dependent on eccentricity. Conclusions In NHPs, SAP visual thresholds are related to the underlying RGCs. The resulting spatial summation based structure-function model can be used to estimate RGC content from any standard white-on-white stimulus size.
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Affiliation(s)
| | | | - Nimesh B Patel
- University of Houston College of Optometry, Houston, Texas, United States
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Tomita R, Rawlyk B, Sharpe GP, Hutchison DM, Shuba LM, Nicolela MT, Chauhan BC. Progressive Changes in the Neuroretinal Rim and Retinal Nerve Fiber Layer in Glaucoma: Impact of Baseline Values and Floor Effects. Ophthalmology 2024; 131:700-707. [PMID: 38176444 DOI: 10.1016/j.ophtha.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To determine whether more severe baseline damage impedes measurement of minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) change in glaucoma patients because of a floor effect. DESIGN Prospective, longitudinal cohort study in a hospital-based setting. PARTICIPANTS The study included patients with open-angle glaucoma and healthy control subjects. Participants had at least 5 years of follow-up with OCT every 6 months. METHODS Baseline global and sectorial MRW and RNFLT values were classified as within normal limits, borderline, or outside normal limits based on reference normative values. Regression analysis was used to determine the magnitude and significance of MRW and RNFLT change. Additionally, the follow-up period for each participant was divided into 2 equal halves (first and second periods) to determine whether there was attenuation of MRW and RNFLT change with follow-up time. MAIN OUTCOME MEASURES Rates of global and sectoral MRW and RNFLT changes (slopes). RESULTS A total of 97 patients with glaucoma (median age, 70.3 years) and 42 healthy subjects (median age, 64.8 years) were followed for a median of 6.9 years and 7.0 years, respectively. The median mean deviation of the visual field in glaucoma patients was -4.30 decibels (dB) (interquartile range, -7.81 to -2.06 dB; range, -20.68 to 1.37 dB). Statistically significant changes in global and sectoral MRW and RNFLT were detected across all baseline classifications; however, there was a tendency for less change with increasing baseline damage. In glaucoma patients, RNFLT slopes, but not MRW slopes, were significantly more positive (less change) in the second period compared with the first. There were also no differences in MRW or RNFLT slopes in the first and second periods in healthy subjects. CONCLUSIONS Significant MRW and RNFLT changes were detected at all levels of baseline damage. However, an attenuation in the rate of RNFLT change compared with MRW indicates an earlier floor effect in RNFLT measurements globally and in equivalent sectors. Because the axonal component of these measurements should be equivalent, our results suggest important differences in tissue remodeling at the level of the optic nerve head and peripapillary retina. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ryo Tomita
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brooklyn Rawlyk
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada; University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Glen P Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna M Hutchison
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lesya M Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcelo T Nicolela
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
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Englmaier VA, Storp JJ, Leclaire MD, Lahme L, Brücher VC, Biermann J, Diener R, Eter N. Accuracy of Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness in glaucoma diagnosis depending on optic disc size. Graefes Arch Clin Exp Ophthalmol 2024; 262:1899-1910. [PMID: 38240777 PMCID: PMC11106137 DOI: 10.1007/s00417-024-06375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND/AIM The aim of this paper is to compare retinal nerve fiber layer thickness (RNFL) and Bruch's membrane opening-based minimum rim width (BMO-MRW) in terms of their performance in detecting early and moderate/advanced glaucoma using receiver operating characteristics (ROC) analysis and the classification using the 5th percentile as a cut-off. METHODS One hundred eyes from 100 patients with early glaucoma (mean deviation (MD): < -5.0 dB) and 100 eyes from 100 patients with moderate/advanced glaucoma (MD: > -5.0 dB) were carefully matched to healthy controls based on optic disc size. Then, the dataset was divided, based on the 50th percentile of the measured Bruch's