Comparison of Stratus OCT and GDx VCC in Detecting Localized Retinal Nerve Fiber Layer Defects

Young Cheol Yoo; Ki Ho Park

doi:10.3341/jkos.2008.49.6.942

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Yoo and Park: Comparison of Stratus OCT and GDx VCC in Detecting Localized Retinal Nerve Fiber Layer Defects

Original Article

J Korean Ophthalmol Soc 2008;49(6):942-950.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.942

Comparison of Stratus OCT and GDx VCC in Detecting Localized Retinal Nerve Fiber Layer Defects

Young Cheol Yoo, M.D.¹, Ki Ho Park, M.D.^2,

¹Department of Ophthalmology, Hallym University College of Medicine, Gangdong Sacred Heart Hospital Seoul, Korea

²Department of Ophthalmology, Seoul National University College of Medicine Seoul, Korea

Address reprint requests to Ki Ho Park, M.D. Department of Ophthalmology, Seoul National University College of Medicine #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: kihopark@snu.ac.kr

25 March 2008 Accepted 29 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the abilities of optical coherence tomography (Stratus OCT) and scanning laser polarimetry with variable corneal compensation (GDx VCC) in detecting localized retinal nerve fiber layer (RNFL) defects of red‐ free photography

Methods

Thirty six normal subject and 50 patients with localized RNFL defects were included in this study. Only one eye per subject was considered. The peripapillary RNFL was divided into 12 clock-hour sectors and localized RNFL defects were evaluated in these 12 sectors. To compare the diagnostic performance of Stratus OCT and GDx VCC based on the findings of red-free photography, we calculated the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of each analyzer using a criterion of 1≥ clock hours abnormal at the <5% level.

Results

The sensitivity (78.6%), specificity (94.4%), and AUC (0.872) of Stratus OCT were not significantly different from those of GDx VCC (83.3%, 94.4%, and 0.882, respectively) (McNemar test, p=0.75, 1.00, and 0.82, respectively). However, the sensitivity (64.0%) of Stratus OCT for superior RNFL defect was significantly lower than that (84.8%) for inferior defect (Fisher’s exact test, p=0.02).

Conclusions

The sensitivity of the sector average of Stratus OCT and the deviation map of GDx VCC were fair in discriminating localized RNFL defects, and the specificity of those were excellent. In addition, the diagnostic performance was not significantly different between two analyzers.

Keywords: Area under the receiver operating characteristic curve, Optical coherence tomography, Scanning laser polarimetry, Sensitivity, Specificity

References

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Figure 1.

Method to identify a localized retinal nerve fiber layer (RNFL) defect by the Stratus OCT optical coherence tomography and GDx VCC scanning laser polarimetry with variable corneal compensation. (A) Red-free RNFL photograph of right eye of a 69 year-old male patient. The peripapillary RNFL was divided into 12 clock-hour sectors like a sector average analysis of Stratus OCT. There is a wedge-shaped RNFL defect at the inferotemporal region (white arrows). (B) Sector average analysis of Stratus OCT of the same eye. There are all 12 sectors and 2 abnormal sectors at 6 and 7 clock-hour (red arrows), which are correlated with the finding of red-free photograph. (C) Deviation map analysis of GDx VCC of the same eye. The peripapillary RNFL was artificially divided into 12 sectors like the sector average analysis of Stratus OCT. There are a few color-coded squares abnormal at p<0.05 (white arrows), which are correlated with the finding of red-free photograph.

Figure 2.

Ven diagrams showing the number of eyes discriminated into having a localized retinal nerve fiber layer (RNFL) defect by Stratus OCT or GDx VCC among the eyes with a superior RNFL defect (A), among the eyes with an inferior RNFL defect (B), and among the eyes with a RNFL defect in either superior or inferior RNFL region (C).

Table 1.

Demographics and clinical characteristics of study group

	RNFL defect group (n=50)	Healthy control group (n=36)	P-value
Age, year (mean±SD)	54.54±12.75	52.53±14.90	0.50^*
Sex, no (men:women)	26:24	14:22	0.33^†
BCVA (mean±SD)	0.83±0.14	0.89±0.11	0.09^*
SE, diopter (mean±SD)	‐1.98±2.91	‐1.36±2.44	0.41^*
IOP, mmHg (mean±SD)	17.57±3.92	13.99±2.98	<0.01^*
Vertical C/D ratio (mean±SD)	0.67±0.19	0.43±0.13	<0.01^*
DM:DD ratio	2.52±0.27	2.57±0.24	0.45^*
MD, dB (mean±SD)	‐3.93±3.57	‐0.66±1.12	<0.01^*
PSD, dB (mean±SD)	6.29±4.41	1.29±0.31	<0.01^*

RNFL=retinal nerve fiber layer; SD=standard deviation; BCVA=best corrected visual acuity; SE=spherical equivalent; IOP=intraocular pressure; C/D=cup to disc; DM:DD ratio=disc-to-macula distance to vertical disc diameter ratio; MD=mean deviation; PSD=pattern standard deviation;

^* Independent t-test

^† Chi-square test.

Table 2.

Quantitatively measured peripapillary retinal nerve fiber layer thickness of study group

	RNFL defect group (n=50)	Healthy control group (n=36)	P-value^*
Superior RNFL thickness
Stratus OCT	107.28±17.72	134.25±12.74	<0.01
GDx VCC	59.82±9.79	70.64±8.06	<0.01
Inferior RNFL thickness
Stratus OCT	99.58±24.36	135.11±16.04	<0.01
GDx VCC	53.91±10.22	66.73±8.09	<0.01
Average RNFL thickness
Stratus OCT	85.16±15.54	108.12±9.94	<0.01
GDx VCC	49.09±8.49	57.34±5.82	<0.01

RNFL=retinal nerve fiber layer; OCT=optical coherence tomography; GDx VCC=scanning laser polarimetry with variable corneal compensation;

^* Independent t-test.

Table 3.

Diagnostic performance of Stratus OCT and GDx VCC for localized retinal nerve fiber layer defect

	Stratus OCT	GDx VCC	P-value
Superior RNFL Defect (n=25)
Sensitivity (95% CI)	64.0% (44.5‐79.8%)	72.0% (52.4‐85.7%)	0.75^*
Specificity (95% CI)	96.7% (88.8‐99.1%)	100.0% (94.1‐100.0%)	0.50^*
AUC (95% CI)	0.804 (0.704‐0.881)	0.860 (0.768‐0.925)	0.45^†
Inferior RNFL Defect (n=33)
Sensitivity (95% CI)	84.8% (69.1‐93.3%)	81.8% (65.6‐91.4%)	1.00^*
Specificity (95% CI)	96.2% (87.2‐99.0%)	94.3% (84.6‐98.1%)	1.00^*
AUC (95% CI)	0.905 (0.823‐0.958)	0.881 (0.793‐0.941)	0.64^†
Overall RNFL Defect (n=42)
Sensitivity (95% CI)	78.6% (64.1‐88.3%)	83.3% (69.4‐91.7%)	0.75^*
Specificity (95% CI)	94.4% (81.9‐98.5%)	94.4% (81.9‐98.5%)	1.00^*
AUC (95% CI)	0.872 (0.783‐0.934)	0.882 (0.795‐0.942)	0.84^†

OCT=optical coherence tomography; GDx VCC=scanning laser polarimetry with variable corneal compensation; RNFL=retinal nerve fiber layer; CI=confidence interval; AUC=area under receiver operating characteristic curve

^* McNemar test

^† Pairwise comparison.

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