July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Comparison of the glaucoma diagnostic performance of individualized and of age corrected normal limits of retinal nerve fiber layer thickness values as measured with optical coherence tomography.
Author Affiliations & Notes
  • Clemens Vass
    Dept of Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Florian Schwarzhans
    CEMSIIS, Medical University of Vienna, Vienna, Austria
  • Hemma Resch
    Dept of Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Ivania Pereira
    CEMSIIS, Medical University of Vienna, Vienna, Austria
  • Philipp Fuchs
    Dept of Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Georg Fischer
    CEMSIIS, Medical University of Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships   Clemens Vass, Carl Zeiss Meditec (F), Carl Zeiss Meditec (R); Florian Schwarzhans, None; Hemma Resch, None; Ivania Pereira, Carl Zeiss Meditec (F); Philipp Fuchs, None; Georg Fischer, None
  • Footnotes
    Support  Supported by Grant of Wiener Wissenschafts-, Forschungs- and Technologiefonds, WWTF – LS11-046.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2123. doi:
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      Clemens Vass, Florian Schwarzhans, Hemma Resch, Ivania Pereira, Philipp Fuchs, Georg Fischer; Comparison of the glaucoma diagnostic performance of individualized and of age corrected normal limits of retinal nerve fiber layer thickness values as measured with optical coherence tomography.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2123.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To use our published multivariate model of retinal nerve fiber layer (RNFL) variation to generate patient specific individualized expected values (EV) of the RNFL thickness, and to investigate whether normalized individual deviations from the EV (DoEV) of RNFL thickness improve the discrimination between healthy and glaucomatous subjects.

Methods : This prospective study compares 69 cases of early to moderate glaucoma with existing data of 202 healthy subjects. All subjects underwent optical coherence tomography (OCT) (Cirrus®, Carl Zeiss Meditec) in macula and circumpapillary areas. The 2D projection images were used to determine retinal vessel density (RVD) at a 3.4mm diameter circle, as published. The regression model was recalculated using 281 healthy subjects of the Cirrus normative database (CND) considering 8 factors: RVD, fovea distance and angle, optic disk (OD) size, ratio and angle and refractive error. The EVs were calculated twice: 1) age corrected EV (AEV) based on CND using intercept and slope of age; 2) individual EV (IEV), using intercept and slopes of our multivariate model. The DoEV for the AEV and the IEV were calculated for 12 sectors and normalized by dividing through the standard deviations (nDoEV). The minimum nDoEV for the 12 sectors was determined for each subject using the AEV and the IEV. The diagnostic value of the minimum nDoEV of AEV and the IEV was analyzed using AROC. Sensitivities at fixed specificities were compared between methods with McNemar test.

Results : For the minimum nDoEV of AEV and IEV the AROCs were 0.855 (0.796-0.914) and 0.893 (0.840-0.946). Although this was not significantly different (Fig. 1), there was an improved sensitivity at high specificities for nDoEV of IEV compared to the AEV (Tab. 1).

Conclusions : Application of patient specific IEV improved sensitivity at high specificity level above 95% compared to standard AEV.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Comparison between IEV with AEV of sensitivities at fixed specificities (McNemar tests)

Comparison between IEV with AEV of sensitivities at fixed specificities (McNemar tests)

 

AROC for the minimum nDoEV of AEV (blue line) compared to the IEV (green line).

AROC for the minimum nDoEV of AEV (blue line) compared to the IEV (green line).

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