membrane opening area (BMO-A), into small (BMO-A < 1.95 mm2) and large optic discs (BMO-A > 1.95 mm2). Finally, the discriminative performance of BMO-MRW and RNFL between glaucoma and controls using ROC analysis and the manufacturer's classification based on the 5th percentile was analyzed. RESULTS In discriminating between glaucoma and matched healthy controls, global BMO-MRW and global RNFL thickness had comparable areas under the ROC curve for eyes with early glaucoma and both small BMO-As (ROC ± confidence interval [CI] 0.91 [0.87 to 0.95] and 0.88 [0.83 to 0.93]) and large BMO-As (0.86 [0.82 to 0.92] and 0.84 [0.79 to 0.90]), as well as in moderate/advanced glaucoma with small BMO-As (0.99 [0.98 to 1.00] and 0.97 [0.95 to 1.00]) and large BMO-As (0.94 [0.91 to 0.98] and 0.97 [0.94 to 1.00]). Using the calculated 5th percentile as a threshold value, the sensitivities for the detection of early and moderate/advanced glaucoma were comparable for BMO-MRW and RNFL in eyes with small optic discs (early glaucoma: fifty-two percent and 61%; moderate/advanced glaucoma: ninety-one percent and 92%). In eyes with large optic discs, the sensitivity of BMO-MRW was inferior to that of RNFL for both early (38% versus 51%) and moderate/advanced (80% versus 91%) glaucoma. CONCLUSION Based on an ROC analysis, the discriminative performance of BMO-MRW and RNFL between patients with early and moderate/advanced glaucoma and a healthy control group matched based on optic disc size is comparable in eyes with BMO-As smaller and larger 1.95 mm2. Using a classification based on the 5th percentile, as used in clinical practice, RNFL is shown to be superior to BMO-MRW regarding sensitivity in glaucoma detection with large optic discs. This study underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma, especially in cases of large optic discs.
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Affiliation(s)
- Verena Anna Englmaier
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany.
| | - Jens Julian Storp
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Martin Dominik Leclaire
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Larissa Lahme
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Viktoria Constanze Brücher
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Julia Biermann
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Raphael Diener
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany
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Kumar P, Campbell P, Vaddavalli PK, Hull CC, Bharadwaj SR. Structure-Function Relationship in Keratoconus: Spatial and Depth Vision. Transl Vis Sci Technol 2023; 12:21. [PMID: 38149965 PMCID: PMC10756247 DOI: 10.1167/tvst.12.12.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose The purpose of this study was to determine changes in spatial and depth vision with increasing severity of keratoconus and to model the structure-function relationship to identify distinct phases of loss in visual function with disease severity. Methods Best-spectacle corrected, monocular high-contrast visual acuity, contrast sensitivity function (CSF) and stereoacuity of 155 cases (16-31 years) with mild to advanced bilateral keratoconus was determined using standard psychophysical tests. Disease severity was quantified using the multimetric D-index. The structure-function relationship was modeled using linear, positive exponential, negative exponential, and logistic nonlinear regression equations. Results The logistic regression model explained the highest proportion of variance for spatial vision, without bias in the residual plots (R2 ≥ 66%, P < 0.001). Visual acuity showed a distinct ceiling phase and a steeper loss rate with increasing D-index (1.8 units/D-index) in this model. The area under the CSF lacked this ceiling phase and had a shallower loss rate (0.28 units/D-index). Stereoacuity loss with D-index was poorly explained by all models tested (P ≤ 0.2). Cases with lower and bilaterally symmetric D-index had better stereoacuity (181.6-376 arc seconds) than those with higher D-index (>400 arc second); both were significantly poorer than controls (approximately 30 arc second). Conclusions Vision loss in keratoconus varies with the visual function parameter tested. Contrast sensitivity may be an earlier indicator of spatial vision loss than visual acuity. Depth perception is significantly deteriorated from very early stages of the disease. Translational Relevance The study outcomes may be used to forecast longitudinal vision loss in keratoconus and to apply appropriate interventions for timely preservation/enhancement of vulnerable visual functions.
