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Renato Lisboa, Mauro T. Leite, Robert N. Weinreb, Linda M. Zangwill, Felipe A. Medeiros; Diagnostic Innovations in Glaucoma Study (DIGS): Diagnosing Glaucoma with Spectral Domain Optical Coherence Tomography in Patients Suspected of Having the Disease. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5620.
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To compare the diagnostic accuracies of Spectralis spectral domain optical coherence tomography (SDOCT) and the Heidelberg Retina Tomography (HRT; Heidelberg Engineering, Dossenheim, Germany) for detection of glaucoma in patients suspected of having the disease.
This was an observational cohort study including 134 eyes from 88 patients suspected of having glaucoma based on the appearance of the optic disc. Patients were recruited from the Diagnostic Innovations in Glaucoma Study (DIGS). All eyes underwent retinal nerve fiber layer (RNFL) imaging with the Spectralis SD-OCT and topographic imaging with HRT confocal scanning laser ophthalmoscope (CSLO) within 6 months. All patients had normal standard automated perimetry visual fields at the time of imaging and were classified based on history of documented stereophotographic evidence of progressive glaucomatous change in the appearance of the optic nerve occurring before the imaging sessions. Areas under the receiver operating characteristic curves (AUC) were calculated to summarize the diagnostic accuracy for each parameter.
Forty-eight eyes with progressive glaucomatous optic nerve change were included in the glaucoma group, and 86 eyes without any evidence of progressive damage to the optic nerve followed untreated for an average time of 8.2 + 3.3 years were included in the normal group. The parameter with the largest AUC obtained with the Spectralis SDOCT was the temporal superior RNFL average thickness (0.88 + 0.03), followed by global RNFL average thickness (0.86 + 0.03) and temporal inferior RNFL average thickness (0.81 + 0.04). The parameter with the largest AUC obtained with the CSLO was rim area (0.72 + 0.05), followed by rim volume (0.71 + 0.05), and linear cup to disk ratio (0.66 + 0.05). The contour line-independent parameter glaucoma probability score measured by HRT had a smaller AUC (0.64 + 0.05) than rim area and rim volume. Temporal superior RNFL average thickness measured by Spectralis SDOCT performed significantly better than rim area measured by CSLO (0.88 vs. 0.72; p = 0.008).
RNFL assessment with Spectralis SDOCT performed better than optic disc topographic parameters obtained by the CSLO in diagnosing glaucoma in a cohort of individuals suspected of having the disease.
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