July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Structure-Function Agreement in Glaucomatous Eyes Is Better Than Commonly Thought if a Topographical Method is Employed.
Author Affiliations & Notes
  • Donald C Hood
    Psychology and Ophthalmology, Columbia University, New York, New York, United States
  • Emmanouil (Manos) Tsamis
    Psychology, Columbia University, New York, New York, United States
  • Nikhil Bommakanti
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • Devon Joiner
    Psychology, Columbia University, New York, New York, United States
  • Lama Al-Aswad
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • Dana Blumberg
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • George Cioffi
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • Jeffrey M Liebmann
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • C Gustavo De Moraes
    Ophthalmology, Columbia Universiy, New York, New York, United States
  • Footnotes
    Commercial Relationships   Donald Hood, Heidelberg Eng, Inc (F), Heidelberg Eng, Inc (C), Heidelberg Eng, Inc (R), Novartis (F), Novartis (C), Novartis (R), Topcon, Inc (F), Topcon, Inc (C), Topcon, Inc (R); Emmanouil (Manos) Tsamis, None; Nikhil Bommakanti, None; Devon Joiner, None; Lama Al-Aswad, None; Dana Blumberg, None; George Cioffi, None; Jeffrey Liebmann, Carl Zeiss (C), Heidelberg Eng, Inc (C), Heidelberg Eng, Inc (S), Topcon, Inc (C); C Gustavo De Moraes, Carl Zeiss (F), Heidelberg Eng, Inc (F), Topcon, Inc (F)
  • Footnotes
    Support  NIH Grant EY02115
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1782. doi:https://doi.org/
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      Donald C Hood, Emmanouil (Manos) Tsamis, Nikhil Bommakanti, Devon Joiner, Lama Al-Aswad, Dana Blumberg, George Cioffi, Jeffrey M Liebmann, C Gustavo De Moraes; Structure-Function Agreement in Glaucomatous Eyes Is Better Than Commonly Thought if a Topographical Method is Employed.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1782. doi: https://doi.org/.

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

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Abstract

Purpose : To test the hypothesis that the agreement between structural (OCT) and functional (visual field) damage is improved by topographically comparing deviation/probability maps,1 an objective, automated, topographical method was compared to more traditional measures of agreement.

Methods : Wide-field, swept-source OCT scans (Topcon, Inc), which included the disc and macular regions, and 24-2 and 10-2 visual fields (VF) were obtained from 45 healthy control eyes/individuals with normal fundus exams and IOP <22 mmHg, and 53 eyes/patients with 24-2 MD better than -6dB. The referring glaucoma specialist diagnosed these 53 eyes as “definite glaucoma”, based upon all information for that eye. All individuals had a spherical refractive error between ±6D. In addition to standard metrics of the VF (MD, PSD, GHT) and OCT (global, quadrant and clock hour RNFL thickness), the topographical (T) agreement between the 24-2 and 10-2 VF total deviation probability maps and OCT deviation/probability maps was assessed. To obtain an objective, automated assessment of the latter, a custom program was developed in R. The following criteria defined agreement: 2 abnormal points on the combined 24-2 and 10-2 probability map at ≤5% that fell upon a region ≤10% on the RGC+IPL or RNFL probability maps.

Results : For the T-method, only 7 (13.2%) of the 53 eyes with early glaucoma failed to show agreement (“misses”), while 2 (4.4%) of the 45 healthy eyes showed agreement. Both of the latter were easily identified as mistakes, as the abnormal region of the VF did not replicate. Without the 10-2, the misses for the T-method increased to 18 (34.0%) eyes. The best VF standard metrics (i.e., 24-2 GHT or PSD, or 10-2 PSD) combined with best OCT (quadrants) had 16 (30.2%) misses, while omitting the 10-2 VF resulted in 20 (37.7%) misses.

Conclusions : First, agreement between structural and functional damage can be improved by obtaining 10-2, as well as 24-2, VFs and comparing abnormal locations on the VFs to abnormal RGC andRNFL OCT regions. In this way, the addition of a 10-2 test adds significant, clinically-useful information about early glaucoma. Second, an objective, automated approach provides a novel way of providing structure-function corroboration of damage and serves as the underpinning for future artificial intelligence applications. 1. Hood DC, De Moraes CG. (2018) J. of Glaucoma. 27:657.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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