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Affiliation(s)
- Preetam Kumar
- Department of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, Northampton Square, London, United Kingdom
- Brien Holden Institute of Optometry and Vision Sciences, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Peter Campbell
- Department of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, Northampton Square, London, United Kingdom
| | - Pravin K. Vaddavalli
- The Shantilal Sanghvi Cornea Institute, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Christopher C. Hull
- Department of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, Northampton Square, London, United Kingdom
| | - Shrikant R. Bharadwaj
- Brien Holden Institute of Optometry and Vision Sciences, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
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Braeu FA, Chuangsuwanich T, Tun TA, Perera SA, Husain R, Kadziauskienė A, Schmetterer L, Thiéry AH, Barbastathis G, Aung T, Girard MJA. Three-Dimensional Structural Phenotype of the Optic Nerve Head as a Function of Glaucoma Severity. JAMA Ophthalmol 2023; 141:882-889. [PMID: 37589980 PMCID: PMC10436184 DOI: 10.1001/jamaophthalmol.2023.3315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/05/2023] [Indexed: 08/18/2023]
Abstract
Importance The 3-dimensional (3-D) structural phenotype of glaucoma as a function of severity was thoroughly described and analyzed, enhancing understanding of its intricate pathology beyond current clinical knowledge. Objective To describe the 3-D structural differences in both connective and neural tissues of the optic nerve head (ONH) between different glaucoma stages using traditional and artificial intelligence-driven approaches. Design, Setting, and Participants This cross-sectional, clinic-based study recruited 541 Chinese individuals receiving standard clinical care at Singapore National Eye Centre, Singapore, and 112 White participants of a prospective observational study at Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. The study was conducted from May 2022 to January 2023. All participants had their ONH imaged using spectral-domain optical coherence tomography and had their visual field assessed by standard automated perimetry. Main Outcomes and Measures (1) Clinician-defined 3-D structural parameters of the ONH and (2) 3-D structural landmarks identified by geometric deep learning that differentiated ONHs among 4 groups: no glaucoma, mild glaucoma (mean deviation [MD], ≥-6.00 dB), moderate glaucoma (MD, -6.01 to -12.00 dB), and advanced glaucoma (MD, <-12.00 dB). Results Study participants included 213 individuals without glaucoma (mean age, 63.4 years; 95% CI, 62.5-64.3 years; 126 females [59.2%]; 213 Chinese [100%] and 0 White individuals), 204 with mild glaucoma (mean age, 66.9 years; 95% CI, 66.0-67.8 years; 91 females [44.6%]; 178 Chinese [87.3%] and 26 White [12.7%] individuals), 118 with moderate glaucoma (mean age, 68.1 years; 95% CI, 66.8-69.4 years; 49 females [41.5%]; 97 Chinese [82.2%] and 21 White [17.8%] individuals), and 118 with advanced glaucoma (mean age, 68.5 years; 95% CI, 67.1-69.9 years; 43 females [36.4%]; 53 Chinese [44.9%] and 65 White [55.1%] individuals). The majority of ONH structural differences occurred in the early glaucoma stage, followed by a plateau effect in the later stages. Using a deep neural network, 3-D ONH structural differences were found to be present in both neural and connective tissues. Specifically, a mean of 57.4% (95% CI, 54.9%-59.9%, for no to mild glaucoma), 38.7% (95% CI, 36.9%-40.5%, for mild to moderate glaucoma), and 53.1 (95% CI, 50.8%-55.4%, for moderate to advanced glaucoma) of ONH landmarks that showed major structural differences were located in neural tissues with the remaining located in connective tissues. Conclusions and Relevance This study uncovered complex 3-D structural differences of the ONH in both neural and connective tissues as a function of glaucoma severity. Future longitudinal studies should seek to establish a connection between specific 3-D ONH structural changes and fast visual field deterioration and aim to improve the early detection of patients with rapid visual field loss in routine clinical care.
