June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Optical coherence tomography summary metrics perform poorly for assessing progression in early glaucoma
Author Affiliations & Notes
  • Melvi Del Valle Eguia
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Zane Zemborain
    Psychology, Columbia University, New York, New York, United States
  • Emmanouil Tsamis
    Psychology, Columbia University, New York, New York, United States
  • Ashley Sun
    Psychology, Columbia University, New York, New York, United States
  • Joseph Percival
    Psychology, Columbia University, New York, New York, United States
  • Hamin Kim
    Psychology, Columbia University, New York, New York, United States
  • C Gustavo De Moraes
    Ophthalmology, Columbia University, New York, New York, United States
  • Robert Ritch
    Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Donald C Hood
    Psychology, Columbia University, New York, New York, United States
    Ophthalmology, Columbia University, New York, New York, United States
  • Footnotes
    Commercial Relationships   Melvi Eguia, None; Zane Zemborain, None; Emmanouil Tsamis, Topcon (R); Ashley Sun, None; Joseph Percival, None; Hamin Kim, None; C Gustavo De Moraes, Belite (C), Carl Zeiss (C), Galimedix (C), Heidelberg (R), National Institute of Health (R), Novartis (C), Perfuse Therapeutics (C), Reichert (C), Research to Prevent Blindness (R), Topcon (R); Robert Ritch, None; Donald Hood, Heidelberg (R), Heidelberg (F), Heidelberg (C), Novartis (C), Novartis (F), Novartis (R), Topcon (F), Topcon (R), Topcon (C)
  • Footnotes
    Support  EY-025253, EY-02115
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3931. doi:
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      Melvi Del Valle Eguia, Zane Zemborain, Emmanouil Tsamis, Ashley Sun, Joseph Percival, Hamin Kim, C Gustavo De Moraes, Robert Ritch, Donald C Hood; Optical coherence tomography summary metrics perform poorly for assessing progression in early glaucoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3931.

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

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Abstract

Purpose : To evaluate methods, based on summary metrics, for assessing progression in glaucoma suspects and early glaucoma (24-2 visual field, mean deviation better than -6 dB) using optical coherence tomography (OCT) scans.

Methods : Spectral-domain OCT circle (3.5mm) scans of the disc from 89 eyes with an average of 3.28 [range 2-5] scans within 6 months formed a variability (V) group; 47 eyes were early glaucoma or suspects and 42 were healthy controls. 159 eyes from 100 patients (early glaucoma or suspects) with 2 OCT circle scans, 1.7±0.55 yrs. apart, formed the long-term group. All scans were taken with Heidelberg GPME, which acquires follow-up circle scans based on the baseline. Circumpapillary retinal nerve fiber layer (cRNFL) thickness measures were obtained for global (G), temporal (T), temporal inferior (TI) and superior (TS) regions. Quantile regression was applied on all metrics of the V group, with the independent variable being the baseline values and dependent variable all follow-up values. The 95% and 5% confidence limits (CI) of each metric defined “statistical progressors” and “statistical improvers” of the long-term group. For the reference standard (RS), 4 experts identified progressors by evaluating all OCT and 10-2 and 24-2 VF information, including OCT reports with probability maps (Fig).

Results : The G and TI metrics showed the highest number of “statistical progressors”, 53 (33%) and 55 (34%) (Table). Based upon the RS, 56 eyes were defined as progressors. The 4 metrics missed many of these 56 statistical progressors; false negative (FN) rates of 37.5% to 58.5%. And, based upon the RS, 103 eyes were defined as non-progressors. All 4 metrics, identified over 20% of these 103 eyes as progressors, false positive (FP) rates of 19.4% to 22.3%.

Conclusions : Summary metrics of the cRNFL are not adequate for detecting progression in eyes with early glaucoma. These metrics resulted in FPs based on a clinically relevant RS, and also miss eyes that are clearly progressing on probability maps (Fig, lower panel). Factors contributing to FN and FP included subtle local thinning, segmentation errors and other pathologies (schisis, ERMs).

This is a 2020 ARVO Annual Meeting abstract.

 

Fig. The gray line on the thickness map (red arrow) corresponds to the baseline test.

Fig. The gray line on the thickness map (red arrow) corresponds to the baseline test.

 

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