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Christian Y. Mardin, Mareike Steinhaeuser, Ralf Tornow, Anselm Juenemann, Friedrich Kruse, Robert Laemmer; Can Spectral-domain Oct Be Used To Improve The Diagnostic Capability Of The Hrt?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):655.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the effect of a spectral-domain (SD) OCT guided reference plane for laser scanning-tomography of the optic disc on diagnostic accuracy in patients with early and advanced glaucomas.
194 eyes of 89 normals, 39 preperimetric and 66 perimetric glaucomas from the Erlanger glaucoma registry (NTC00494923) were imaged simultanously with SD-OCT (Spectralis) and HRT II (both Heidelberg Engineering, Germany). Temporal edge of Elschnig’s scleral rim was visualized with SD-OCT, the distance to the surface measured perpendicularly to disc’s surface (A) and to scleral plane (B), and both values applied to the 0° position of HRT’s contour line creating a new reference plane (rp). Values for HRT’s standard variables (rim and cup area/volume, third moment, globally and in four sectors) with rp A and rp B were compared to HRT’s standard (st) rp 50µm below contour line’s 350-356° or -10° to -4°. Sensitivity (S) at 90% specificity was calculated and Receiver Operating Characteristics (ROC) curves and area under ROC (AUC) were used to determine diagnostic precision using SPSS Version 14.
Refractive error (Dpt) was between -5.0 and +5.0, visual acuity above 20/32. Perimetric mean defect (dB, mean, sd) was: controls 0.38 ± 0,8; preperimetric -0.05 ± 1.2; perimetric glaucomas 7.7 ± 6.4. Disc area was not significantly different between diagnostic groups. Reference height was significantly higher with rp A and B than with st.rp(p<0.001). Third moment was not influenced by a new rp. Rim/cup area/volume were significantly different with rp A and B than with st.rp. Rim volume global and in four sectors in preperimetric glaucoma showed higher AUC and sensitivity values with the new rp: rim volume superior AUC 0.66 vs. 0.72, S 38% vs. 46% (p<0.01). Perimetric glaucomas did not show significantly higher AUC and sensitivity values with rp A and B except for rim volume inferior: AUC 0.89 vs 0.91, S 70% vs S 79% (p<0.01). Rp A and B’s accuracy was not significantly different from each other.
SD-OCT corrected rp significantly improved the discrimination between normal and glaucomatous discs using HRT’s rim volume. There was no or just a tendency for the other variables in both diagnostic groups. Segmentation of SD-OCT’s disc’s volume scans with Elschnig’s scleral rim as reference plane might be an important tool to increase the significance of HRT II measurements in long term follow-ups.
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