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Anna Silverman, Lucie Sharpsten, Felipe A Medeiros, Naira Khachatryan, Naama Hammel, Christopher A Girkin, Jeffrey M Liebmann, Robert N Weinreb, Linda M Zangwill; Diagnostic Innovations in Glaucoma Study (DIGS): Diagnostic Accuracy of the Spectralis Normative Database in Differentiating between Healthy and Early Visual Field Defect Eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4773.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the diagnostic accuracy of the global and sector analysis for detection of early visual field damage using the normative database of the Spectralis spectral-domain optical coherence tomography (SD-OCT).
Glaucoma suspects defined as having ocular hypertension (OHT; IOP > 21 mm Hg) or a suspicious appearing optic disc (GON) at baseline without a history of repeatable visual field damage from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) with at least 2 years of follow-up were included. Healthy eyes defined as having no history of repeatable visual field damage or ocular hypertension were included. Global and sectoral retinal nerve fiber layer thickness (RNFLT) was measured using the Spectralis SD-OCT classified as within normal limits (WNL), borderline (BL) and outside normal limits (ONL). The sensitivity of ONL classification was estimated at the time glaucoma suspect eyes developed repeatable visual field damage (VFD) and/or abnormal photos. The specificity of WNL classification was estimated in healthy eyes.
463 glaucoma suspect eyes and 338 healthy eyes were included. 27 of 236 eyes in the GON group and 18 of 227 eyes in the OHT group developed VFD. The average MD was -0.36, 0.08 and -0.03 for the GON, OHT and healthy groups respectively. The sensitivity of the ONL classification among eyes with VFD was 7 (38.9%) among the OHT eyes and 15 (55.6%) in GON eyes. Few of the OHT and GON eyes that did not develop VFD, had an ONL classification (23 (11.0%) and 49 (23.4%), respectively) at their last follow-up visit. The specificity of WNL classification in healthy eyes was 323 (95.6%).
The Spectralis normative database has a high specificity for identifying healthy eyes. In eyes with very early visual field or photo damage, ONL classification was present in approximately 22 (48.9%) of glaucoma suspects. Longer follow up is needed to determine whether eyes classified as ONL without VFD will develop VFD in the future.
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