Moorfields Regression Analysis Research Articles

Myopia and glaucoma progression among patients with juvenile onset open angle glaucoma: A retrospective follow up study.

To identify the risk factors for glaucoma progression, especially the association with myopia, among treated juvenile open angle glaucoma (JOAG) patients. Glaucomatous progression was analysed in the eyes of JOAG patients with at least 5-years of follow up in this retrospective study. Baseline variables such as age, inheritance pattern, baseline intraocular pressure (IOP), baseline central corneal thickness, visual acuity, baseline refractive error, spherical equivalent (SE) and duration of follow-up were noted. Stereoparametric global trend analysis and Moorfields Regression Analysis on confocal scanning laser ophthalmoscopy were used to detect progression. Variables associated with glaucoma progression, with respect to progressors (PG) and non-progressors (NPG) were analysed. Since both eyes of a patient were taken for analysis, a generalised estimating equation method was used to correct the bias. Among 74 eyes (37 subjects), glaucoma progression was noted in 11 eyes (14.9%) of 8 patients, with a median time to progression of 7.4years (range 5-15.5years). For myopes (SE≤-1.00D), glaucoma progression was 18 times more likely than mild and no myopes (>-1DS) (p=0.03, 95% CI: 1.14, 217.44). The prevalence of myopia in the JOAG, PG and NPG cohorts was 70.3%, 87.5%, and 65.5%, respectively. Myopia progression was noted at follow up in 70% patients. One-unit increase in baseline vertical cup disc ratio, 1mmHg increase in IOP fluctuations and 1dB year-1 depression of visual field were associated with 0.44, 0.06 and 0.07D year-1 increases in the rate of myopia progression, respectively. JOAG progressors had a greater baseline myopic refraction and a faster myopia development over time. The development of myopia in JOAG eyes could be an indicator of glaucoma progression, and hence progressing myopic (≤-1D) JOAG patients should be followed up more rigorously.

Comparison of Structural Defects between Optic Disc and Ganglion Cell Complex in Patients with Glaucoma

Purpose: To evaluate the agreement of glaucomatous structural defects of the ganglion cell complex (GCC) detected with the spectral domain optical coherence tomography (sdOCT) with the optic nerve head alterations detected with the Heidelberg retina tomography (HRT), of glaucoma patients with ocular hypertension or open angle glaucoma.
 Material and Methods: Ninety patients eyes with structural glaucomatous defects were enrolled. All of them underwent imaging examination of GCC with sdOCT and the optic disk with HRT. The Cohen's kappa coefficient of agreement was used.
 Results: The agreement between the optic disc and GCC using the parameters of the programs analysis of the HRT, the moorfields regression analysis (MRA) and glaucoma probability score (GPS) was not significant. Instead between MRA and GPS a good agreement was calculated. Significant agreements were found between MRA and GPS on one hand and GCC on the other, considering location and length of the glaucomatous damage, while non significant agreements were found between GPS and GCC for the location and the length of the glaucomatous structural defect.
 Conclusions: There is no significance (Please explain further if you are referring to significance in terms of the difference, similarity or agreement) between HRT and sdOCT for the detection of the glaucomatous damage between the optic nerve head and the ganglion cell complex. Instead MRA and GCC detect comparable areas and lengths of the glaucomatous damage. On the other hand GPS records larger deficits relative to MRA and has not a significant agreement with the study of GCC.

Scanning laser ophthalmoscopy in an elderly Indian population

ABSTRACTPurpose: To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg retina tomograph (HRT), in an elderly population.Methods: A population-based, cross-sectional study included 1460 eyes of 1460 consecutive, subjects >60 years, in North India. All subjects underwent a detailed ophthalmic evaluation and imaged on HRT. Stereometric parameters, Moorfields regression analysis (MRA) and discriminant function analysis were analyzed. Correlation between ONH parameters and disc area, age, sex, and intraocular pressure was analyzed.Results: Disc size had a normal Gaussian distribution (2.22 ± 0.48 mm2), but all other stereometric parameters showed a wide variation.MRA found 1320 (90.4%) eyes within normal limits, 71 (4.86%), borderline limits, and 69 (4.73%) outside normal limits.Comparison of eyes meeting International Society of Geographical and Epidemiological Ophthalmology criteria for a glaucoma suspect, C:D > 0.7, with those that did not show a statistically significant difference in the cup area, rim area, rim disc ratio, and cup volume (p = 0.02, 0.02, 0.02, 0.03, respectively).An Intraocular pressure (IOP) ≥21 mmHg was seen in 3.01%, and only 12 eyes out of 1460, 0.82%, had an IOP ≥21 mmHg and a cup:disc ratio of more than 0.7. A van Herick estimation of < Grade 3 was seen in 19.4%Conclusions: Stereometric parameter data, MRA, and clinical examination in this population at high risk for glaucoma found that about 10% of individuals over 60 years of age could be classified as glaucoma suspects and would need further evaluation.

