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Abstract
Purpose
To assess the distinction ability for differentiating glaucoma patients based on optic disc, retinal nerve fiber layer (RNFL) and ganglion cell‐ inner plexiform layer (GCIPL) measured using spectral domain optical coherence tomography (SD‐ OCT). Additionally, the diagnostic ability of these parameters was evaluated by comparing preperimetic glaucoma patients who frequently visited the clinic and normal patients with and without a large physiologic cup/disc (C/D) ratio.
Methods
Using SD-OCT, the optic disc, RNFL and GCIPL of preperimetic glaucoma patients were compared with normal peo-ple with and without a large C/D ratio from March, 2011 to December, 2014 at Department of Ophthalmology, Inha University Hospital. Preperimetic glaucoma was defined using the normal standard automated perimetry for glaucomatous optic nerve changes such as asymmetry of vertical C/D ratio, rim thinning, notching, excavation and RNFL defect.
Results
When comparing preperimetic glaucoma patients to normal people without large disc cupping, the most reliable param-eter for optic disc parameters, vertical C/D ratio (0.89), showed more reliable diagnostic ability than the most reliable parameter for retinal nerve fiber, inferior RNFL thickness (0.79) and superonasal and inferonasal GCIPL thickness were the most reliable GCIPL parameters ( p = 0.005 and 0.002, respectively). When comparing preperimetic glaucoma patients to normal people hav-ing a large physiologic disc cupping, average C/D ratio among optic nerve parameters, inferior RNFL thickness among RNFL thickness parameters and inferior GCIPL thickness among GCIPL parameters showed highly reliable diagnostic abilities. These 3 parameters were not statistically different (all p > 0.05) and had lower distinction ability than reported in previous studies.
References
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Figure 1.
Comparision of receiver operating curves between ONH, RNFL and GCIPL parameters. (A) AUROC values: 0.89 in VCDR, 0.72 in Inf RNFL, 0.70 in GCIPL. The difference between VCDR and Inf RNFL, VCDR and Inferotemp GCIPL were stat-istically significant ( p < 0.001, DeLong method). (B) AUROC values: 0.72 in Inf RNFL, 0.70 in Avg CDR, 0.67 in Inf GCIPL. The difference between Inf RNFL and Avg CDR and Inf GCIPL were not statistically significant ( p > 0.05, DeLong method). ONH = optic nerve head; RNFL = retinal nerve fiber layer; GCIPL = ganglion cell inner plexiform layer; AUROC = area under receiver operating curve; VCDR = vertical cup-disc ratio; Inf RNFL = inferior retinal nerve fiber layer; Inferotemp = in-ferotemporal; Avg CDR = average cup-to-disc ratio; Inf GCIPL = inferior ganglion cell inner plexiform layer.
Table 1.
Demographic characteristics of the study population
| Preperimetric glaucoma (n = 47) | Normal group (n = 66) | Large physiologic cupping group (n = 55) | p-value∗ | |
|---|---|---|---|---|
| Age (years) | 51.57 ± 10.66 | 49.73 ± 10.67 | 49.48 ± 11.44 | 0.58 |
| Intraocular pressure (mm Hg) | 15.37 ± 2.99 | 14.67 ± 3.29 | 14.15 ± 2.33 | 0.12 |
| Spherical equivalent (diopter) | -1.28 ± 2.55 | -0.50 ± 1.39 | -0.54 ± 1.46 | 0.09 |
| Mean deviation (dB) | -1.58 ± 1.36 | -1.07 ± 1.52 | -1.12 ± 2.61 | 0.33 |
| Pattern standard deviation (dB) | 1.80 ± 0.42 | 1.61 ± 0.36 | 1.77 ± 0.94 | 0.22 |
Table 2.
