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Yingna Liu, Huseyin Simavli, Christian Que, Mustafa Akduman, Jennifer Rizzo, Edem Tsikata, Rie Maurer, Johannes F De Boer, Teresa C Chen; Comparison of peripapillary retinal thickness (RT) with retinal nerve fiber layer (RNFL) thickness measurements for diagnostic capability and artifact rates.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4561.
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© ARVO (1962-2015); The Authors (2016-present)
Optical coherence tomography (OCT) RNFL thickness measurements are widely used for glaucoma evaluations, but a high rate of artifacts limits its clinical utility. We performed a retrospective, cross sectional study to compare a new parameter, peripapillary RT, with the traditional RNFL thickness parameter for diagnostic capability and artifact rates. We hypothesize that peripapillary RT measurements from three-dimensional (3D) volume scans have comparable diagnostic capabilities for primary open angle glaucoma (POAG) but fewer artifacts compared to RNFL thickness.
We included 1188 patients who underwent Spectralis OCT imaging from September 2009 to July 2013, and reviewed 2313 two-dimensional (2D) RNFL scans, one from each eye, for overall RNFL and quadrant thickness and for artifacts. We also reviewed the 3D volume scans of 156 patients for overall and quadrant RT. We checked 193 B-scans for each 3D scan, for a total of 30,108 B-scans, for artifacts. Three different size RT annuli were used: outer circumpapillary annuli (OCA) 1 bounded by circle diameters of 2.00 and 3.00 mm; OCA2 by 2.22 and 3.45 mm; and OCA3 by 1.00 and 3.00 mm. Areas under the receiver operating characteristic (AUROC) curves were calculated for both overall and quadrant RNFL and RT. Statistical significance was established at p values < 0.05. To determine the artifact rates, the number of scans with at least one artifact was divided by the number of scans.
The average age of 1188 patients was 61.3 ± 35.3 years; 53.9% were females; 71.2% were white. Of the 156 patients with 3D scans, 89 had POAG and 67 were normal subjects. The RT quadrants with the best diagnostic capabilities were the inferior quadrant of OCA1 and inferior quadrant of OCA2, with AUROC values of 0.959 and 0.945, respectively. The RNFL areas with best diagnostic capabilities were the inferior quadrant and overall RNFL, with AUROC values of 0.930 and 0.909, respectively. Scan artifacts were detected in 46.3% of 2D RNFL scans, while no artifacts were detected in RT scans.
The diagnostic capability of RT parameters is comparable to, and sometimes better than, RNFL parameters for diagnosing POAG, and with fewer artifacts. Assessment of RT may be useful in the evaluation of glaucoma.
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