Diagnostic Precision of the Confocal Scanning Laser Ophthalmoscopy in the Large Optic Disc with Physiological Excavation - a Long-Term Study

17 Subjects with presumed bilateral physiological cupping and large optic discs were included in this long-term follow-up study. All subjects underwent regular detailed ophthalmologic examinations, including intraocular pressure measurement via Goldmann applanation tonometry (GAT), retinal nerve fiber layer imaging via optical coherence tonometry (OCT) and visual field testing and optic disc imaging using the HRT. Glaucomatous progression was identified using the HRT's tools (stereometric trend analysis [STA] and topographic change analysis [TCA]). In the initial examination, all 17 subjects were classified as "pathological", by the HRT's Moorfield's Regression Analysis (MRA). Over the observation period of 9.2 ± 5 years, only 1 of the 17 subjects showed an ensured conversion to normal tension glaucoma with glaucomatous visual field defects. The remaining 16 subjects show no visual field defects to date. STA showed significant changes in 3 subjects alone, in 1 subject TCA showed a significant change alone, and in 1 subject both analyses showed a progressive change. After 9 years of regular examinations, 16 of the 17 subjects that were classified as "pathological" using MRA showed no glaucomatous visual field defects. In 5 out of these 16 subjects, progressive changes of the optic disc could be recorded via HRT. Therefore, the diagnostic precision of the HRT measurements seems to be limited in patients with large discs and physiological cupping.

Comparison of isolated-check visual evoked potential and standard automated perimetry in early glaucoma and high-risk ocular hypertension.

To compare the diagnostic performance of isolated-check visual evoked potential (icVEP) and standard automated perimetry (SAP), for evaluating the application values of icVEP in the detection of early glaucoma. Totally 144 subjects (288 eyes) were enrolled in this study. icVEP testing was performed with the Neucodia visual electrophysiological diagnostic system. A 15% positive-contrast (bright) condition pattern was used in this device to differentiate between glaucoma patients and healthy control subjects. Signal-to-noise ratios (SNR) were derived based on a multivariate statistic. The eyes were judged as abnormal if the test yielded an SNR≤1. SAP testing was performed with the Humphrey Field Analyzer II. The visual fields were deemed as abnormality if the glaucoma hemifield test results outside normal limits; or the pattern standard deviation with P<0.05; or the cluster of three or more non-edge points on the pattern deviation plot in a single hemifield with P<0.05, one of which must have a P<0.01. Disc photographs were graded as either glaucomatous optic neuropathy or normal by two experts who were masked to all other patient information. Moorfields regression analysis (MRA) used as a separate diagnostic classification was performed by Heidelberg retina tomograph (HRT). When the disc photograph grader was used as diagnostic standard, the sensitivity for SAP and icVEP was 32.3% and 38.5% respectively and specificity was 82.3% and 77.8% respectively. When the MRA Classifier was used as the diagnostic standard, the sensitivity for SAP and icVEP was 48.6% and 51.4% respectively and specificity was 84.1% and 78.0% respectively. When the combined structural assessment was used as the diagnostic standard, the sensitivity for SAP and icVEP was 59.2% and 53.1% respectively and specificity was 84.2% and 84.6% respectivlely. There was no statistical significance between the sensitivity or specificity of SAP and icVEP, regardless of which diagnostic standard was based on. The diagnostic performance of icVEP is not better than that of SAP in the detection of early glaucoma.

Comparison of Ethnic-specific Databases in Heidelberg Retina Tomography-3 to Discriminate Between Early Glaucoma and Normal Chinese Eyes.

