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Abstract
Purpose
To assess the agreement and compare the performance of glaucoma diagnosis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements between two different spectraldomain optical coherence tomography (SD-OCT) devices.
Methods
Eighty nine eyes of 56 patients with glaucoma and 42 eyes of 25 healthy individuals were imaged with Cirrus and Spectralis OCT in a single visit. Agreement between RNFL thickness measurements was assessed using intraclass coefficient (ICC) and Bland-Altman plots. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC) for quadrants and average RNFL thickness.
Results
ICC values for agreement between both instruments were good for quadrants and average RNFL thickness (all ≥ 0.81). However, Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant (difference = 4.27 µm in normal group, 3.91 µm in glaucoma group, p < 0.001 for both). The RNFL thickness parameter with the largest AUCs was the average RNFL thickness for the Spectralis OCT and the Cirrus OCT (0.85 vs. 0.87, p = 0.30). The pairwise comparison among the receiver operating characteristic curves showed no statistical difference for all parameters.
Conclusions
Although Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant, agreement of RNFL measurement between both the devices was generally good and there was no statistically significant difference in the performance of glaucoma diagnosis between both instruments.
References
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Figure 1.
Bland-Altman plots of agreement between Spectralis and Cirrus optical coherence tomography in normal eyes. These plots are generated by plotting the difference between the measurements against the average of the measurements. The solid line represents the trend line and the dashed lines represent the mean bias and the 95% limits of agreement. (A) Inferior, (B) superior, (C) nasal, (D) temporal quadrant, and (E) average retinal nerve fiber layer thickness. SD = standard deviation.
Figure 2.
Bland-Altman plots of agreement between Spectralis and Cirrus optical coherence tomography in patients with open-angle glaucoma. (A) Inferior, (B) superior, (C) nasal, (D) temporal quadrant, and (E) average retinal nerve fiber layer thickness. SD = standard deviation.
Figure 3.
The receiver operating characteristic curve of average, inferior and superior quadrant parapapillary retinal nerve fiber layer thickness for discrimination between normal and glaucomatous eyes. Sensitivities and specificities were described as percentage (%).
Table 1.
Demographic and clinical characteristics of the patients enrolled in the study
| Normal | Glaucoma | p-value | |
|---|---|---|---|
| No. of eyes (patients) | 42 (25) | 89 (56) | |
| Age (years) | 42.1 ± 16.7 | 56.8 ± 15.1 | 0.128* |
| Sex (male/female) | 25/17 | 45/44 | 0.074† |
| Mean deviation (dB) | –1.2 ± 1.5 | –7.8 ± 5.7 | <0.001‡ |
| Pattern standard deviation (dB) | 1.7 ± 0.4 | 7.2 ± 5.0 | 0.030‡ |
| Central corneal thickness (μ m) | 550.4 ± 24.9 | 547.8 ± 35.5 | 0.011‡ |
| Spherical equivalent (diopter) | –3.6 ± 3.9 | –2.1 ± 3.4 | 0.092‡ |
| Axial length (mm) | 24.8 ± 1.9 | 24.5 ± 1.7 | 0.150‡ |
| Torsion degree (o) | –2.5 ± 13.4 | –3.1 ± 15.1 | 0.634‡ |
| Tilt index | 1.2 ± 0.1 | 1.2 ± 0.1 | 0.850‡ |
Table 2.
Comparison of retinal nerve fiber layer thickness measured with Cirrus and Spectralis optical coherence tomography
| Normal | Glaucoma | |||||
|---|---|---|---|---|---|---|
| Cirrus | Spectralis | p-value* | Cirrus | Spectralis | p-value* | |
| Inferior (μ m) | 111.7 ± 21.0 | 112.7 ± 22.8 | 0.520 | 83.4 ± 25.1 | 83.2 ± 28.1 | 0.818 |
| Superior (μ m) | 113.4 ± 20.2 | 114.5 ± 20.7 | 0.265 | 85.4 ± 21.2 | 85.3 ± 24.4 | 0.982 |
| Nasal (μ m) | 62.5 ± 10.7 | 61.4 ± 13.7 | 0.346 | 59.8 ± 10.8 | 59.6 ± 12.4 | 0.790 |
| Temporal (μ m) | 71.5 ± 15.4 | 75.8 ± 14.8 | <0.001 | 60.5 ± 15.0 | 64.4 ± 16.4 | <0.001 |
| Average (μ m) | 91.2 ± 12.4 | 91.7 ± 12.7 | 0.245 | 72.3 ± 12.9 | 72.4 ± 14.6 | 0.887 |
Table 3.
Intraclass correlation coefficient of retina nerve fiber layer thickness measurement with Cirrus and Spectralis optical coherence tomography
Table 4.
The area under receiver operator characteristics curve (AUC) and confidence interval (CI) of retinal nerve fiber layer thickness in average and 4 quadrants for discrimination of glaucoma from normal eyes
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