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Abstract
Purpose
To evaluate diagnostic power to detect glaucoma in high myopic eyes with peripapillary atrophy among optical coherence tomography (OCT) parameters.
Methods
Fifty eyes of 31 glaucoma patients with myopia of -6.00 diopters or less and a peripapillary atrophy (PPA) were classified into a group with a PPA located beyond the circumpapillary OCT scan circle (group A) and a group with a PPA confined within the scan circle (group B). Circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), and ganglion cell-inner plexiform layer (GCIPL) thickness were measured in each group and the diagnostic power of each measurement was compared by area under the receiver operating characteristic curve (AUC).
Results
There were no significant differences in the age, gender, intraocular pressure, optic disc size, and mean deviation between the 2 groups. The spherical equivalent of group A was significantly larger than group B (mean -11.9 vs. -7.3 diopters, p = 0.002). In group A, the AUC of average GCIPL thickness was significantly higher than average cpRNFL and average TM thickness (p < 0.05). Additionally, when comparing parameters that showed the highest AUC value in each method, the AUC of GCIPL thickness was significantly higher than cpRNFL thickness (p = 0.046). In subgroup analysis of spherical equivalent matching between the 2 groups (subgroup A and B), the highest AUC value of GCIPL thickness was significantly higher than cpRNFL and TM thickness in subgroup A (p < 0.05). In group B and subgroup B, there was no statistical significance among AUC values of the 3 different methods (p > 0.05).
References
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Figure 1.
Classification of the subject group by the area of the peripapillary atrophy in relation to the optic disc scan circle of Cirrus OCT. (A) Case with a peripapillary atrophy area, which is distributed beyond the circle (group A). (B) Case with a peripapillary atrophy area, which is confined within the circle (group B).
Figure 2.
Receiver operating characteristic (ROC) curves for average circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), ganglion cell-inner plexiform layer (GCIPL) thickness in group with a peripapillary atrophy area distributed beyond the circle (A) and group with a peripapillary atrophy area confined within the circle (B). (A) AUC values: 0.742 in cpRNFL, 0.728 in TM, 0.865 in GCIPL. The differences between cpRNFL and GCIPL (p = 0.042, DeLong method), TM and GCIPL (p = 0.009) were statistically significant. (B) AUC values: 0.892 in cpRNFL, 0.854 in TM, 0.877 in GCIPL. The differences among three parameters were not statistically significant (p > 0.05, DeLong method).
Figure 3.
Receiver operating characteristic (ROC) curves for the parameters which show the largest area under ROC curves (AUC) value from circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), ganglion cell-inner plexiform layer (GCIPL) thickness measurement in group with a peripapillary atrophy area distributed beyond the circle (A) and group with a peripapillary atrophy area confined within the circle (B). (A) AUC values: 0.742 in average cpRNFL, 0.773 in temporal outer TM, 0.865 in superotemporal GCIPL. The difference between superotemporal GCIPL and average cpRNFL was statistically significant (p = 0.046, DeLong method). The differences between average cpRNFL and temporal outer TM, superotemporal GCIPL and temporal outer TM were not statistically significant (p > 0.05). (B) AUC values: 0.892 in average cpRNFL, 0.862 in temporal inner TM, 0.897 in superotemporal GCIPL. The differences among three parameters were not statistically significant (p > 0.05, DeLong method).
Figure 4.
Receiver operating characteristic (ROC) curves for the parameters which show the largest area under ROC curves (AUC) value from circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), ganglion cell-in-ner plexiform layer (GCIPL) thickness measurement in spherical equivalent matched subgroup with a peripapillary atrophy area distributed beyond the circle (Sub-A) and subgroup with a peripapillary atrophy area confined within the circle (Sub-B). Sub-A: AUC values: 0.755 in temporal cpRNFL, 0.827 in temporal outer TM, 0.968 in superotemporal GCIPL. The differences between TM and GCIPL (p = 0.010, DeLong method), cpRNFL and GCIPL (p = 0.001) were statistically significant. Sub-B: AUC values: 0.965 in average cpRNFL, 0.967 in temporal outer TM, 0.985 in superotemporal GCIPL. The differences among three parameters were not statistically significant (p > 0.05, DeLong method).
