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Michael S. Kook, Jung Hwa Na, Youngrok Lee, Kyung Sub Lee, Jongrak Lee; Usefulness of institution-specific measurement variability in the Detection of Retinal Nerve Fiber Layer (RNFL) and Macular Thickness change using Spectral-Domain Optical Coherence Tomography (SD-OCT) in Glaucomatous Eyes with Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2012;53(14):233.
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To derive the institution-specific test-retest variability using Cirrus SD-OCT and apply this information to investigate its ability to detect progressive visual field (VF) change based on Humphrey field analyzer (HFA) in glaucomatous eyes.
Intersession test-retest variability of each clock hour, quadrant, average RNFL thickness, and full-thickness macular (FTM) parameters [outer temporal (OT), superior temporal (SO), outer nasal (ON), outer inferior (OI), inner temporal (IT), inner superior (IS), inner nasal (IN), and inner inferior (II), fovea, cube volume, and cube average] were calculated from stable glaucoma subjects (control 1 group). "Significant thickness change" was defined as thickness measurement that exceeds the 95% CI of test-retest variability. The sensitivity and specificity of Cirrus SD-OCT for identification of progressive VF change were tested on progressive and stable control 2 groups using the criteria defined from the intersession test-retest variability.
The intersession test-retest variability defined at the 95% level for the average RNFL thickness was 6.7um. The quadrant thicknesses were 5.2 um for temporal, 7.7 um for superior, 12.1 um for nasal, and 9.9um for inferior quadrant. Full macular thickness showed similar test-retest variability in comparison with RNFL thickness while OT showed highest test-retest variability at 95% level of 18.2 um.VF changes detected in the progressive glaucoma group were well correlated wtih "significant thickness change" in either quadrant or clock hour in RNFL scan with topographic agreement while stable group showed no "significant thickness change" based on variability criteria.
Derivation of site- or institution-specific variability data associated with SD-OCT may be useful to discover the true variability associated with a given institution or operator that performs the SD-OCT measurements. The application of this data to detect VF progression was useful with a reasonably high sensitivity in our study and may be a better approach than the use of internal normative data that consists of different individuals with different races in detecting true progression in glaucoma..
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