False Negative Findings of Optical Coherence Tomography in Eyes with Localized Nerve Fiber Layer Defects

Sung Min Kang; Ki Bang Uhm

doi:10.3341/JKOS.2011.52.4.454

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Kang and Uhm: False Negative Findings of Optical Coherence Tomography in Eyes with Localized Nerve Fiber Layer Defects

Original Article

J Korean Ophthalmol Soc 2011;52(4):454-461.

Published online: 6 September 2011

DOI: https://doi.org/10.3341/JKOS.2011.52.4.454

False Negative Findings of Optical Coherence Tomography in Eyes with Localized Nerve Fiber Layer Defects

Sung Min Kang, M.D., Ki Bang Uhm, MD, PhD

Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea

Address reprint requests to Ki Bang Uhm, MD, PhD Department of Ophthalmology, Hanyang University Seoul Hospital #17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea Tel: 82-2-2290-8570, Fax: 82-2-2291-8517, E-mail: KBUhm@hanyang.ac.kr

Received 27 September 20109 November 2010 Accepted 15 February 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify the risk factors associated with false negative findings of optical coherence tomography (Stratus OCT) in patients with photographic localized retinal nerve fiber layer (RNFL) defects.

Methods

Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects were included in the present study. The patients were divided into 2 groups according to the presence or absence of detection of photographic defects by OCT. Gender, age, refractive error, diabetes, hypertension, central corneal thickness, type of glaucoma, mean deviation, pattern standard deviation, average RNFL thickness, disc area, and photographic RNFL defect related variables (location, number, and angular width) were compared between the 2 groups. Each variable was initially evaluated by univariate analysis and significant variables (p < 0.1) were included in the logistic regression analysis.

Results

Photographic RNFL defects were not detected by OCT in 51 (25.9%) of the 197 eyes. The angular locations and widths of RNFL defects by OCT were significantly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient R = 0.98 and 0.64, respectively). Logistic regression analysis revealed the risk factors for false negative findings of OCT included average RNFL thickness (odds ratio = 1.106, 95% confidence interval [CI] =1.057-1.156, p < 0.001) and angular width of defect (odds ratio = 0.929, 95% CI = 0.884-0.977, p = 0.004).

Conclusions

This present study suggests that false negative findings of OCT in patients with photographic localized RNFL defects were associated with thicker RNFL thickness and smaller angular width of RNFL defect.

Keywords: Glaucoma, Optical coherence tomography, Retinal nerve fiber layer defect, Risk factor

References

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Figure 1.

Example of false negative finding. Inferior localized retinal nerve fiber layer defect was observed on the red-free photograph, but optical coherence tomography result was normal at the corresponding location on the sector average analysis.

Figure 2.

The angular locations of localized retinal nerve fiber layer (RNFL) defects on red-free fundus photography were measured to evaluate the angular width and location of localized RNFL defects. Reference line was from the optic disc center to the temporal margin of the optic disc (0°). The angles between reference line and the line from the center of the disc to the points at which the upper and lower margins of the localized RNFL defect met with the optic disc margin were measured. The directional angle was assessed in a clockwise direction in right eyes and a counter-clockwise direction in left eyes.

Figure 3.

The number of eyes (total = 197) and retinal nerve fiber layer (RNFL) defects (total = 273) by location on red-free RNFL photographs.

Figure 4.

Frequency distribution of photographic retinal nerve fiber layer (RNFL) defects by clock-hour location on red-free RNFL photographs. Defects were most commonly observed at 7 o’clock and 11 o’clock.

Figure 5.

Scatterplot of the angular locations of the retinal nerve fiber layer (RNFL) defects detected by red-free RNFL photograph and those of RNFL defects detected by optical coherence tomography (OCT) (R = 0.980).

Figure 6.

Scatterplot of the angular widths of the retinal nerve fiber layer (RNFL) defects detected by red-free RNFL photograph and those of RNFL defects detected by optical coherence tomography (OCT) (R = 0.642).

Table 1.

