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).
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.
![jkos-49-942f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-942f1.gif)
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).
![jkos-49-942f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-49-942f2.gif)
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* |
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 |
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† |