Purpose:To compare the diagnostic accuracy of the 3 race-specific normative databases in Heidelberg Retina Tomography (HRT)-3, in differentiating between early glaucomatous and healthy normal Chinese eyes.Method:52 healthy volunteers and 25 glaucoma patients were recruited for this prospective cross-sectional study. All underwent standardized interviews, ophthalmic examination, perimetry and HRT optic disc imaging. Area under the curve (AUC) receiver operating characteristics, sensitivity and specificity were derived to assess the discriminating abilities of the 3 normative databases, for both Moorfields Regression Analysis (MRA) and Glaucoma Probability Score (GPS).Results:A significantly higher percentage (65%) of patients were classified as “within normal limits” using the MRA-Indian database, as compared to the MRA-Caucasian and MRA-African-American databases. However, for GPS, this was observed using the African-American database. For MRA, the highest sensitivity was obtained with both Caucasian and African-American databases (68%), while the highest specificity was from the Indian database (94%). The AUC for discrimination between glaucomatous and normal eyes by MRA-Caucasian, MRA-African-American and MRA-Indian databases were 0.77 (95% CI, 0.67-0.88), 0.79 (0.69-0.89) and 0.73 (0.63-0.84) respectively. For GPS, the highest sensitivity was obtained using either Caucasian or Indian databases (68%). The highest specificity was seen with the African-American database (98%). The AUC for GPS-Caucasian, GPS-African-American and GPS-Indian databases were 0.76 (95% CI, 0.66-0.87), 0.77 (0.67-0.87) and 0.76 (0.66-0.87) respectively.Conclusion:Comparison of the 3 ethnic databases did not reveal significant differences to differentiate early glaucomatous from normal Chinese eyes.

Morphological Diagnostics in Paediatric Glaucoma-Analysis of the Disc Damage Likelihood Scale by KOWA Non Mydriatic Fundus Camera and its Correlation to HRT and OCT

Title: Morphological diagnostics in paediatric glaucoma Background: Morphological parameters vary in paediatric glaucoma with a minor knowledge on standard values available compared to an adult cohort. Accordingly, we designed a study to assess the objectively measured disc damage likelihood scale (DDLS) by KOWA stereophotography as a novel parameter in comparison to standard glaucoma diagnostics, HRT 3 and OCT. Methods and Findings: Prospective study of 47 eyes (n=47) categorized into three groups; 14 normal optic discs (11 female f, 3 male m, 12.7 ± 6.1years), 15 glaucoma suspects (3f, 12m, 11.7 ± 3.1years) and 18 paediatric glaucoma (10f, 8m, 11.2 ± 2.5years). Stereometric measurements of the optic disc by KOWA camera, Moorfields regression analysis (MRA) and glaucoma probability score (GPS) of the HRT3 and retinal nerve fibre layer (RNFL) of the OCT were analysed. Results were split in 2 groups: Diagnosis 1 was defined as “outside normal limits”, Diagnosis 2 as “borderline or outside normal limits”. Referring to Diagnosis 1 and 2, DDLS did not show a significant correlation with MRA, GPS and RNFL in glaucoma suspects, healthy children and paediatric glaucoma. In paediatric glaucoma the correlation of the GPS compared to KOWA rim/disc ratio was significant in all six quadrants; supernasal (r=-0.794 p=0.006), nasal (r=-0.845 p=0.002), inferonasal (r=-0.659 p=0.038), infertemporal (r=-0.636 p=0.048), temporal (r=-0.656 p=0.039) and superotemporal segment (r=-0.755 p=0.012). Regarding the area under the curve (Receiving operating characteristics ROC) the highest predictive power was demonstrated by DDLS (0.669-0.833) compared to R.Burk (0.142-0.595) and F.S.Mikelberg (0.050-0.619) coefficients considering all devices. Conclusions: The DDLS showed the highest predictive power for glaucomatous damage compared to glaucoma coefficients of the established devices. Additionally, the gold standard of optic nerve head assessment still includes the examination of the fundus photography. As stereo photography is an easy and timesaving instrument, it might be an additive tool in paediatric glaucoma.

Repeatability of Heidelberg Retinal Tomography 3 and effect of alignment algorithm on glaucoma suspects

BackgroundThe Heidelberg Retina Tomograph (HRT) is a commonly‐used clinical instrument for glaucoma diagnosis; however, the repeatability of the two most commonly used analysis tools, Moorfield regression analysis (MRA) and ‘glaucoma probability score’ (GPS) is not known and could have significant implications for patients at risk or suspected of developing glaucoma. Thus, the intra‐visit repeatability of the HRT3 (an objective measure of instrument‐induced variability) was investigated in a glaucoma suspect cohort.MethodsTwo repeat 15° × 15° optic nerve head scans were taken from 164 eyes of 84 patients using the HRT (HRT3, software version 3) during a single visit. The variability of global and sectoral rim area, rim volume and GPS were analysed with and without image alignment using SPSS 22.0. Repeatability was evaluated as absolute difference between the two measurements.ResultsRepeatability of the global rim area, rim volume and GPS were high with and without image registration. Variability increased by a small, yet significant amount without image alignment (p < 0.001 to p = 0.002). This increase was more prominent for sectoral analysis with the exception of the rim area and volume in the temporal sector (p = 0.034 to p < 0.001). Increase in the variability of the GPS was also significant (p < 0.001).ConclusionHRT3 demonstrated high short‐term repeatability, which significantly improved with image registration for all global measurements. Sectoral analysis demonstrated higher repeatability with image registration for some of the sectors in rim area and volume analysis and all sectors for the GPS. Therefore, depending upon the assessed parameters, image registration may play a significant role in the interpretation of results in glaucoma suspects.

