September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Integrating funduscopy, optical coherence tomography (OCT), and ultrasound to differentiate optic disc edema (ODE) from pseudo optic disc edema (PODE)
Author Affiliations & Notes
  • Joseph Nayfach
    College of Optometry, University of Houston, Houston, Texas, United States
  • Han Cheng
    College of Optometry, University of Houston, Houston, Texas, United States
  • Jui-Kai Wang
    Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States
  • Mona K Garvin
    Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States
    Center for the Prevention and Treatment of Visual Loss, VA Health Care System, Iowa City, Iowa, United States
  • Roberto Saenz
    College of Optometry, University of Houston, Houston, Texas, United States
  • Rosa Tang
    College of Optometry, University of Houston, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   Joseph Nayfach, None; Han Cheng, None; Jui-Kai Wang, None; Mona Garvin, None; Roberto Saenz, None; Rosa Tang, None
  • Footnotes
    Support  NIH T35EY7088
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4541. doi:
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      Joseph Nayfach, Han Cheng, Jui-Kai Wang, Mona K Garvin, Roberto Saenz, Rosa Tang; Integrating funduscopy, optical coherence tomography (OCT), and ultrasound to differentiate optic disc edema (ODE) from pseudo optic disc edema (PODE). Invest. Ophthalmol. Vis. Sci. 2016;57(12):4541.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To identify clinical data (funduscopic signs, OCT, and ultrasound) that are useful for differentiating ODE from PODE

Methods : The retrospective study included 21 subjects with ODE (mean age: 31.4±12.7 years) and 25 with PODE (age 27.3±12.2 years). Diagnosis was made by an experienced neuro-ophthalmologist at the University of Houston MS Eye CARE Clinic based on comprehensive neuro-ophthalmologic examination and diagnostic neurological evaluation. Selected features were identified from fundus photographs by a clinician blinded to diagnosis: blurred disc margins, elevated disc, retinal or choroidal folds, thickened peripapillary RNFL, telangiectasia, hemorrhages, exudates, and significant interocular asymmetry. Custom segmentation software was utilized to determine Retinal Nerve Fiber Layer (RNFL) thickness, Optic Nerve Head Volume (ONHV), and Total Retinal Thickness (TRT) from OCT volumes. The presence of disc drusen on B scan ultrasound was noted from medical records.

Results : When used alone, funduscopy showed 100% sensitivity and 60% specificity in detecting ODE (AUC=0.946). Logistical regression analysis of funduscopy data showed that RNFL thickening exhibited high sensitivity (100%), and other funduscopic signs including folds, soft exudates, hemes, and significant asymmetry were highly specific for ODE. OCT parameters (ONHV, RNFL, and TRT) demonstrated modest sensitivity and specificity (ONHV AUC=.806, RNFL AUC=.783, TRT AUC=.756). Logistical regression of OCT parameters revealed a strong ODE correlation to RNFL thickness, with a modest effect for ONH volume and TRT. Using regression tree analysis, decision trees were created using funduscopy, OCT, and ultrasound data. The integration of OCT data into the regression model slightly increased the AUC compared to using funduscopy data alone (0.950 vs 0.946). When ultrasound data identifying drusen were then added to the model, the AUC further increased (0.992 vs 0.950, p < 0.05), showing 100% sensitivity, 90% specificity.

Conclusions : We demonstrated that differentiation of ODE from PODE with high sensitivity and specificity may depend upon integrating multiple sources of clinical information, suggesting a combined approach may yield better results. Further, utilizing regression tree analysis may provide useful insights to aid in accurate diagnosis of ODE.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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