The comparision of SDOCT parameters among preperimetric glaucoma group, normal group, large physiologic cupping group
| Preperimetric glaucoma group (n = 47) | Normal group (n = 66) | Large physiologic cupping group (n = 55) | p-value∗ | p-value† | p-value‡ | |
|---|---|---|---|---|---|---|
| SSI of ONH scan | 9.28 ± 0.85 | 9.06 ± 1.02 | 9.20 ± 0.84 | 0.45 | 0.47 | 0.72 |
| Disc area (mm2)2 | 2.34 ± 0.50 | 2.20 ± 0.36 | 2.33 ± 0.34 | 0.11 | 0.18 | 0.98 |
| Rim area (mm2) | 1.02 ± 0.22 | 1.24 ± 0.18 | 1.11 ± 0.16 | <0.001 | <0.001 | 0.12 |
| Cup volume (mm3) | 0.58 ± 0.25 | 0.31 ± 0.15 | 0.52 ± 0.21 | <0.001 | <0.001 | 0.33 |
| Avg cup-disc area ratio | 0.75 ± 0.78 | 0.63 ± 0.09 | 0.71 ± 0.05 | <0.001 | <0.001 | 0.13 |
| Vertical cup-disc ratio | 0.71 ± 0.08 | 0.59 ± 0.84 | 0.67 ± 0.06 | <0.001 | <0.001 | 0.04 |
| Inf RNFL (μ m) | 110.04 ± 20.95 | 126.26 ± 13.48 | 125.96 ± 16.04 | <0.001 | <0.001 | <0.001 |
| Sup RNFL (μ m) | 109.70 ± 18.35 | 121.20 ± 12.68 | 118.86 ± 18.35 | <0.001 | <0.001 | 0.02 |
| Nasal RNFL (μ m) | 68.02 ± 12.07 | 69.53 ± 9.48 | 70.71 ± 10.43 | 0.44 | 0.76 | 0.44 |
| Temporal RNFL (μ m) | 65.23 ± 13.88 | 70.17 ± 9.31 | 70.50 ± 11.81 | 0.09 | 0.07 | 0.04 |
| Avg RNFL (μ m) | 88.23 ± 13.03 | 96.83 ± 7.80 | 96.61 ± 10.02 | <0.001 | <0.001 | <0.001 |
| SSI of GCIPL | 9.64 ± 0.64 | 9.64 ± 0.71 | 9.63 ± 0.70 | 0.99 | 0.99 | 0.99 |
| Avg GCIPL (μ m) | 76.89 ± 9.99 | 82.74 ± 5.35 | 81.96 ± 6.18 | <0.001 | <0.001 | 0.002 |
| Min GCIPL (μ m) | 73.09 ± 11.13 | 79.61 ± 7.52 | 78.80 ± 8.00 | <0.001 | <0.001 | 0.005 |
| Superotemp GCIPL (μ m) | 76.39 ± 12.18 | 81.91 ± 5.81 | 80.91 ± 6.27 | 0.002 | 0.003 | 0.02 |
| Sup GCIPL (μ m) | 77.41 ± 10.31 | 83.59 ± 6.86 | 82.82 ± 6.78 | <0.001 | <0.001 | 0.003 |
| Superonasal GCIPL (μ m) | 80.37 ± 9.89 | 84.67 ± 5.28 | 84.30 ± 6.74 | 0.006 | 0.01 | 0.03 |
| Inferonasal GCIPL (μ m) | 77.17 ± 10.68 | 82.71 ± 5.65 | 81.80 ± 7.23 | <0.001 | <0.001 | 0.01 |
| Inf GCIPL (μ m) | 74.22 ± 11.25 | 80.50 ± 6.13 | 79.95 ± 7.09 | <0.001 | <0.001 | 0.002 |
| Inferotemp GCIPL (μ m) | 76.37 ± 11.44 | 83.21 ± 5.66 | 81.95 ± 6.31 | <0.001 | <0.001 | 0.002 |
Values are presented as mean ± SD unless otherwise indicated. SDOCT = spectral domain optical coherence tomography; SSI = signal strength index; ONH = optic nerve head; Avg = average; Inf = in-ferior; RNFL = retinal nerve fiber layer; Sup = superior; GCIPL = ganglion cell inner plexiform layer; Min = minimum; Superotemp = superotemporal; Inferotemp = inferotemporal.
Table 3.