Bruch's Membrane Opening-Minimum Rim Width Assessment With Spectral-Domain Optical Coherence Tomography Performs Better Than Confocal Scanning Laser Ophthalmoscopy in Discriminating Early Glaucoma Patients From Control Subjects.

To compare the diagnostic performance and evaluate diagnostic agreement for early glaucoma detection between a confocal scanning laser ophthalmoscope (CSLO) and a spectral-domain optical coherence tomography (SD-OCT). Fifty-five eyes of 55 open-angle glaucoma patients and 42 eyes of 42 healthy control subjects were enrolled in this observational, cross-sectional study. All participants underwent comprehensive ophthalmic examination, visual field testing, and optic nerve head and retinal nerve fiber layer imaging by CSLO (HRT3) and SD-OCT (Spectralis OCT). The agreements of categorical classifications were evaluated (κ statistics). Area under receiver operating characteristic curves (AUROC) and sensitivity at 95% fixed specificity were computed. The agreements of HRT3 and Spectralis OCT categorical classifications were fair to moderate (κ ranged between 0.33 and 0.54), except for Moorfields regression analysis of the HRT3 and the OCT global Bruch's membrane opening-minimum rim width (BMO-MRW) (criterion 1 κ=0.63, criterion 2 κ=0.67). The AUROC of OCT global BMO-MRW (0.956) was greater than those of HRT3 cup-to-disc area ratio (0.877, P=0.0063), vertical cup-to-disc ratio (0.872, P=0.0072), and cup area (0.845, P=0.0005). At 95% specificity, Spectralis OCT global BMO-MRW attained a higher sensitivity than HRT3 cup-to-disc area ratio (P<0.001). The BMO-MRW assessment with SD-OCT performed well in discriminating early glaucoma patients from control subjects and had a better performance than CSLO. The diagnostic classifications of HRT3 and Spectralis OCT may reach good agreement.

Comparison of Heidelberg Retina Tomograph-3 glaucoma probability score and Moorfields regression analysis of optic nerve head in glaucoma patients and healthy individuals.

To compare the sensitivity and specificity of Moorfields regression analysis (MRA) and glaucoma probability score (GPS) between healthy and glaucomatous eyes with Heidelberg Retinal Tomograph 3 (HRT-3). The study included 120 eyes of 75 glaucoma patients and 138 eyes of 73 normal subjects, for a total of 258 eyes of 148 individuals. All measurements were performed with the HRT-3. Diagnostic test criteria (sensitivity, specificity, etc.) were used to evaluate how efficiently GPS and MRA algorithms in the HRT-3 discriminated between the glaucoma and control groups. The GPS showed 88% sensitivity and 66% specificity, whereas MRA had 71.5% sensitivity and 82.5% specificity. There was 71% agreement between the final results of MRA and GPS in the glaucoma group. Excluding borderline patients from both analyses resulted in 91.6% agreement. In the control group the level of agreement between MRA and GPS was 64% including borderline patients and 84.1% after excluding borderline patients. The accuracy rate is 92% for MRA and 91% for GPS in the glaucoma group excluding borderline patients. The difference was nor statistically different. In both cases, agreement was higher between MRA and GPS in the glaucoma group. We found that both sensitivity and specificity increased with disc size for MRA, while the sensitivity increased and specificity decreased with larger disc sizes for GPS. HRT is able to quantify and clearly reveal structural changes in the ONH and RNFL in glaucoma.

Confocal Laser Scanning Tomography to Predict Visual Field Conversion in Patients With Ocular Hypertension and Early Glaucoma.

