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SeokHwan Kim, Ko Eun Kim, Sohee Oh, Jin Wook Jeoung, Min Hee Suh, Martha Kim, Ki Ho Park, Dong Myung Kim; Spectral-domain optical coherence tomography in glaucoma: its additive role in structural diagnosis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):855.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the additive role of spectral-domain optical coherence tomography (SD-OCT) in the structural diagnosis in glaucoma.
One hundred and nine eyes of 109 healthy individuals and 151 eyes of 151 glaucoma patients with different severities (52 early, 50 moderate, and 49 advanced) were included. Four structural-diagnostic examination sets were prepared based on stereo optic disc photography (SDP), red-free retinal nerve fiber layer photography (RNFLP), and SD-OCT: (1) SDP (S), (2) SDP and SD-OCT (SO), (3) SDP and RNFLP (SR), and (4) SDP, RNFLP, and SD-OCT (SRO). Five glaucoma specialists were instructed to classify subjects as normal or glaucoma using each of the 4 diagnostic sets in the order S, SO, SR, and SRO, with a 1-month interval between the evaluations. The interobserver agreement was evaluated using Kappa (κ) statistics. The overall collective diagnostic performance of the 5 glaucoma specialists according to the 4 combination sets and the different glaucoma severity was compared using the generalized estimating equation.
The five glaucoma specialists showed an excellent level of interobserver agreement on the diagnostic assessments based on the 4 sets. In the case of each glaucoma specialist, the diagnostic performance increased with the addition of SD-OCT to SDP, though there were individual differences in significance. In the comparison of the collective diagnostic performance of the specialists, addition of SD-OCT to SDP showed an approximately 2-fold significant increase in the diagnostic accuracy. The diagnostic performance also increased with the increasing number of structural examinations, SRO showing the best performance, about 7-fold higher than that of S-only. Adding SD-OCT to SDP significantly enhanced the specialists’ structural-diagnostic ability with respect to the moderate stage of glaucoma, though not mild or advanced glaucoma.
SD-OCT significantly enhanced the diagnostic accuracy of the glaucoma specialists' performance, showing its additive diagnostic value in judging glaucomatous structural damage. Disease severity should be taken into consideration when employing SD-OCT as an additional structural examination in clinical practice.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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