Purchase this article with an account.
Donald C Hood, Eleanor Kim, Ashley Sun, Dana Blumberg, Jeffrey M Liebmann, Robert Ritch, C Gustavo De Moraes; Combining Structural (Visual Field) and Functional (OCT) Information to Confirm Early Glaucoma: A Topographical Method is Better Than Metrics.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4987.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare conventional metrics to a topographical method for combining optical coherence tomography (OCT) and visual field (VF) information in order to confirm early glaucoma.
Widefield OCT scans and 24-2 and 10-2 VFs were obtained on 101 eyes of 101 patients with, or suspected, early open-angle glaucoma; eyes had 24-2 mean deviation better than -6dB. Two glaucoma specialists independently judged 44 eyes as “healthy” (H eyes) and 57 as “glaucomatous” (G eyes), based upon disc photos, 10-2 and 24-2 VF, OCT, max IOP, family history, refractive error and corneal thickness. The best conventional VF metric for classifying eyes as abnormal was an abnormal 24-2 (GHT or PSD) and/or an abnormal 10-2 (PSD); the best conventional OCT metric was circumpapillary layer RNFL quadrant thickness. For the metric (M) method, eyes were considered abnormal if one of these VF metrics and the OCT were abnormal. For the topographical (T) method, eyes were considered abnormal if 3 or more 10-2 or 24-2 points at ≤5%, or 2 at 1%, fell within regions of abnormality (red, ≤1%) on RGC+ and/or RNFL probability maps. In Fig. 1 (left panels), the regions abnormal on the 10-2 (within black borders) and 24-2 (red borders) are shown on OCT probability maps (right panels) with the symbols indicating the abnormal 10-2 (squares) and 24-2 (circles) locations falling within abnormal OCT abnormal (red) regions.
For the M method, there were 15 (26.3%) misses (i.e., 15 of the 57 G eyes were classified as normal). For the T method, there were only 3 (5.3%) misses, and 2 of these showed qualitative agreement (e.g., Fig. 2A). The methods falsely classified 1 (T) and M (0) of the 44 H eyes as abnormal. Fig. 2B shows results for an H eye with 24-2 PSD/GHT, 10-2 PSD and OCT (quadrant) all within normal limits, but with abnormal 10-2 VF locations topographically agreeing with RGC+ regions (open squares). Note: the 24-2 (10-2) metric by itself missed 13 (13) of the 57 G eyes; the associated T methods missed 13 (7).
There is excellent agreement between VF and OCT measures of early glaucoma as long as a topographical method, not conventional metrics, is employed and both 24-2 and 10-2 VF abnormalities are considered. 1. Hood et al., TVST (2016); 2. Muhamad et al., J Glau (2017).
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only