To compare Moorfields regression analysis (MRA), Glaucoma probability score (GPS), and different discriminant functions to predict future visual field conversion of patients with ocular hypertension and early glaucoma. The study included 120 eyes of patients with ocular hypertension and 110 eyes of patients with early glaucoma from the Erlangen glaucoma registry. Annually, all patients underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography, and HRT (Heidelberg Retina Tomograph I-III; Heidelberg Engineering) measurements. The cohort was divided into 2 groups based on the development of repeatable glaucomatous visual fields. Positive predictive values and negative predictive values were compared for MRA, GPS, and the classification of Bathija, Iester, Mardin, and Mikelberg at baseline. Kaplan-Meier Survival curves and Logrank tests were used to evaluate equality of survival distributions for different test results. Median follow-up was 9.04 years. 26 eyes (11.3%) demonstrated glaucomatous visual field loss in the follow-up. MRA temporal-superior and temporal-inferior outside normal limits were predictive of future visual field loss with positive predictive values of 33.3% and 28.6%. Normal GPS Temporal Sector demonstrated a negative predictive value of 96.4% and normal results in discriminant functions between 94.7% and 95.5%. Confocal scanning laser tomography is a useful imaging modality to predict future visual field conversion. Development of visual field defects in 10 years is highly unlikely, if GPS classification and/or classification of discriminant analysis at baseline are normal. MRA temporal-superior and temporal-inferior outside normal limits are associated with future VF conversion (ClinicalTrials.gov number, NCT00494923).

Can Automated Imaging for Optic Disc and Retinal Nerve Fiber Layer Analysis Aid Glaucoma Detection?

PurposeTo compare the diagnostic performance of automated imaging for glaucoma.DesignProspective, direct comparison study.ParticipantsAdults with suspected glaucoma or ocular hypertension referred to hospital eye services in the United Kingdom.MethodsWe evaluated 4 automated imaging test algorithms: the Heidelberg Retinal Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany) glaucoma probability score (GPS), the HRT Moorfields regression analysis (MRA), scanning laser polarimetry (GDx enhanced corneal compensation; Glaucoma Diagnostics (GDx), Carl Zeiss Meditec, Dublin, CA) nerve fiber indicator (NFI), and Spectralis optical coherence tomography (OCT; Heidelberg Engineering) retinal nerve fiber layer (RNFL) classification. We defined abnormal tests as an automated classification of outside normal limits for HRT and OCT or NFI ≥ 56 (GDx). We conducted a sensitivity analysis, using borderline abnormal image classifications. The reference standard was clinical diagnosis by a masked glaucoma expert including standardized clinical assessment and automated perimetry. We analyzed 1 eye per patient (the one with more advanced disease). We also evaluated the performance according to severity and using a combination of 2 technologies.Main Outcome MeasuresSensitivity and specificity, likelihood ratios, diagnostic, odds ratio, and proportion of indeterminate tests.ResultsWe recruited 955 participants, and 943 were included in the analysis. The average age was 60.5 years (standard deviation, 13.8 years); 51.1% were women. Glaucoma was diagnosed in at least 1 eye in 16.8%; 32% of participants had no glaucoma-related findings. The HRT MRA had the highest sensitivity (87.0%; 95% confidence interval [CI], 80.2%–92.1%), but lowest specificity (63.9%; 95% CI, 60.2%–67.4%); GDx had the lowest sensitivity (35.1%; 95% CI, 27.0%–43.8%), but the highest specificity (97.2%; 95% CI, 95.6%–98.3%). The HRT GPS sensitivity was 81.5% (95% CI, 73.9%–87.6%), and specificity was 67.7% (95% CI, 64.2%–71.2%); OCT sensitivity was 76.9% (95% CI, 69.2%–83.4%), and specificity was 78.5% (95% CI, 75.4%–81.4%). Including only eyes with severe glaucoma, sensitivity increased: HRT MRA, HRT GPS, and OCT would miss 5% of eyes, and GDx would miss 21% of eyes. A combination of 2 different tests did not improve the accuracy substantially.ConclusionsAutomated imaging technologies can aid clinicians in diagnosing glaucoma, but may not replace current strategies because they can miss some cases of severe glaucoma.