Table 1.
Comparison of characteristics in group with a peripapillary atrophy distributed beyond the optical coherence tomography scan circle (PPA beyond circle, Group A) and in group with a peripapillary atrophy confined within the scan circle (PPA within circle, Group B)
|
Group A (PPA beyond circle) |
Group B (PPA within circle) |
p* | |||||
|---|---|---|---|---|---|---|---|
| Glaucoma | No glaucoma | p | Glaucoma | No glaucoma | p | ||
| Number of eyes | 16 | 13 | 34 | 29 | |||
| Type of glaucoma (%) | |||||||
| NTG | 12 (75.0) | 23 (67.6) | |||||
| POAG | 4 (25.0) | 11 (32.4) | |||||
| Age (years) | 41.1 ± 11.5 | 38.9 ± 16.3 | 0.468† | 40.1 ± 10.3 | 36.7 ± 9.3 | 0.107† | 0.876† |
| Sex (male : female) | 6:5 | 6:5 | 1.000‡ | 9:11 | 10:7 | 0.402‡ | 0.157‡ |
| IOP (mm Hg) | 18.4 ± 2.3 | 16.6 ± 2.6 | 0.538† | 18.5 ± 4.3 | 15.2 ± 2.7 | 0.070† | 0.980† |
| SE (diopters) | -11.9 ± 4.6 | -10.7 ± 3.5 | 0.948† | -7.3 ± 1.8 | -7.6 ± 1.5 | 0.203† | 0.002† |
| Disc size (mm2) | 2.3 ± 0.5 | 2.1 ± 0.3 | 0.080† | 2.1 ± 0.3 | 2.0 ± 0.3 | 0.064† | 0.089† |
| MD (dB) | -6.2 ± 3.8 | -2.7 ± 2.6 | 0.007† | -4.9 ± 2.9 | -2.1 ± 1.9 | 0.001† | 0.297† |
| PSD (dB) | 4.3 ± 3.0 | 3.1 ± 2.4 | 0.193† | 4.9 ± 3.7 | 2.9 ± 1.3 | 0.004† | 0.776† |
Table 2.
Optical coherence tomography parameters in group with a peripapillary atrophy distributed beyond the scan circle (PPA beyond circle, Group A) and in group with a peripapillary atrophy confined within the scan circle (PPA within circle, Group B)
|
Group A (PPA beyond circle) |
Group B (PPA within circle) |
p* | |||||
|---|---|---|---|---|---|---|---|
| Glaucoma | No glaucoma | p | Glaucoma | No glaucoma | p | ||
| Circumpapillary retinal nerve fiber layer thickness (μm) | |||||||
| Mean | 81.7 ± 2.0 | 89.8 ± 2.2 | 0.036 | 74.8 ± 2.1 | 92.8 ± 1.1 | <0.001 | 0.022 |
| Superior | 93.2 ± 4.5 | 89.1 ± 5.1 | 0.980 | 91.1 ± 3.3 | 112.9 ± 1.6 | <0.001 | 0.902 |
| Inferior | 90.2 ± 6.4 | 96.0 ± 4.0 | 0.212 | 83.9 ± 4.0 | 113.4 ± 3.0 | <0.001 | 0.411 |