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Affiliation(s)
- Fabian A. Braeu
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Singapore–MIT Alliance for Research and Technology, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Thanadet Chuangsuwanich
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tin A. Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Shamira A. Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Aiste Kadziauskienė
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Alexandre H. Thiéry
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - George Barbastathis
- Singapore–MIT Alliance for Research and Technology, Singapore
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge
| | - Tin Aung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Michaël J. A. Girard
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Shi L, Mohammadi M, Mohammadzadeh V, Su E, Weiss RE, Caprioli J, Nouri-Mahdavi K. Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width. Am J Ophthalmol 2023; 253:181-188. [PMID: 37150336 PMCID: PMC10859221 DOI: 10.1016/j.ajo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare rates of change (RoC) of peripapillary retinal nerve fiber layer (RNFL) and Bruch membrane opening-based minimum rim width (BMO-MRW) thickness in moderate-to-advanced glaucoma. DESIGN Prospective cohort study. METHODS Longitudinal optical coherence tomography (OCT) optic nerve head volume scans of 113 eyes of 113 glaucoma patients with moderate-to-advanced or central damage were exported. This study estimated and compared global and sectoral RoC with linear mixed effects models and simple linear regression (SLR) of RNFL and BMO-MRW thickness. Permutation analyses were used to test significance of RoC in the SLR model. It also compared longitudinal signal-to-noise ratios (LSNR) defined as RoC divided by residual standard deviation (SD) between the two groups. RESULTS Mean (SD) follow-up and median (IQR) OCT scan sessions were 5.2 (1.3) years and 10 (8-11), respectively. Baseline average (SD) visual field mean deviation was -9.2 (5.8) dB. Based on SLR, a higher proportion of significant negative RNFL RoC was observed compared to BMO-MRW in the inferotemporal (35% vs 20%; P = .015) and inferonasal (42% vs 17%; P < .001) sectors. Permutation analyses also demonstrated a higher proportion of worsening RNFL RoC than BMO-MRW in the inferotemporal (P = .026) and inferonasal (P < .001) sectors along with overall lower positive RoC. Longitudinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally, and in the inferotemporal, inferonasal, and superonasal sectors (P ≤ .01). CONCLUSIONS Longitudinal RNFL OCT measurements are more likely to detect structural change and demonstrate better LSNR compared with BMO-MRW in eyes with central or moderate-to-advanced glaucoma damage at baseline.
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Affiliation(s)
- Lynn Shi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Massood Mohammadi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Vahid Mohammadzadeh
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Joseph Caprioli
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Kouros Nouri-Mahdavi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M).
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De Gainza A, Morales E, Rabiolo A, Yu F, Afifi AA, Nouri-Mahdavi K, Caprioli J. A Metascore of Multiple Imaging Methods to Measure Long-Term Glaucoma Structural Progression. Transl Vis Sci Technol 2022; 11:15. [PMID: 36129700 PMCID: PMC9513740 DOI: 10.1167/tvst.11.9.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop a structural metascore (SMS) that combines measurements from different devices and expresses them on a single scale to facilitate their long-term analysis. Methods Three structural measurements (Heidelberg Retina Tomograph II [HRT] rim area, HD-Cirrus optical coherence tomography [OCT] average retinal nerve fiber layer [RNFL] thickness, Spectralis OCT RNFL global thickness) were normalized on a scale of 0 to 100 and converted to a reference value. The resultant metascores were plotted against time. SMS performance was evaluated to predict future values (internal validation), and correlations between the average grades assigned by three clinicians were compared with the SMS slopes (external validation). Results The linear regression fit with the variance approach, and adjustment to a Spectralis equivalent was the best-performing approach; this was denominated metascore. Plots were created for 3416 eyes of 1824 patients. The average baseline age (± standard deviation) was 69.8 (±13.9), mean follow-up was 11.6 (±4.7) years, and mean number of structural scans per eye was 10.0 (±4.7). The mean numbers of scans per device were 3.8 (±2.5), 5.0 (±2.9), and 1.3 (±3.0) for HRT, Cirrus, and Spectralis, respectively. The metascore slopes' median was -0.3 (interquartile range 1.1). Correlations between the average grades assigned by the three clinicians and the metascore slopes were -0.51, -0.49, and -0.69 for the first (structural measurement printouts alone), second (metascore plots alone), and third (printouts + metascore plots) series of gradings, respectively. The average absolute predictive ability was 7.63/100 (whereas 100 = entire normalized scale). Conclusions We report a method that converts Cirrus global RNFL and HRT global rim area normalized measurements to Spectralis global RNFL equivalent values to facilitate long-term structural follow-up. Translational Relevance Because glaucoma changes usually occur slowly, patients are often examined with different instruments during their follow-up, a method that "unifies" structural measurements provided by different devices, which could assist patients' longitudinal structural follow-up.