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

Many glaucoma referrals from the community to hospital eye services are unnecessary. Imaging technologies can potentially be useful to triage this population. To assess the diagnostic performance and cost-effectiveness of imaging technologies as triage tests for identifying people with glaucoma. Within-patient comparative diagnostic accuracy study. Markov economic model comparing the cost-effectiveness of a triage test with usual care. Secondary care. Adults referred from the community to hospital eye services for possible glaucoma. Heidelberg Retinal Tomography (HRT), including two diagnostic algorithms, glaucoma probability score (HRT-GPS) and Moorfields regression analysis (HRT-MRA); scanning laser polarimetry [glaucoma diagnostics (GDx)]; and optical coherence tomography (OCT). The reference standard was clinical examination by a consultant ophthalmologist with glaucoma expertise including visual field testing and intraocular pressure (IOP) measurement. (1) Diagnostic performance of imaging, using data from the eye with most severe disease. (2) Composite triage test performance (imaging test, IOP measurement and visual acuity measurement), using data from both eyes, in correctly identifying clinical management decisions, that is 'discharge' or 'do not discharge'. Outcome measures were sensitivity, specificity and incremental cost per quality-adjusted life-year (QALY). Data from 943 of 955 participants were included in the analysis. The average age was 60.5 years (standard deviation 13.8 years) and 51.1% were females. Glaucoma was diagnosed by the clinician in at least one eye in 16.8% of participants; 37.9% of participants were discharged after the first visit. Regarding diagnosing glaucoma, HRT-MRA had the highest sensitivity [87.0%, 95% confidence interval (CI) 80.2% to 92.1%] but the lowest specificity (63.9%, 95% CI 60.2% to 67.4%) and GDx had the lowest sensitivity (35.1%, 95% CI 27.0% to 43.8%) but the highest specificity (97.2%, 95% CI 95.6% to 98.3%). HRT-GPS had sensitivity of 81.5% (95% CI 73.9% to 87.6%) and specificity of 67.7% (95% CI 64.2% to 71.2%) and OCT had sensitivity of 76.9% (95% CI 69.2% to 83.4%) and specificity of 78.5% (95% CI 75.4% to 81.4%). Regarding triage accuracy, triage using HRT-GPS had the highest sensitivity (86.0%, 95% CI 82.8% to 88.7%) but the lowest specificity (39.1%, 95% CI 34.0% to 44.5%), GDx had the lowest sensitivity (64.7%, 95% CI 60.7% to 68.7%) but the highest specificity (53.6%, 95% CI 48.2% to 58.9%). Introducing a composite triage station into the referral pathway to identify appropriate referrals was cost-effective. All triage strategies resulted in a cost reduction compared with standard care (consultant-led diagnosis) but with an associated reduction in effectiveness. GDx was the least costly and least effective strategy. OCT and HRT-GPS were not cost-effective. Compared with GDx, the cost per QALY gained for HRT-MRA is £22,904. The cost per QALY gained with current practice is £156,985 compared with HRT-MRA. Large savings could be made by implementing HRT-MRA but some benefit to patients will be forgone. The results were sensitive to the triage costs. Automated imaging can be effective to aid glaucoma diagnosis among individuals referred from the community to hospital eye services. A model of care using a triage composite test appears to be cost-effective. There are uncertainties about glaucoma progression under routine care and the cost of providing health care. The acceptability of implementing a triage test needs to be explored. The National Institute for Health Research Health Technology Assessment programme.

Association Between Alzheimer's Disease and Glaucoma: A Study Based on Heidelberg Retinal Tomography and Frequency Doubling Technology Perimetry.

Aim: To assess the frequency of glaucoma-like alterations in Alzheimer's disease (AD) patients using Heidelberg Retinal Tomograph III (HRT-3) and Frequency Doubling Technology (FDT) perimetry.Methods: The study included 51 eyes of 51 AD subjects and 67 eyes of 67 age- and sex-matched controls. Subjects underwent an ophthalmological examination including measurements of intraocular pressure (IOP), Matrix FDT visual field testing, optic nerve head morphology and retinal nerve fiber layer thickness (RNFLt) assessment by slit-lamp biomicroscopy and HRT-3.Results: The frequency of alterations was significantly higher in the AD group (27.5 vs. 7.5%; p = 0.003; OR = 4.69). AD patients showed lower IOP (p = 0.000) despite not significantly different values of central corneal thickness (CCT) between the groups (p = 0.336). Of all the stereometric parameters measured by HRT-3, RNFLt was significantly lower in AD patients (p = 0.013). This group also had significantly worse results in terms of Moorfields Regression Analysis (p = 0.027). Matrix showed significantly worse Mean Deviation (MD) (p = 0.000) and Pattern Standard Deviation (PSD) (p = 0.000) values and more altered Glaucoma Hemifield Test (p = 0.006) in AD patients. Pearson's R correlation test showed that Mini Mental State Examination is directly correlated with MD (R = 0.349; p = 0.034) and inversely correlated with PSD (R = −0.357; p = 0.030).Conclusion: Patients with AD have a higher frequency of glaucoma-like alterations, as detected by the use of HRT-3. These alterations were not associated with elevated IOP or abnormal CCT values.

Significance of the disc damage likelihood scale objectively measured by a non-mydriatic fundus camera in preperimetric glaucoma.

