Abstract
PurposeTo evaluate the diagnostic ability of macular ganglion cell and inner plexiform layer measurements in glaucoma, obtained using swept source (SS) and spectral domain (SD) optical coherence tomography (OCT) and to compare to circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements.MethodsThe study included 106 glaucomatous eyes of 80 subjects and 41 eyes of 22 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Macular ganglion cell and inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and cpRNFL thickness were assessed using SS-OCT and SD-OCT, and area under the receiver operating characteristic curves (AUCs) were calculated to determine ability to differentiate glaucomatous and healthy eyes and between early glaucomatous and healthy eyes.ResultsMean (± standard deviation) mGCIPL and mGCC thickness were thinner in both healthy and glaucomatous eyes using SS-OCT compared to using SD-OCT. Fixed and proportional biases were detected between SS-OCT and SD-OCT measures. Diagnostic accuracy (AUCs) for differentiating between healthy and glaucomatous eyes for average and sectoral mGCIPL was similar in SS-OCT (0.65 to 0.81) and SD-OCT (0.63 to 0.83). AUCs for average cpRNFL acquired using SS-OCT and SD-OCT tended to be higher (0.83 and 0.85, respectively) than for average mGCC (0.82 and 0.78, respectively), and mGCIPL (0.73 and 0.75, respectively) but these differences did not consistently reach statistical significance. Minimum SD-OCT mGCIPL and mGCC thickness (unavailable in SS-OCT) had the highest AUC (0.86) among macular measurements.ConclusionAssessment of mGCIPL thickness using SS-OCT or SD-OCT is useful for detecting glaucomatous damage, but measurements are not interchangeable for patient management decisions. Diagnostic accuracies of mGCIPL and mGCC from both SS-OCT and SD-OCT were similar to that of cpRNFL for glaucoma detection.
Highlights
Mean (± standard deviation) Macular ganglion cell and inner plexiform layer (mGCIPL) and macular ganglion cell complex (mGCC) thickness were thinner in both healthy and glaucomatous eyes using swept source (SS)-optical coherence tomography (OCT) compared to using spectral domain (SD)-OCT
Diagnostic accuracy (AUCs) for differentiating between healthy and glaucomatous eyes for average and sectoral mGCIPL was similar in swept-source OCT (SS-OCT) (0.65 to 0.81) and SD-OCT (0.63 to 0.83)
Assessment of mGCIPL thickness using SS-OCT or SD-OCT is useful for detecting glaucomatous damage, but measurements are not interchangeable for patient management decisions
Summary
The diagnosis of glaucoma in clinical practice largely depends on identification of characteristic structural changes to the optic nerve head, which are often accompanied by functional deficits on visual field testing.[1,2] As glaucomatous visual loss is irreversible, early diagnosis is important; this can be challenging due to large inter-individual variation in normal disc appearance, inter-observer differences in disc evaluation, and lack of sensitivity of visual field testing due to physiological redundancy in retinal ganglion cell receptive fields.[3,4]Recent advances in imaging technologies, especially the development of optical coherence tomography (OCT), provide a means for the objective evaluation of structural changes to the optic nerve head and retina in glaucoma, and offer the potential for improved detection of disease. The diagnosis of glaucoma in clinical practice largely depends on identification of characteristic structural changes to the optic nerve head, which are often accompanied by functional deficits on visual field testing.[1,2] As glaucomatous visual loss is irreversible, early diagnosis is important; this can be challenging due to large inter-individual variation in normal disc appearance, inter-observer differences in disc evaluation, and lack of sensitivity of visual field testing due to physiological redundancy in retinal ganglion cell receptive fields.[3,4]. [12] Measurement of macular retinal ganglion cell-related structure may offer a plausible adjunct or alternative to traditional circumpapillary measurements for glaucoma diagnosis. As the macula is largely devoid of large vessels and has a readily identifiable center, assessment of the macula may overcome some limitations of circumpapillary measurements, such as interference from retinal and optic nerve head vasculature, parapapillary atrophy, and variable placement of the measurement circle around the disc
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