Diagnostic Abilities to Detect Glaucomatous Abnormality Using Normal Retinal Thickness Measured by Optical Coherence Tomography

Eun Jin Bae; Kyoung Lae Kim; Young Cheol Yoo

doi:10.3341/jkos.2014.55.6.860

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Bae, Kim, and Yoo: Diagnostic Abilities to Detect Glaucomatous Abnormality Using Normal Retinal Thickness Measured by Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2014;55(6):860-867.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.6.860

Diagnostic Abilities to Detect Glaucomatous Abnormality Using Normal Retinal Thickness Measured by Optical Coherence Tomography

Eun Jin Bae, MD, Kyoung Lae Kim, MD, Young Cheol Yoo, MD

Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Address reprint requests to Young Cheol Yoo, MD, Department of Ophthalmology, Kangdong Sacred Heart Hospital, #150 Seongan-ro, Gangdong-gu, Seoul 134-701, Korea, Tel: 82-2-2224-2274, Fax: 82-2-470-2088, E-mail: demian7435@gmail.com

Received 16 August 2013 Revised 15 January 2014 Accepted 15 May 2014

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

Recently, the introduction of spectral-domain optical coherence tomography (SD-OCT) has enabled measurement of retinal thickness in the posterior pole in 64 sectors. SD-OCT was used to evaluate the diagnostic effectiveness in detecting glau-comatous abnormality of visual field sensitivity. A normal value for retinal thickness was determined and then compared in corre-sponding local sectors.

Methods

Thirty healthy controls and 30 glaucoma subjects were evaluated. Macular thickness values from the 4 adjacent square cells in an 8 × 8 posterior pole retinal thickness map were averaged for a mean retinal thickness (MRT) value. A normative database was prepared using the data from the healthy eyes of this study to determine the diagnostic criteria for MRT. If the MRT value was <5% (Criteria A) or <1% (Criteria B) of the normative database, it was considered to be abnormal. The abnormalities of the MRT value for each diagnostic criteria were compared with the visual field sensitivity results in the corresponding positions.

Results

The concordance of abnormalities between MRT and visual field sensitivity at 16 measured points was low in both criteria A (Kappa value; −0.418∼0.429) and B (Kappa value; −0.363∼0.444). Based on the results of the visual field at each focal point, the sensitivities and specificities of MRT values using the 2 criteria ranged from 0% to 100%.

Conclusions

In this study, MRT values showed low correlation and diagnostic ability to detect decreased sensitivity of the visual field in corresponding points, when customized criteria derived from a normative database were applied.

Keywords: Glaucoma, Retinal thickness, Spectral domain optical coherence tomography, Standard automated perimetry

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Figure 1.

The mean retinal thickness mapping corresponding to the visual field sensitivity. (A) A macular thickness map yielded by posterior pole asymmetry analysis of spectral domain optical coherence tomography is divided into 64 squares centered on the fovea. (B) We divided both the superior and inferior hemifields into 8 sectorsparts based on the horizontal raphe. Retinal thickness values of 4 ad-jacent square cells in the 8 χ8 grid of the posterior pole thickness map were averaged on the mean retinal thickness value. (C) Among the 52 test points of the central 24-2 pattern, the central 4 ×4 points corresponding to the 24° χ 24° posterior pole thickness map of the SPECTRALIS spectral-domain optical coherence tomography (SD-OCT) were considered. Same number between (B) and (C) indicated a pair of sector to undergo statistical analysis.

Table 1.

Demographic characteristics of study participants

	Normal (n = 30)	Glaucoma (n = 30)	p-value
Age (years)	52.03 ± 3.98	58.80 ± 4.12	0.55^*
Sex (M:F)	13:17	20:10	0.07^†
Axial length (mm)	23.83 ± 0.46	24.10 ± 0.58	0.30^*
Posterior pole retinal thickness (μm)	294.15 ± 33.98	278.3 ± 41.03	<0.01^*
Global index of standard automated perimetry
MD (dB)	0.34 ± 0.91	-3.18 ± 5.89	0.03^*
PSD (dB)	1.36 ± 0.10	3.92 ± 1.86	<0.01^*

Values are presented as mean ± SD.

MD = median deviation; PSD = pattern standard deviation.

^* Independent t-test;

^† Chi-square test.

Table 2.