| Temporal | 84.1 ± 3.7 | 102.5 ± 5.9 | 0.041 | 64.3 ± 2.3 | 80.5 ± 2.6 | <0.001 | <0.001 |
| Nasal | 60.9 ± 4.9 | 70.2 ± 4.8 | 0.252 | 59.8 ± 1.7 | 64.7 ± 1.8 | 0.054 | 0.624 |
| Total macular thickness (μm) | |||||||
| Mean | 260.7 ± 3.7 | 271.7 ± 3.4 | 0.043 | 262.1 ± 2.3 | 279.5 ± 1.3 | <0.001 | 0.835 |
| Fovea | 266.6 ± 4.5 | 267.6 ± 2.7 | 0.220 | 250.0 ± 3.1 | 265.4 ± 2.3 | <0.001 | 0.033 |
| Superior (3 mm) | 317.3 ± 4.7 | 320.4 ± 4.0 | 0.375 | 312.9 ± 2.8 | 326.4 ± 2.3 | 0.001 | 0.835 |
| Inferior (3 mm) | 307.0 ± 3.6 | 312.5 ± 5.2 | 0.488 | 299.0 ± 3.1 | 320.5 ± 2.1 | <0.001 | 0.155 |
| Temporal (3 mm) | 302.1 ± 2.9 | 307.9 ± 2.7 | 0.105 | 296.2 ± 2.7 | 316.0 ± 2.1 | <0.001 | 0.220 |
| Nasal (3 mm) | 316.4 ± 5.0 | 326.4 ± 3.7 | 0.076 | 313.6 ± 3.0 | 329.5 ± 2.6 | <0.001 | 0.462 |
| Superior (6 mm) | 263.3 ± 2.7 | 275.1 ± 2.7 | 0.061 | 264.4 ± 2.6 | 275.1 ± 2.0 | 0.003 | 0.990 |
| Inferior (6 mm) | 247.3 ± 3.1 | 253.8 ± 4.0 | 0.259 | 242.4 ± 3.2 | 264.5 ± 1.5 | <0.001 | 0.432 |
| Temporal (6 mm) | 247.1 ± 2.6 | 256.8 ± 3.7 | 0.014 | 248.1 ± 3.4 | 263.4 ± 3.0 | <0.001 | 0.686 |
| Nasal (6 mm) | 278.8 ± 7.4 | 271.7 ± 3.4 | 0.043 | 278.7 ± 2.9 | 294.5 ± 3.1 | 0.001 | 0.485 |
| Ganglion cell and inner plexiform layer thickness (μm) | |||||||
| Mean | 68.3 ± 2.5 | 79.0 ± 1.1 | 0.001 | 68.8 ± 1.5 | 79.3 ± 1.0 | <0.001 | 0.873 |
| Superotemporal | 69.8 ± 2.3 | 82.4 ± 2.8 | 0.001 | 69.1 ± 1.5 | 80.1 ± 1.2 | <0.001 | 0.531 |
| Superior | 71.8 ± 2.1 | 78.3 ± 2.0 | 0.054 | 71.6 ± 1.3 | 79.5 ± 1.0 | <0.001 | 0.873 |
| Superonasal | 71.9 ± 5.0 | 81.2 ± 2.5 | 0.402 | 72.8 ± 1.6 | 80.4 ± 1.1 | 0.001 | 0.778 |
| Inferonasal | 70.8 ± 4.4 | 80.6 ± 3.0 | 0.012 | 68.5 ± 2.0 | 79.4 ± 1.0 | <0.001 | 0.980 |
| Inferior | 60.7 ± 4.5 | 71.2 ± 1.8 | 0.085 | 65.9 ± 1.9 | 75.6 ± 1.2 | <0.001 | 0.523 |
| Inferotemporal | 65.0 ± 3.7 | 80.3 ± 2.1 | 0.001 | 65.7 ± 2.2 | 80.6 ± 1.4 | <0.001 | 0.980 |
Table 3.