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Affiliation(s)
| | | | | | - Fei Yu
- UCLA, Los Angeles, CA, USA
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Bartlett RL, Frost BE, Mortlock KE, Fergusson JR, White N, Morgan JE, North RV, Albon J. Quantifying biomarkers of axonal degeneration in early glaucoma to find the disc at risk. Sci Rep 2022; 12:9366. [PMID: 35672326 PMCID: PMC9174204 DOI: 10.1038/s41598-022-12036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
To evaluate regional axonal-related parameters as a function of disease stage in primary open angle glaucoma (POAG) and visual field (VF) sensitivity. Spectral domain optical coherence tomography was used to acquire 20° scans of POAG (n = 117) or healthy control (n = 52) human optic nerve heads (ONHs). Region specific and mean nerve fibre layer (NFL) thicknesses, border NFL and peripapillary NFL, minimum rim width (MRW)/ area (MRA) and prelamina thickness; and volume were compared across POAG disease stages and with visual field sensitivity. Differences identified between early glaucoma (EG), preperimetric glaucoma (PG) and control (C) ONHs included thinner PG prelamina regions than in controls (p < 0.05). Mean border NFL was thinner in EG (p < 0.001) and PG (p = 0.049) compared to control eyes; and EG mean, and inferior and ST, border NFL was thinner than in PG (p < 0.01). Mean, superior and inferior PG peripapillary NFL were thinner than in controls (p < 0.05), and EG ST peripapillary NFL was thinner than in PG (p = 0.023). MRW differences included: PG SN and inferior less than in controls (p < 0.05); thinner EG mean regional, inferior, nasal, and ST MRW versus PG MRW (p < 0.05). Regional border NFL, peripapillary NFL, MRW, MRA, prelamina thickness (except centre, p = 0.127) and prelamina volume (p < 0.05) were significantly associated with VF mean deviation (MD). Novel axon-derived indices hold potential as biomarkers to detect early glaucoma and identify ONHs at risk.
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Affiliation(s)
- R L Bartlett
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - B E Frost
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- School of Biosciences, Cardiff University, Cardiff, UK
| | - K E Mortlock
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J R Fergusson
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - N White
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - R V North
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J Albon
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK.
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK.
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Choi HS, Joo CW, Park SP, Na KI. A Decrease in Bruch's Membrane Opening-Minimum Rim Area Precedes Decreased Retinal Nerve Fiber Layer Thickness and Visual Field Loss in Glaucoma. J Glaucoma 2021; 30:1033-1038. [PMID: 34628426 DOI: 10.1097/ijg.0000000000001947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022]
Abstract
PRCIS A decrease in Bruch's membrane opening-minimum rim area, which represents the optic nerve head (ONH), preceded a decrease in the peripapillary retinal nerve fiber layer thickness (RNFLT) and the visual field index (VFI). PURPOSE This study aimed to investigate the relative comparison between a decrease in BMO-MRA, the peripapillary RNFLT, and the VFI, according to the severity of glaucoma. MATERIALS AND METHODS This retrospective cross-sectional study included 121 eyes (73 with open-angle glaucoma and 48 normal eyes). The ONH and retinal nerve fiber layer were analyzed using spectral domain optical coherence tomography, and VFI was obtained using the Humphrey Field Analyzer. The tipping points of RNFLT for VFI and BMO-MRA were estimated using broken-stick regression models. Polynomial regression analysis was performed, and the changes in the 3 parameters were expressed as a graph. RESULTS The tipping point of the RNFLT for the VFI was 88.62 μm [95% confidence interval (CI): 79.59-97.65; P=0.001]. The tipping point of the RNFLT for BMO-MRA was 60.00 μm (95% CI: 48.28-71.72; P=0.220). Above the tipping point, BMO-MRA decreased with a decrease in the RNFLT (slope=0.0135; 95% CI: 0.0115-0.0155; P<0.001); below the tipping point, BMO-MRA did not decrease significantly (slope=0.0002; 95% CI: -0.0177 to 0.0181; P=0.983). Polynomial regression analysis showed that with the progression of glaucoma, BMO-MRA decreased more rapidly, and this preceded a decrease in the RNFLT followed by a decrease in the VFI. CONCLUSION The ONH parameter, BMO-MRA, showed a faster decrease than RNFLT and VFI in early glaucoma. BMO-MRA may help detect early glaucomatous damage and its progression.