PurposeTo assess the correlation between the disc damage likelihood scale (DDLS) objectively measured by a non-mydriatic fundus camera, Heidelberg Retina Tomograph 3, and optic coherence tomography in preperimetric glaucoma.MethodsOne-hundred-twenty-five patients with preperimetric primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (n=30) were included (mean age 58.9±15.9 years). All three devices graded the optic disc topography: Diagnosis 1 was defined as “outside normal limits”, while Diagnosis 2 as “borderline or outside normal limits”.ResultsFor Diagnosis 1, a significant correlation was shown between DDLS and Moorfields regression analysis (P=0.022), and for Diagnosis 2 with glaucoma probability score analysis (P=0.024), in POAG. In pseudoexfoliation glaucoma, DDLS did not correlate significantly with Heidelberg Retina Tomograph 3 and optic coherence tomography. Regarding the area under the curve the highest predictive power was demonstrated by the objective DDLS (0.513–0.824) compared to Burk (0.239–0.343) and Mikelberg (0.093–0.270) coefficients.ConclusionsThe DDLS showed a significant correlation to the Moorfields regression analysis in preperimetric POAG. The objective DDLS showed the highest predictive power and thus is an additive tool in diagnosing preperimetric glaucoma.

Evaluation of Agreement between HRT III and iVue OCT in Glaucoma and Ocular Hypertension Patients.

Purpose. To determine the agreement between Moorfields Regression Analysis (MRA), Glaucoma Probability Score (GPS) of Heidelberg retinal tomograph (HRT III), and peripapillary nerve fibers thickness by iVue Optical Coherence Tomography (OCT). Methods. 72 eyes with ocular hypertension or primary open angle glaucoma (POAG) were included in the study: 54 eyes had normal visual fields (VF) and 18 had VF damage. All subjects performed achromatic 30° VF by Octopus Program G1X dynamic strategy and were imaged with HRT III and iVue OCT. Sectorial and global MRA, GPS, and OCT parameters were used for the analysis. Kappa statistic was used to assess the agreement between methods. Results. A significant agreement between iVue OCT and GPS for the inferotemporal quadrant (κ: 0.555) was found in patients with abnormal VF. A good overall agreement between GPS and MRA was found in all the eyes tested (κ: 0.511). A good agreement between iVue OCT and MRA was shown in the superonasal (κ: 0.656) and nasal (κ: 0.627) quadrants followed by the superotemporal (κ: 0.602) and inferotemporal (κ: 0.586) sectors in all the studied eyes. Conclusion. The highest percentages of agreement were found per quadrant of the MRA and the iVue OCT confirming that in glaucoma damage starts from the temporal hemiretina.

Evaluation of subjects with a moderate cup to disc ratio using optical coherence tomography and Heidelberg retina tomograph 3: impact of the disc area.

Aim:The aim was to evaluate subjects with a moderate cup to disc ratio using optical coherence tomograph (OCT) and Heidelberg retina tomograph (HRT) 3.Settings and Design:We included 80 patients with early glaucoma and 80 nonglaucomatous subjects with moderate cup/disc ratio (range of 0.5–0.8) to this cross-sectional study.Subjects and Methods:We compared results of color-coded algorithms of HRT 3 (Moorfields regression analysis [MRA] and Glaucoma probability score [GPS]) and OCT. All outputs are classified into three categories: Within normal limits (WNLs), borderline and outside normal limits (ONLs). Diagnostic accuracies of algorithms were determined using the highest sensitivity criteria.Results:The sensitivities of global MRA, GPS and OCT were 0.75, 0.925 and 0.725, respectively, in average disc area group and 0.85, 1.0 and 0.425, respectively, in large disc area group. The specificities of global MRA, GPS and OCT were 0.55, 0.15 and 0.85, respectively, in average disc area group and 0.425, 0.025 and 0.80, respectively, in large disc area group. Area under receiver operating characteristic curve (AUROC) of global MRA, GPS and OCT were 0.667, 0.617 and 0.792, respectively, in average disc area group and 0.746, 0.576 and 0.627, respectively, in large disc area group. AUROC of global MRA and OCT combination in the average and large disc area groups were 0.828 and 0.825, respectively.Conclusions:In contrast to GPS and OCT algorithms, diagnostic performance of MRA algorithm increased in large disc area group. Combining MRA and OCT algorithms produced satisfactory diagnostic performance in subjects with an average and large disc area.