Area under receiver operator characteristics curve values of the optical coherence tomography parameters in group with a peripapillary atrophy distributed beyond the scan circle (PPA beyond circle, Group A) and in group with a peripapillary atrophy confined within the scan circle (PPA within circle, Group B)
| Group A (PPA beyond circle, n = 16) | Group B (PPA within circle, n = 34) | p-value* | |
|---|---|---|---|
| Circumpapillary retinal nerve fiber layer thickness (CI) | |||
| Mean | 0.742 (0.550-0.936) | 0.892 (0.796-0.968) | 0.040 |
| Superior | 0.494 (0.261-0.727) | 0.844 (0.734-0.955) | N/A |
| Inferior | 0.646 (0.430-0.862) | 0.872 (0.773-0.971) | 0.005 |
| Temporal | 0.740 (0.548-0.930) | 0.820 (0.714-0.926) | 0.304 |
| Nasal | 0.637 (0.419-0.855) | 0.645 (0.506-0.784) | 0.933 |
| Total macular thickness (CI) | |||
| Mean | 0.728 (0.502-0.913) | 0.854 (0.739-0.932) | 0.099 |
| Fovea | 0.643 (0.416-0.870) | 0.787 (0.668-0.906) | 0.101 |
| Superior (3 mm) | 0.601 (0.372-0.829) | 0.745 (0.622-0.868) | 0.109 |
| Inferior (3 mm) | 0.581 (0.347-0.816) | 0.854 (0.759-0.950) | 0.001 |
| Temporal (3 mm) | 0.688 (0.474-0.903) | 0.862 (0.770-0.954) | 0.022 |
| Nasal (3 mm) | 0.701 (0.494-0.908) | 0.764 (0.645-0.884) | 0.454 |
| Superior (6 mm) | 0.711 (0.506-0.916) | 0.721 (0.591-0.851) | 0.910 |
| Inferior (6 mm) | 0.633 (0.408-0.858) | 0.845 (0.739-0.950) | 0.011 |
| Temporal (6 mm) | 0.773 (0.577-0.968) | 0.794 (0.672-0.915) | 0.734 |
| Nasal (6 mm) | 0.731 (0.525-0.936) | 0.744 (0.612-0.875) | 0.883 |
| Ganglion cell and inner plexiform layer thickness (CI) | |||
| Mean | 0.865 (0.699-1.000) | 0.877 (0.779-0.976) | 0.857 |
| Superotemporal | 0.865 (0.721-1.000) | 0.897 (0.803-0.990) | 0.609 |
| Superior | 0.720 (0.519-0.920) | 0.818 (0.707-0.928) | 0.224 |
| Superonasal | 0.596 (0.363-0.829) | 0.759 (0.634-0.885) | 0.081 |
| Inferonasal | 0.777 (0.588-0.967) | 0.826 (0.719-0.934) | 0.529 |
| Inferior | 0.695 (0.495-0.895) | 0.775 (0.649-0.901) | 0.354 |
| Inferotemporal | 0.854 (0.671-1.000) | 0.858 (0.750-0.966) | 0.956 |
Table 4.
Comparison of characteristics in the spherical equivalent matched subgroup A and subgroup B
|
Subgroup A* (PPA beyond circle) |
Subgroup B† (PPA within circle) |
p‡ | |||||
|---|---|---|---|---|---|---|---|
| Glaucoma | No glaucoma | p | Glaucoma | No glaucoma | p | ||
| Number of eyes | 12 | 12 | 12 | 24 | |||
| Type of glaucoma (%) | |||||||
| NTG | 10 (83.3) | 8 (66.7) | |||||
| POAG | 2 (16.7) | 4 (33.3) | |||||
| Age (years) | 40.4 ± 10.1 | 43.1 ± 14.5 | 0.694§ | 39.6 ± 6.7 | 36.7± 9.6 | 0.186§ | 0.918§ |
| Sex (male : female) | 3:4 | 4:4 | 0.595∏ | 3:6 | 5:9 | 0.633∏ | 0.549∏ |
| IOP (mm Hg) | 18.6 ± 2.5 | 17.3 ± 2.9 | 0.331§ | 18.5 ± 3.8 | 16.8 ± 2.6 | 0.213§ | 0.923§ |
| SE (diopters) | -9.2 ± 2.0 | -9.8 ± 2.3 | 0.413§ | -8.9 ± 1.9 | -8.1 ± 1.3 | 0.137§ | 0.799§ |
| Disc size (mm2) | 2.3 ± 0.3 | 2.1 ± 0.3 | 0.070§ | 2.0 ± 0.5 | 1.9 ± 0.3 | 0.851§ | 0.115§ |
| MD (dB) | -6.0 ± 3.8 | -2.5 ± 2.4 | 0.008§ | -5.1 ± 3.3 | -2.2 ± 2.0 | 0.012§ | 0.657§ |
| PSD (dB) | 4.8 ± 3.1 | 3.0 ± 1.8 | 0.180§ | 5.2 ± 3.2 | 2.5 ± 1.4 | 0.039§ | 0.717§ |
Table 5.