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Affiliation(s)
- Hyun Sup Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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10
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Celebi ARC, Park EA, Verticchio Vercellin AC, Tsikata E, Lee R, Shieh E, Antar H, Freeman M, Zhang J, Que C, Simavli H, McClurkin M, Guo R, Elze T, de Boer JF, Chen TC. Structure-Function Mapping Using a Three-Dimensional Neuroretinal Rim Parameter Derived From Spectral Domain Optical Coherence Tomography Volume Scans. Transl Vis Sci Technol 2021; 10:28. [PMID: 34019635 PMCID: PMC8142720 DOI: 10.1167/tvst.10.6.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the structure-function relationship in glaucoma using Humphrey visual field (HVF) perimetry and a three-dimensional neuroretinal rim parameter derived from spectral domain optical coherence tomography (SD-OCT) volume scans. Methods Structure-function correlation was analyzed globally and regionally (four quadrants and four sectors). Structural data included peripapillary retinal nerve fiber layer (RNFL) thickness and minimum distance band (MDB) neuroretinal rim thickness, defined as the shortest distance between the inner cup surface and the outer retinal pigment epithelium/Bruch's membrane complex. Logarithmic regression analyses were performed and Pearson correlation coefficients determined to assess relationship strength. Results The study consisted of 102 open-angle glaucoma patients and 58 healthy subjects. The Pearson correlation coefficient for global MDB thickness (R = 0.585) was higher than for global RNFL thickness (R = 0.492), but the difference was not statistically significant (P = 0.18). The correlation coefficients for regional MDB thicknesses and corresponding HVF sensitivities were higher than those for regional RNFL thicknesses and HVF in six out of eight regions (P = 0.08 to 0.47). In the remaining two out of eight regions, the correlation coefficients were higher for RNFL thickness than for MDB thickness (P = 0.15 to 0.20). Conclusions Three-dimensional MDB neuroretinal rim thickness relates to visual function as strongly as the most commonly used SD-OCT parameter for glaucoma, two-dimensional peripapillary RNFL thickness. Translational Relevance This paper illustrates the potential for 3D OCT algorithms to improve in vivo imaging in glaucoma.
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Affiliation(s)
- Ali Riza Cenk Celebi
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Elli A Park
- Boston University School of Medicine, Boston, MA, USA
| | - Alice Chandra Verticchio Vercellin
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, Rome, Italy
| | - Edem Tsikata
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ramon Lee
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Eric Shieh
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hussein Antar
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Madeline Freeman
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Smith College School for Social Work, Northampton, MA, USA
| | - Jing Zhang
- Peking University First Hospital, Beijing, China
| | - Christian Que
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, University of East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Huseyin Simavli
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Kudret Eye Hospital, Istanbul, Turkey
| | | | - Rong Guo
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tobias Elze
- Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston, MA, USA
| | - Johannes F de Boer
- LaserLaB Amsterdam, Department of Physics and Astronomy, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Teresa C Chen
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA
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11
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Fortune B. Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma. Clin Exp Optom 2021; 102:286-290. [DOI: 10.1111/cxo.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, USA,
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12
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Nouri-Mahdavi K, Weiss RE. Detection of Glaucoma Deterioration in the Macular Region with Optical Coherence Tomography: Challenges and Solutions. Am J Ophthalmol 2021; 222:277-284. [PMID: 32950510 DOI: 10.1016/j.ajo.2020.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Macular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGCs) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance. DESIGN Perspective with review of relevant literature. METHODS Review of challenges and issues related to detection of change on macular OCT images in glaucoma eyes. The primary outcome measures were confounding factors affecting the detection of change on macular OCT images. RESULTS The main challenges to detection of structural progression in the macula consist of the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, the confounding effects of concurrent macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, the use of artificial intelligence methods, and the implementation of statistical approaches suitable for multidimensional longitudinal data. CONCLUSIONS Macular OCT imaging is a crucial structural imaging modality for assessing central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and therefore assist clinicians with timely institution of appropriate treatment.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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13
