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Kim, Kim, and Kim: Comparison of Diagnostic Power Among OCT Parameters According to Peripapillary Atrophy in High Myopic Glaucoma
Original Article

J Korean Ophthalmol Soc 2013;54(12):1844-1855.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1844

Comparison of Diagnostic Power Among OCT Parameters According to Peripapillary Atrophy in High Myopic Glaucoma

Woo Jin Kim, MD1, Kyung Nam Kim, MD1, Chang Sik Kim, MD, PhD1, 2,

1Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea

2Research Institute for Medical Science, Chungnam National University, Daejeon, Korea

Address reprint requests to Chang Sik Kim, MD, PhD Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea, Tel: 82-42-280-7606, Fax: 82-42-255-3745, E-mail: kcs61@cnu.ac.kr

Received 29 March 201317 July 2013       Accepted 29 October 2013

Copyright © 2013 Korean Ophthalmological Society

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 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).

Conclusions

Assessment of GCIPL parameters is a useful technique for glaucoma diagnosis in patients with high myopia and PPA extending beyond circumpapillary OCT scan circle.

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Keywords: Ganglion cell, Glaucoma, High myopia, Optical coherence tomography, Peripapillary atrophy

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jkos-54-1844f1.tif
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).
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jkos-54-1844f2.tif
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).
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jkos-54-1844f3.tif
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).
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jkos-54-1844f4.tif
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).
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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†

Values are presented as mean ± SD.

PPA = peripapillary atrophy; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; IOP = intraocular pressure; SE = spherical equivalents; MD = mean deviation; PSD = pattern standard deviation.

* Comparison between PPA beyond circle and PPA within circle in the glaucoma group

† Mann-Whitney U test

‡ Chi-square test.

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

Values are presented as mean ± SD.

PPA = peripapillary atrophy.

* Comparison between PPA beyond circle and PPA within circle in the glaucoma group.

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

PPA = peripapillary atrophy; CI = confidence interval (95%); N/A = not applicable.

* DeLong method comparing difference between group A and B.

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§

Values are presented as mean ± SD.

PPA = peripapillary atrophy; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; IOP = intraocular pressure; SE = spherical equivalents; MD = mean deviation; PSD = pattern standard deviation.

* Patients with a peripapillary atrophy distributed beyond the OCT scan circle (PPA beyond circle)

† Patients with a peripapillary atrophy confined within the OCT scan circle (PPA within circle)

‡ Comparison between PPA beyond circle and PPA within circle in the glaucoma group

§ Mann-Whitney U-test

∏ Chi-square test.

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

PPA = peripapillary atrophy; CI = confidence interval (95%); N/A = not applicable.

* DeLong method comparing difference between subgroup A and B.

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