Comparison between photographic retinal nerve fiber layer (RNFL) defects not detected by optical coherence tomography (OCT) group and detected by OCT group

Variable	Not detected by OCT	Detected by OCT	p-value
Variable	(n = 51)	(n = 146)	p-value
Gender			1.00^*
Male	29 (25.7%)	84 (74.3%)
Female	22 (26.2%)	62 (73.8%)
Age (mean ± SD, yr)	56.9 ± 12.3	56.5 ± 12.5	0.84^†
Spherical equivalent (mean ± SD, diopter)	-0.83 ± 2.09	-0.87 ± 2.65	0.91^†
Hypertension			0.08^*
Yes	21 (34.4%)	40 (65.6%)
No	30 (22.1%)	106 (77.9%)
Diabetes			0.22^*
Yes	13 (34.2%)	25 (65.8%)
No	38 (23.9%)	121 (76.1%)
Central corneal thickness (mean ± SD, μ m)	532.6 ± 35.0	538.6 ± 35.0	0.30^†
Type of glaucoma			<0.001^*
Preperimetric	17 (70.8%)	7 (29.2%)
Perimetric	34 (19.7%)	139 (80.3%)
SAP mean deviation (mean ± SD, dB)	-3.71 ± 2.93	-7.95 ± 6.46	<0.001^†
SAP pattern standard deviation (mean ± SD, dB)	3.66 ± 2.85	7.08 ± 4.13	<0.001^†
Photographic RNFL defect
Location			0.01^*
Inferior hemiretina	21 (26.9%)	57 (73.1%)
Superior hemiretina	19 (40.4%)	28 (59.6%)
Both hemiretina	11 (15.3%)	61 (84.7%)
Number (mean ± SD)	1.25 ± 0.48	1.43 ± 0.51	0.02^‡
Sum of angular width (mean ± SD, degrees)^§	18.9 ± 11.1	42.3 ± 23.2	<0.001^†
OCT average RNFL thickness (mean ± SD, μ m)	95.7 ± 10.7	74.9 ± 15.9	<0.001^†
HRT disc area (mean ± SD, mm²)	2.09 ± 0.40	2.25 ± 0.54	0.05^†

Data are expressed as mean ± standard deviation.

^* By Chi-square test;

^† By unpaired t-test;

^‡ By Mann-Whitney U test;

^§ sum of angular widths of defects: the summated width of the angle of RNFL defects around the optic disc.

HRT = heidelberg retina tomograph.

Table 2.

Factors associated with false negative results of optical coherence tomography in eyes with localized retinal nerve fiber layer (RNFL) defects

Factors	Logistic regression		p-value
Factors	Odds ratio	95% confidence interval	p-value
Average RNFL thickness (μ m)	1.106	1.057-1.156	<0.001
Angular width of defect (degree)	0.929	0.884-0.977	0.004

Table 3.

Retinal nerve fiber layer (RNFL) thickness and detection of photographic defects by optical coherence tomography (OCT)

RNFL thickness (μ m)	No. of eyes	Mean ± SD (μ m)	Not detected by OCT	Detected by OCT	p-value^*
Average^†					<0.001
31.0-74.8	66	60.6 ± 10.3	2 (3.0%)	64 (97.0%)
74.9-82.8	66	81.7 ± 4.5	12 (18.2%)	54 (81.8%)
97.2-100.4	65	98.8 ± 6.4	37 (56.9%)	28 (43.1%)
Inferior quadrant^†					<0.001
19.0-77.0	66	60.6 ± 11.8	1 (1.5%)	65 (98.5%)
77.3-108.0	66	91.8 ± 8.7	10 (15.2%)	56 (84.8%)
109.0-162.0	65	126.4 ± 12.4	40 (61.5%)	25 (38.5%)
Superior quadrant^†					<0.001
22.0-91.0	66	70.2 ± 16.9	3 (4.5%)	63 (95.5%)
91.0-114.0	66	102.5 ± 6.7	12 (18.2%)	54 (81.8%)
114.0-159.0	65	127.0 ± 9.8	36 (55.4%)	29 (44.6%)

^* by Pearson Chi-Square test;

^† Average, inferior quadrant, and superior quadrant retinal nerve fiber layer thickness were divided into tertile.

Table 4.

Sum of angular width of photographic retinal nerve fiber layer (RNFL) defect (the summated width of the angle of RNFL defects around the disc) and detection of photographic defects by optical coherence tomography (OCT)

Sum of angular width of photographic RNFL defect (degree)	Not detected by OCT	Detected by OCT	p-value^*
			<0.001
≤10	11 (91.7%)	1 (8.3%)
11-20	24 (58.5%)	17 (41.5%)
21-30	6 (13.3%)	39 (86.7%)
31-40	8 (24.2%)	25 (75.8%)
>40	2 (3.0%)	64 (97.0%)
Total	51 (25.9%)	146 (74.1%)

^* by Pearson Chi-Square test.

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