Diagnostic ability of SDOCT parameters in differentiating preperimetric glaucoma from normal group and large physio-logic cupping group
| OCT parameters | Preperimetric glaucoma from normal group | Preperimetric glaucoma from large physiologic cupping group | p-value* | ||||
|---|---|---|---|---|---|---|---|
| AUROC (95% CI) | Sensitivity at 95% specificity (95% CI, %) | Sensitivity at 80% specificity (95% CI, %) | AUROC (95% CI) | Sensitivity at 95% specificity (95% CI, %) | Sensitivity at 80% specificity (95% CI, %) | p-value∗ | |
| ONH parameters | |||||||
| Rim area | 0.79 (0.70-0.88) | 47.8 | 60.9 | 0.64 (0.53-0.75) | 27.7 | 46.8 | 0.04 |
| Disc area | 0.63 (0.53-0.73) | 8.5 | 27.7 | 0.53 (0.42-0.64) | 6.4 | 23.4 | 0.19 |
| Avg cup-disc area ratio | o 0.88 (0.82-0.95) | 54.3 | 84.8 | 0.70 (0.60-0.80) | 21.3 | 53.2 | 0.002 |
| Vertical cup-disc ratio | 0.89 (0.83-0.96) | 54.3 | 78.3 | 0.69 (0.59-0.79) | 21.3 | 46.8 | <0.001 |
| Cup volume | 0.84 (0.76-0.92) | 51.1 | 72.3 | 0.59 (0.48-0.71) | 10.6 | 23.4 | <0.001 |
| RNFL parameters | |||||||
| Avg RNFL | 0.70 (0.59-0.81) | 43.5 | 56.5 | 0.69 (0.58-0.79) | 34.8 | 54.3 | 0.83 |
| Sup RNFL | 0.70 (0.60-0.81) | 23.9 | 56.5 | 0.64 (0.53-0.75) | 19.6 | 34.8 | 0.45 |
| Temp RNFL | 0.64 (0.53-0.75) | 19.6 | 50.0 | 0.63 (0.52-0.74) | 17.4 | 45.7 | 0.90 |
| Nasal RNFL | 0.56 (0.45-0.68) | 15.2 | 30.4 | 0.59 (0.47-0.70) | 13.0 | 35.1 | 0.80 |
| Inf RNFL | 0.72 (0.62-0.82) | 41.3 | 58.7 | 0.72 (0.62-0.82) | 34.8 | 56.5 | 0.94 |
| GCIPL parameters | |||||||
| Avg GCIPL | 0.68 (0.57-0.79) | 34.8 | 54.3 | 0.65 (0.54-0.76) | 28.3 | 47.8 | 0.69 |
| Min GCIPL | 0.67 (0.57-0.79) | 17.4 | 50.0 | 0.65 (0.55-0.76) | 17.4 | 39.1 | 0.80 |
| Superotemp GCIPL | 0.70 (0.60-0.80) | 28.3 | 52.2 | 0.66 (0.55-0.76) | 28.3 | 39.1 | 0.58 |
| Sup GCIPL | 0.69 (0.58-0.79) | 32.6 | 56.5 | 0.66 (0.55-0.77) | 23.9 | 45.7 | 0.73 |
| Superonasal GCIPL | 0.65 (0.54-0.76) | 23.9 | 50.0 | 0.63 (0.52-0.74) | 23.9 | 45.7 | 0.85 |
| Inferonasal GCIPL | 0.65 (0.54-0.75) | 28.3 | 39.1 | 0.63 (0.52-0.74) | 21.7 | 32.6 | 0.81 |
| Inferior GCIPL | 0.68 (0.58-0.79) | 34.8 | 50.0 | 0.67 (0.56-0.78) | 32.6 | 47.8 | 0.88 |
| Inferotemp GCIPL | 0.70 (0.60-0.80) | 39.1 | 54.3 | 0.65 (0.54-0.76) | 23.9 | 39.1 | 0.46 |
SDOCT = spectral domain optical coherence tomography; OCT = optical coherence tomography; AUROC = area under receiver operating characteristic curve; CI = confidence interval; ONH = optic nerve head; Avg = average; RNFL = retinal nerve fiber layer; Sup = superior; Temp = temporal; Inf = inferior; GCIPL = ganglion cell inner plexiform layer; Min= minimum; Superotemp = superotemporal; Inferotemp= inferotemporal.
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