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S. F. Sandler, N. M. Radcliffe, K. Y. Kay, C. Tello, R. Ritch, D. C. Hood, J. M. Liebmann; Detection of Retinal Nerve Fiber Layer Defects by Optic Nerve Photography, Confocal Laser Polarimetry and Fourier-domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4646.
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© ARVO (1962-2015); The Authors (2016-present)
To compare Fourier-domain optical coherence tomography (FDOCT), optic nerve photography and confocal laser polarimetry (GDx-VCC) for the detection of retinal nerve fiber layer (RNFL) injury in glaucomatous and normal eyes.
Consecutive patients undergoing FDOCT (Topcon 3D-1000, Topcon, Inc., Paramus, NJ), GDx-VCC (Carl Zeiss Meditec, Inc., Dublin, CA), optic nerve photography, and perimetry were enrolled. Glaucomatous eyes had an achromatic visual field defect consistent with glaucoma (SITA-SAP 24-2, Carl Zeiss Meditec, Inc., Dublin, CA). Normal subjects had no history of glaucoma and a normal SITA-SAP examination. Disc photographs and FDOCT thickness maps were visually inspected by 2 observers, masked to the appearance of the optic disc and visual field, and the superior and inferior parapapillary RNFL classified as normal or abnormal. A GDx defect was defined as a Nerve Fiber Index (NFI) greater than 30 and/or an arcuate cluster of superpixels (p<0.5%).
12 normal eyes (7 patients) and 29 glaucomatous eyes (21 patients) were evaluated. Mean deviation (-7.68 ± 6.73 dB vs. 0.23 ± 1.04 dB, p < 0.001, t-test) and pattern standard deviation (7.34 ± 4.33 dB vs. 1.35 ± 0.23 dB, p < 0.001) were greater in glaucomatous eyes. Sensitivity and specificity data can be found in the table. For eyes with visual field loss >5 dB, sensitivity was 100% for GDx and FDOCT and 60% for disc photography. Disagreements among observers were more common in review of optic nerve photographs (10/41 eyes, kappa=0.49) than GDx (4/41, kappa=0.81) or FDOCT (1/41, kappa=0.95).
Visual inspection of FDOCT images showed a greater sensitivity in detecting RNFL defects than did a review of optic nerve photography.
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