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Ko Eun Kim, Jin Wook Jeoung, Seok Hwan Kim, Ki Ho Park, Dong Myung Kim; False-positive diagnostic classification of retinal nerve fiber layer deviation map: differential diagnosis between myopic eyes with and without glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4543.
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© ARVO (1962-2015); The Authors (2016-present)
To differentiate abnormal retinal nerve fiber layer (RNFL) diagnostic classification in myopia from that in myopic glaucomatous patients on spectral-domain optical coherence tomography (SD-OCT) RNFL deviation map.
Seventy-nine healthy eyes of 79 myopes (axial length ≥ 24 mm) and 61 eyes of 61 myopic glaucoma patients were imaged with Cirrus-HD SD-OCT. Abnormal diagnostic classification was defined as yellow or red color-coded area on RNFL deviation map. The pattern and spatial distribution of abnormal color-coded area, its correlation with defect on RNFL thickness map were compared between myopic eyes with and without glaucoma. Additionally, associated factors for myopic false-positive results were evaluated using univariate and multivariate logistic regression analyses.
Of 79 healthy myopic eyes, 35 eyes (44.3%) showed abnormal RNFL deviation map as presented in Figure 1. Myopic false-positive defect was predominantly located in superior-nasal-inferior area of the optic disc (n=35, 100%, Fig 2), while myopic glaucomatous defect in superior-superotemporal or inferior-inferotemporal area. In regard to the spatial distribution relative to retinal vessels, 77.1% (n=27) of myopic false-positive color-coded area was located in between the vessels, not extending temporally beyond superior and inferior major vessels. All myopic glaucomatous eyes showed decrease in RNFL thickness on the corresponding area of RNFL thickness map. By contrast, myopic eyes with abnormal color-coded area showed discrepant results in RNFL thickness map, showing prominent superior and inferior RNFL bundles on RNFL thickness map. Small disc area was significantly associated with false-positive RNFL deviation map after multivariate analysis (odds ratio = 0.089, P = 0.002).
Although myopia is known as a highly significant factor for abnormal RNFL diagnostic classification, our findings suggest that distinctive characteristics on RNFL deviation map would aid in distinguishing myopic false-positive results from true glaucomatous damage.
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