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Nouri-Mahdavi K, Fatehi N, Caprioli J. Longitudinal Macular Structure-Function Relationships in Glaucoma and Their Sources of Variability. Am J Ophthalmol 2019; 207:18-36. [PMID: 31078529 PMCID: PMC6842082 DOI: 10.1016/j.ajo.2019.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To review central structure-function (SF) relationships in glaucoma; to compare contributions of within-session and between-session variability to total variability of macular optical coherence tomography (OCT) thickness measurements; and to test the hypothesis that longitudinal within-eye variability of central SF relationships is smaller than between-individual variability. METHODS We reviewed the pertinent literature on central SF relationships in glaucoma. Thirty-eight eyes (20 normal or glaucoma subjects) had ×3 macular images per session over 3 sessions, and superpixels thickness measurements for ganglion cell layer (GCL), ganglion cell/inner plexiform layer (GCIPL), ganglion cell complex (GCC), and full macular thickness (FMT) were exported. Linear mixed models were used for estimating contributions of between- and within-session variability to total thickness variability. One hundred twenty eyes with ≥3 10° visual fields (VFs)/OCT images were enrolled for the longitudinal study. We investigated within-eye longitudinal SF relationships (GCIPL thickness vs VF total deviations) with a change-point regression model and compared within-eye to between-individual variabilities with components-of-variance models. RESULTS In the cross-sectional study, the between-session component contributed 8%, 11%, 11%, and 36% of total variability for GCL, GCIPL, GCC, and FMT, respectively. In the longitudinal study, between-individual variability explained 78%, 77%, and 67% of total SF variability at 3.4°, 5.6°, and 6.8° eccentricities, respectively (P < .05). SF relationships remained stable over time within individual eyes. CONCLUSIONS Within-session variability accounts for most of macular thickness variability over time. Longitudinal within-eye SF variability is smaller than between-individual variability. Study of within-eye SF relationships could help clinicians better understand SF linking in glaucoma and help refine progression algorithms. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
| | - Nima Fatehi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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14
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Zheng F, Yu M, Leung CKS. Diagnostic criteria for detection of retinal nerve fibre layer thickness and neuroretinal rim width abnormalities in glaucoma. Br J Ophthalmol 2019; 104:270-275. [PMID: 31147377 PMCID: PMC7025733 DOI: 10.1136/bjophthalmol-2018-313581] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/10/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
Background/aims Although measurements of the Bruch’s membrane opening minimum rim width (BMO-MRW) and retinal nerve fibre layer thickness (RNFLT) with optical coherence tomography (OCT) have been widely adopted in the diagnostic evaluation of glaucoma, there is no consensus on the diagnostic criteria to define BMO-MRW and RNFLT abnormalities. This study investigated the sensitivities and specificities of different diagnostic criteria based on the OCT classification reports for detection of glaucoma. Methods 340 eyes of 137 patients with glaucoma and 87 healthy individuals, all with axial length ≤26mm, had global and sectoral BMO-MRW and RNFLT measured with Spectralis OCT (Heidelberg Engineering). Six diagnostic criteria were examined: global measurement below the fifth or the first percentile; ≥1 sector measurement below the fifth or the first percentile; superotemporal and/or inferotemporal measurement below the fifth or the first percentile. The sensitivities and specificities of BMO-MRW/RNFLT assessment for detection of glaucoma (eyes with visual field (VF) defects) were compared. Results Among the six criteria examined, superotemporal and/or inferotemporal measurement below the fifth percentile showed the highest sensitivities and specificities for glaucoma detection. Abnormal superotemporal and/or inferotemporal RNFLT attained a higher sensitivity than abnormal superotemporal and/or inferotemporal BMO-MRW to detect mild glaucoma (mean VF MD: −3.32±1.59 dB) (97.9% and 88.4%, respectively, p=0.006), and glaucoma (mean VF MD: −9.36±8.31 dB) (98.4% and 93.6%, respectively, p=0.006), at the same specificity (96.1%). Conclusions Superotemporal and/or inferotemporal RNFLT/MRW below the fifth percentile yield the best diagnostic performance for glaucoma detection with RNFLT attains higher sensitivities than MRW at the same specificity in eyes without high myopia.
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Affiliation(s)
- Feihui Zheng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Marco Yu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
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15
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Sawada Y, Araie M, Shibata H, Ishikawa M, Iwata T, Yoshitomi T. Differences in Retinal Nerve Fiber Layer Thickness as Assessed on the Disc Center and Bruch’s Membrane Opening Center in Myopic Eyes. ACTA ACUST UNITED AC 2019; 2:145-155. [DOI: 10.1016/j.ogla.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022]
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