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Henriet Springelkamp, Kyungmoo Lee, Roger C Wolfs, Gabrielle HS Buitendijk, Wishal D Ramdas, Johannes R Vingerling, Caroline C W Klaver, Michael David Abramoff, Nomdo M Jansonius; The Value of Optical Coherence Tomography for Glaucoma Detection in a Population-Based Setting. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4740.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) is an accepted diagnostic tool for glaucoma. In addition to thinning of the peripapillary retinal nerve fiber layer (RNFL), thinning of various retinal layers in the macula appears to be important for the assessment of glaucoma as well. We determined the screening performance of thickness measurements of three retinal layers assessed by OCT in a population-based setting.
We included participants from the population-based Rotterdam Study who had undergone visual field testing (Humphrey Field Analyzer) and OCT scanning of the macula and optic nerve head (Topcon 3D OCT 1000). We automatically determined the mean thicknesses of the RNFL, retinal ganglion cell layer (RGCL), and inner plexiform layer for various regions of interest, thus defining a series of OCT parameters, using the Iowa Reference Algorithms. The visual field tests were classified as abnormal if two suprathreshold tests followed by a 24-2 SITA standard test showed reproducible abnormalities; glaucomatous visual field loss (GVFL) was diagnosed per exclusionem. We defined glaucoma as the presence of GVFL and determined areas under the receiver operating characteristics curves (AUCs) for each OCT parameter. Sensitivity at 97.5% specificity was calculated for a subset of variables with the highest AUCs.
We included 1087 controls and 41 cases. The median (IQR) mean deviation of the HFA visual fields of the cases was -6.5 dB (-3.8 to -10.5 dB). The mean RGCL thickness of the inferior half of the macular scan had the highest AUC (0.85; 95% confidence interval 0.83-0.88). The mean thickness of the peripapillary RNFL had an AUC of 0.77 (0.74-0.79). At 97.5% specificity, the mean RGCL thickness of the inferior half of the macular scan had a sensitivity of 53.7% (37.7-69.6%).
The RGCL thickness of the inferior half of the macular scan can discriminate between glaucoma cases and controls in a population-based setting and has - compared to other OCT parameters and other imaging techniques - a good screening performance.
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