Abstract
Purpose :
To test an approach for screening glaucomatous damage based only on OCT.
Methods :
Wide-field scans (Maestro, Topcon, Inc.) were obtained from 100 eyes (51 patients; 24-2 MD: -4.79±5.98dB) from the clinics of an optometry school. Two graders, experienced with the Columbia University (CU) OCT-based method,[1,2] categorized each eye as optic neuropathy consistent with glaucoma (ON-G), not optic neuropathy-glaucoma (NG), or OCT-suspect (S) based upon the Hood report (Fig. 1A).[3] After viewing the horizontal b-scan through the fovea (Fig. 1B), they also commented on the presence of Other Pathologies, and the quality of the scans. Two patients with scans that were judged as “Poor Scan – Unable to judge” on both eyes by both graders were excluded. Disagreements among graders were adjudicated with the OCT information from the other eye included. The per eye gradings were converted to patient referral labels (Table 1). The labels for each patient were compared to the clinical diagnosis made by a glaucoma expert based upon all available OCT, VF, and fundus photo information.
Results :
The agreement between the two graders was excellent. There were no extreme disagreements, (i.e., NG by one grader and ON-G by the other), and only 8 eyes required adjudication. In 45 of the 49 patients, the clinical diagnosis matched the OCT referral decision; 33 of those 45 decisions were to refer (R). In the 4 cases of disagreement, the OCT decision was R, while the clinical diagnosis was not to refer. However, these 4 included clinical diagnoses consistent with a suspect: an arcuate defect judged as congenital hypoplasia (1 eye); progressive degenerative myopia (1 eye); and a suspect with a lack of visual field progression (2 eyes). In addition, based upon the foveal b-scan, outer retinal disease was identified in one eye, while the addition of the OCT from the other eye helped improve OCT grader agreement, as well as identify a patient with a cortical stroke.
Conclusions :
An approach based upon the CU OCT-based method can be used for screening of glaucomatous damage with OCT scans obtained in a clinic. The addition of a horizontal b-scan can aid with the identification of comorbidities, and the simultaneous comparison between a patient’s eyes can also improve the performance of the OCT-only approach. 1. Liebmann et al. JoG, 2022; 2. Hood et al. PRER, 2022; 3. Hood & Raza BJO, 2014.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.