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H. L. Rao, L. M. Zangwill, R. N. Weinreb, P. A. Sample, M. T. Leite, L. M. Alencar, F. A. Medeiros; Effect of Disease Severity on the Diagnostic Accuracy of RTVue Spectral Domain OCT. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2978.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the influence of disease severity on the diagnostic accuracies of optic nerve head (ONH), retinal nerve fiber layer (RNFL) and macular parameters with RTVue (Optovue Inc, Fremont, CA) spectral domain optical coherence tomography (SDOCT) in glaucoma.
In a cross-sectional, observational study, 74 eyes of 44 normal subjects and 140 eyes of 106 glaucoma patients from the Diagnostic Innovations in Glaucoma Study underwent ONH, RNFL and macular imaging with RTVue SDOCT. Glaucoma patients had repeatable abnormal standard automated perimetry (SAP) results (pattern standard deviation abnormal with p>5% and/or abnormal glaucoma hemifield test). Severity of glaucoma was based on Visual Field Index (VFI) values from SAP. Influence of disease severity on the diagnostic accuracy of RTVue was evaluated by receiver operating characteristic (ROC) regression models.
Disease severity had a signficant effect on the diagnostic performances of all three scanning areas of RTVue. Lower VFI values were signficiantly associated with larger areas under ROC curve (AUC; P<0.05 for all analysis). For a VFI value of 99, indicating early damage, AUC for rim area, average RNFL thickness and ganglion cell complex-root mean square (GCC RMS) were 0.766, 0.916 and 0.760, respectively. For a VFI of 70, indicating severe damage, corresponding AUC were 0.818, 0.972 and 0.996, respectively. Sensitivities at fixed specificity of 95% showed that average RNFL thickness had a better sensitivity to detect glaucoma in early stages whereas GCC RMS had a better sensitivity in later stages (Figure).
Diagnostic accuracy of the RTVue scanning protocols for glaucoma is significantly influenced at different degrees by disease severity. RNFL measurements are more sensitive to detect glaucoma in early stages, whereas macular measurements seem to be more sensitive in later stages.
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