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Stephan Schulz, Christian Y. Mardin, Martin Diller, Anselm G. Jünemann, Ralf P. Tornow, Folkert K. Horn, Robert Laemmer; Improvement of Glaucoma Classification based on HRT using a Multi Parameter Analysis and the Relationship to Spectralis RNFL Thickness Measurements. Invest. Ophthalmol. Vis. Sci. 2011;52(14):175.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluation of the diagnostic benefit of a fast comprehensive multi parameter test on disc morphology and its relationship to RNFL thickness measurements in preperimetric and early perimetric glaucoma.
64 controls, 77 preperimetric primary open angle glaucoma (POAG) and 63 early perimetric POAG patients were recruited from the Erlangen Glaucoma Registry. Heidelberg Retina Tomograph (HRT 3) and Spectralis HRA+OCT (both Heidelberg Engineering, Germany) scans were obtained. Retinal nerve fibre layer (RNFL) measurements (circular B-scans: 3.4 mm diameter, 768 A-scans, 25 sweeps) were used as observer independent reference. HRT images were anonymized, masked and evaluated by three experienced investigators. HRT qualitative variables were reflectivity of retinal surface, configuration of double-hump pattern, shape of the cup and fulfilled ISNT-rule. The standard quantitative variables were rim-volume, cup shape measure, FSM, RB, Moorfields analysis (MRA) and glaucoma probability score (GPS). A new additive score for glaucoma was created ranging from 0 to 10. Area under ROC (AUROC) and specificities at a fixed sensitivity have been calculated (SPSS, Version 18.0; Chicago, IL, USA) to evaluate predictive value for glaucoma.
The overall HRT score and RNFL-thickness were significantly different from normals in both diagnostic groups. AUROC curves for preperimetric POAG were: averaged score 0.789, MRA 0.744, GPS 0.686 and for RNFL-thickness 0.916. For perimetric POAG: averaged score 0.920, MRA 0.853, GPS 0.826 and for RNFL-thickness 0.965. Sensitivities at fixed specificity of at least 90% were for preperimetric POAG: averaged score 41.7 %, MRA 32.9%, GPS 28.9 % and for RNFL-thickness 78.9%. For perimetric PAOG: averaged score 73.1 %, MRA 58.1%, GPS 48.4 % and for RNFL-thickness 93.5%. The cut off point for the averaged score was 3.
To differentiate normal from glaucoma eyes RNFL-thickness with Spectralis was the variable with the highest sensitivity followed by the score. Multi parameter analysis improves glaucoma classification based on HRT.
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