Mean retinal thickness of normal and glaucomatous eyes and cut off values in 16 sectors as well as average determined by SD-OCT

	Sector	Control				Glaucoma
	Sector	Mean ± SD (μm)	Range (μm)	<5% (μm)	<1% (μm)	Mean ± SD (μm)	p-value^*
Superior	1	242.61 ± 8.57	230.25-254.50	224.08	217.25	231.76 ± 11.90	<0.01
	2	273.20 ± 9.99	259.50-288.75	251.66	248.75	258.14 ± 15.43	<0.01
	3	292.49 ± 10.23	277.75-311.00	277.79	269.00	273.30 ± 18.02	<0.01
	4	307.06 ± 12.75	287.25-334.00	287.25	284.50	274.10 ± 22.34	<0.01
	5	268.84 ± 12.55	244.50-288.25	242.36	237.00	256.62 ± 13.43	<0.01
	6	322.70 ± 13.50	294.50-338.00	293.55	291.75	306.86 ± 15.70	<0.01
	7	336.46 ± 13.72	305.75-344.25	309.03	308.25	323.58 ± 18.77	0.04
	8	314.27 ± 13.20	289.75-333.25	289.90	282.00	299.94 ± 35.23	0.04
Inferior	1’	268.50 ± 9.89	227.50-321.25	249.15	245.00	224.07 ± 15.32	<0.01
	2’	269.24 ± 11.09	255.00-305.25	250.49	243.75	246.82 ± 14.75	<0.01
	3’	287.96 ± 12.54	268.25-314.75	265.64	261.75	261.62 ± 19.69	<0.01
	4’	304.00 ± 15.00	251.50-324.75	279.30	251.50	272.17 ± 27.47	<0.01
	5’	269.78 ± 16.58	249.50-336.25	244.51	234.75	254.58 ± 13.72	<0.01
	6’	324.26 ± 14.19	295.00-344.50	293.81	290.00	304.43 ± 19.28	<0.01
	7’	331.91 ± 14.12	302.00-352.00	305.36	302.00	319.86 ± 21.19	<0.01
	8’	313.50 ± 15.75	287.75-346.50	287.80	283.50	292.54 ± 20.52	<0.01

Values are presented as mean ± SD.

SD-OCT = spectral-domain optical coherence tomography; SD = standard deviation.

^* Independent t-test to compare mean retinal thickness between healthy control eyes and glaucomatous eye.

Table 3.

Agreements of abnormal judgment between visual field sensitivity and mean retinal thickness, measurement in 16 tested sectors

	Sector	Criteria A^*		Criteria B^†
	Sector	Kappa value	p-value	Kappa value	p-value
Superior	1	-0.320	0.028	0.000	1.000
	2	-0.401	0.002	-0.302	0.015
	3	-0.418	0.014	-0.363	0.015
	4	0.053	0.593	0.094	0.397
	5	0.02	0.894	-0.064	0.506
	6	0.429	0.014	0.429	0.014
	7	0.132	0.356	0.132	0.356
	8	0.173	0.092	0.173	0.092
Inferior	1’	-0.068	0.023	-0.068	0.023
	2’	0.110	0.351	0.187	0.170
	3’	0.233	0.102	0.268	0.070
	4’	0.170	0.190	0.444	0.014
	5’	0.379	0.037	0.380	0.008
	6’	0.286	0.088	0.000	1.000
	7’	-0.119	0.377	-0.105	0.513
	8’	-0.017	0.900	0.020	0.894

^* If the average macular thickness value was <5% of that in the normative database, it was considered to be abnormal;

^† If the average macular thickness value was <1% of that in the normative database, it was considered to be abnormal.

Table 4.

The sensitivity and specificity of diagnostic criteria A and B of retinal thickness measurements to detect abnormal visual field sensitivity in 16 tested sectors

	Sector	Criteria A		Criteria B
	Sector	Sensitivity (%)	Specificity (%)	Sensitivity (%)	Specificity (%)
Superior	1	40.00	20.00	90.00	10.00
	2	14.29	21.74	28.57	21.74
	3	0.00	47.83	14.29	30.43
	4	80.00	32.00	80.00	40.00
	5	11.11	90.48	0.00	95.23
	6	66.67	88.89	66.67	88.89
	7	50.00	78.57	50.00	78.57
	8	100.00	75.86	100.00	75.86
Inferior	1’	80.00	0.00	80.00	0.00
	2’	75.00	50.00	75.00	61.54
	3’	80.00	60.00	80.00	64.00
	4’	80.00	52.00	60.00	88.00
	5’	57.14	82.61	28.57	100.00
	6’	66.67	70.83	66.67	75.00
	7’	0.00	71.43	0.00	82.14
	8’	33.33	62.96	33.33	70.37

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