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R.R. Bourne, C. Bowd, R.N. Weinreb, P. Amini, K. Jahanbakhsh, E.M. Hoffmann, F.A. Medeiros, L.M. Zangwill; Agreement Between Structural Measures of Glaucoma Progression Using Heidelberg Retina Tomograph Topographic Change Analysis and Stereoscopic Optic Disc Photography in the Diagnostic Innovations in Glaucoma Study (DIGS) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2475.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To investigate agreement for glaucoma progression using Heidelberg Retina Tomograph Topographic Change Analysis (HRT–TCA) and stereoscopic optic disc photography. Methods: 131 subjects with ≥4 years of follow–up with good quality 15o HRT images were selected. Subjects who had undergone a trabeculectomy were excluded. A randomly selected eye of each subject was chosen. Using the HRT–TCA, eyes with a cluster of ≥20 superpixels of topographic change compared with baseline in 3 consecutive sets of follow–up images were considered to have confirmed progression. The location of these changes was recorded. Stereoscopic optic disc photographs were assessed for glaucomatous optic neuropathy (GON) by 2 observers in masked fashion, at baseline and for glaucomatous progression, with consensus achieved by an adjudicator in cases of disagreement. Results:Mean age of subjects at baseline was 59.8 (+/–11.2) years and average length of follow–up was 82 months (SD:24; Range:48 to 136), with an average of 6 HRT images per patient. Photographic evidence of progression was observed in 10 (7.6%) eyes, and in 42 (32.1%) eyes by HRT–TCA (change within the disc margin (WDM); agreement (kappa, k= 0.08)). 67 (51.1%) of the subjects had GON at baseline. Of these, 8 (11.9%) progressed on photographs and 21 (31.3%) progressed by HRT–TCA (WDM; k=0.12). Of the 64 subjects (48.8%) with no GON at baseline, 2 (3.1%) progressed on photographs, and 21(32.8%) by HRT–TCA (WDM; k=0.03). Among all subjects, HRT–TCA changes inside the disc margin had a sensitivity of 50.0% (95% CI, 20.1–79.9) and specificity of 69.4% (60.3–77.3) for detecting stereophotographic progression. If changes outside but contiguous with the disc margin were also included, the sensitivity and specificity was 50.0% and 59.5% (50.2–68.2), respectively (k=0.03).Of those that did show photographic progression, there were no significant differences between those detected and missed by HRT–TCA in terms of mean disc size, neuroretinal rim area or cup/disc ratio. Conclusions:Using recommended measures of progression with the HRT–TCA, the specificity for detection of photographic progression was relatively high but sensitivity was low. While ‘false positives’ with the HRT–TCA may indicate areas of unrecognized photographic change, the sensitivity is disappointingly low. Modifications to the HRT–TCA may be needed to improve sensitivity for detection of GON progression.
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