Prevalence of optic neuropathy in alcoholic patients and predictive value of optic nerve alterations for its diagnosis

AbstractPurpose Optic neuropathy (ON) is one of the complications of alcohol. The aim of this study was to assess the prevalence of alcoholic ON in a cohort of patients hospitalized for alcohol withdrawal. Secondary objective was to explore the predictive value of optic nerve changes for diagnosis of ON.Methods This was a single‐center prospective study. A complete eye examination was performed during the patient's alcohol withdrawal. The definition of alcoholic ON used was an assocation of alterations of visual field with impaired color vision. Optic nerve function and morphology were assessed using visual evoked potentials, optical coherence tomography (OCT), Nerve Fiber Indicator from polarimetry (GDx) and Moorfields Regression Analysis of the Heidelberg Retina Tomograph II (MRA‐HRT II).Results Two hundred patients were included prospectively from January 2010 to June 2013 (145 men and 55 women) with a mean age of 47 ± 12 year. The average alcohol consumption was 220 ± 122 g/day. 46 patients (23%) responded to alcoholic ON defintion (13.5 % in both eyes and 9.5% in only one eye). Diagnostic sensitivity and specificity for visual evoked potentials were of 55.5% and 54.5% respectively; for GDx 18% and 97%, respectively; for OCT 38% and 92%, respectively; and for MRA‐HRT II 19% and 79%, respectively.Conclusion A high prevalence of alcoholic ON observed in this study should prompt screening and early treatment. From predictive value of objective optic nerve changes, we discuss the best couple of exams to complete the screening of alcoholic ON.

Combining Multiple HRT Parameters Using the ‘Random Forests' Method Improves the Diagnostic Accuracy of Glaucoma in Emmetropic and Highly Myopic Eyes

To combine multiple Heidelberg Retina Tomograph (HRT) parameters using the Random Forests classifier to diagnose glaucoma, both in highly and physiologically myopic (highly myopic) eyes and emmetropic eyes. Subjects consisted of healthy subjects and age-matched patients with open-angle glaucoma in emmetropic (-1.0 to +1.0 diopters [D], 63 and 59 subjects, respectively) and highly myopic eyes (-10.0 to -5.0 D, 56 and 64 subjects, respectively). First, area under the receiver operating characteristic curve (AUC) was derived using 84 HRT global and sectorial parameters and the representative HRT raw parameter (largest AUC) was identified. Then, the Random Forests method was carried out using age, refractive error, and 84 HRT parameters. The AUCs were also derived using the following: (1) Frederick S. Mikelberg discriminant function (FSM) score, (2) Reinhard O.W. Burk discriminant function (RB) score, (3) Moorfields regression analysis (MRA) score, and (4) glaucoma probability score (GPS). In combined emmetropic and highly myopic population, AUC with Random Forests method (0.96) was significantly larger than AUCs with the representative HRT raw parameter (vertical cup-to-disc ratio [global], 0.89), FSM (0.90), RB (0.83), MRA (0.87), and GPS (0.81) (P < 0.001). Similarly, AUC with the Random Forests method was significantly (P < 0.05) larger than these other parameters, both in emmetropic and highly myopic groups. Also, the Random Forests method achieved partial AUCs above 80%/90% significantly (P < 0.05) larger than any other HRT parameters in all populations. Evaluating multiple HRT parameters using the Random Forests classifier provided accurate diagnosis of glaucoma, both in emmetropic and highly myopic eyes.

Glaucoma Detection in High Myopia with the Heidelberg Retina Tomograph 3

Purpose: To compare the ability of the glaucoma probability score (GPS) and Moorfields regression analysis (MRA) using the Heidelberg Retina Tomograph (HRT) 3 to detect glaucoma in high myopia. Methods: Fifty-five eyes of highly myopic subjects (study group) and 139 eyes of non-highly myopic subjects (control group) were included. HRT images were obtained from all enrolled eyes, and agreement between GPS and MRA in all subjects, the study group, and the control group was established. Diagnostic performances of GPS and MRA were evaluated by including borderline classifications, either as test negatives (most specific criteria) or as test positives (least specific criteria). Results: The agreement between GPS and MRA in all enrolled eyes, the study group, and the control group was κ = 0.56, 0.50, and 0.58, respectively. In the study group, the AUC was 0.728 for GPS and 0.694 for MRA. In the control group, the AUC was 0.751 for GPS and 0.777 for MRA. With the most specific criteria, GPS showed 80.0% sensitivity and 60.0% specificity in the study group, and MRA showed 76.0% sensitivity and 63.3% specificity in the study group. With the least specific criteria, GPS showed 96.0% sensitivity and 40.0% specificity in the study group, and MRA showed 84.0% sensitivity and 40.0% specificity in the study group. Conclusions: In high myopia, GPS showed a high level of sensitivity with maintenance of specificity, compared with MRA using HRT 3. In addition, GPS had higher diagnostic performance than MRA in high myopia; however, there was no statistical difference between the AUC of GPS and MRA.