Area under receiver operator characteristics curve values of the optical coherence tomography parameters in the spherical equivalent matched subgroup A and subgroup B
| Subgroup A (PPA beyond circle, n = 12) | Subgroup B (PPA within circle, n = 12) | p-value* | |
|---|---|---|---|
| Circumpapillary retinal nerve fiber layer thickness (CI) | |||
| Mean | 0.705 (0.573-0.836) | 0.965 (0.815-0.997) | 0.001 |
| Superior | 0.473 (0.326-0.619) | 0.936 (0.787-0.992) | N/A |
| Inferior | 0.586 (0.441-0.732) | 0.913 (0.819-0.999) | 0.001 |
| Temporal | 0.755 (0.633-0.877) | 0.778 (0.610-0.946) | 0.828 |
| Nasal | 0.573 (0.428-0.718) | 0.639 (0.452-0.819) | 0.616 |
| Total macular thickness (CI) | |||
| Mean | 0.705 (0.575-0.834) | 0.867 (0.732-0.899) | 0.073 |
| Fovea | 0.695 (0.566-0.825) | 0.731 (0.532-0.930) | 0.767 |
| Superior (3 mm) | 0.709 (0.577-0.841) | 0.741 (0.558-0.924) | 0.780 |
| Inferior (3 mm) | 0.618 (0.474-0.762) | 0.898 (0.783-1.000) | 0.003 |
| Temporal (3 mm) | 0.773 (0.655-0.890) | 0.908 (0.801-0.990) | 0.083 |
| Nasal (3 mm) | 0.764 (0.646-0.881) | 0.783 (0.599-0.967) | 0.864 |
| Superior (6 mm) | 0.768 (0.649-0.888) | 0.783 (0.611-0.955) | 0.888 |
| Inferior (6 mm) | 0.773 (0.649-0.896) | 0.929 (0.790-0.993) | 0.042 |
| Temporal (6 mm) | 0.827 (0.726-0.928) | 0.967 (0.846-1.000) | 0.015 |
| Nasal (6 mm) | 0.786 (0.672-0.901) | 0.818 (0.665-0.970) | 0.743 |
| Ganglion cell and inner plexiform layer thickness (CI) | |||
| Mean | 0.832 (0.727-0.937) | 0.977 (0.836-1.000) | 0.056 |
| Superotemporal | 0.968 (0.929-1.000) | 0.985 (0.868-1.000) | 0.492 |
| Superior | 0.659 (0.519-0.799) | 0.858 (0.704-0.964) | 0.054 |
| Superonasal | 0.680 (0.511-0.812) | 0.877 (0.723-0.973) | 0.062 |
| Inferonasal | 0.768 (0.641-0.896) | 0.929 (0.769-0.988) | 0.062 |
| Inferior | 0.673 (0.539-0.806) | 0.870 (0.739-0.954) | 0.055 |
| Inferotemporal | 0.927 (0.836-1.000) | 0.983 (0.860-1.000) | 0.203 |
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