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Lee, Chang, Park, Ohn, and Park: Diagnostic Ability of Macular Ganglion Cell Layer Measurements in Glaucoma Using Swept Source Optical Coherence Tomography
Original Article

J Korean Ophthalmol Soc 2016;57(6):941-950.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.941

Diagnostic Ability of Macular Ganglion Cell Layer Measurements in Glaucoma Using Swept Source Optical Coherence Tomography

Eung Suk Lee, MD, Jee Ho Chang, MD, PhD, Tae Kwan Park, MD, PhD, Young Hoon Ohn, MD, PhD, Ka Hee Park, MD

Department of Ophthalmology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Ka Hee Park, MD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: 82-32-621-5053, Fax: 82-32-621-5435 E-mail: khpark@schmc.ac.kr

Received 12 November 2015       Revised 3 March 2016       Accepted 14 April 2016

Copyright © 2016 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 ability of macular ganglion cell complex (mGCC), macular ganglion cell inner plexiform layer (mGCIPL) measurements in glaucoma using swept source deep range imaging optical coherence tomography (DRI OCT-1, Topcon Co., Tokyo, Japan).

Methods

From August of 2014 to July of 2015, 109 eyes of 109 subjects were assessed for the average thickness and sectional thickness of both mGCC and mGCIPL to determine whether there exists any significant difference among advanced stage glaucoma group, early stage glaucoma group and normal group in Swept source OCT. Comparisons were also made between the above measurements and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements in their diagnostic accuracy, sensitivity, and specificity.

Results

The diagnostic ability of mGCC based-mean thickness value (area under the curve [AUC] = 0.78/ 0.99) in detecting early stage glaucoma group as well as advanced stage group was not significantly different from that of cpRNFL thickness measurement. However, there was a significant difference in thickness between mGCIPL (AUC = 0.70) and cpRNFL in early stage glaucoma groups (p = 0.018). The sensitivities and specificities of mGCC were 0.95/0.97, and those of mGCIPL were 0.92/0.97, respectively.

Conclusions

The two swept source OCT based methods measuring retinal ganglion cell layer thickness appeared to have a good diagnostic accuracy, high sensitivity and specificity in detecting glaucomatous eyes. Nevertheless, of the two methods, mGCC thickness measurement was more efficient in detecting early glaucomatous changes.

Keywords: Glaucoma, Macular ganglion cell and inner plexiform layer, Macular ganglion cell complex, Swept source optical coherence tomography

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Figure 1.
Macular and optic nerve cube scan using deep range imaging swept source optic coherence tomography (DRI OCT-1; Topcon Corp., Tokyo, Japan). (A) Macular ganglion cell layer and inner plexiform layer (mGCIPL), (B) macular ganglion cell complex (mGCC), (C) circumpapillary retinal nerve fiber layer (cpRNFL).
jkos-57-941f1.tif
Figure 2.
Comparison of area under the curve (AUC) of retinal nerve fiber layer (RNFL), macular ganglion cell inner plexiform layer (mGCIPL) and macular ganglion cell complex (mGCC) for distinguishing glaucoma from normal group. (A) Receiver operating characteristics (ROC) curve for detection of early glaucoma, (B) curve for detection of advanced glaucoma. p-values for comparing the AUCs were calculated by Delong's method. cpRNFL = circumpapilary retinal nerve fiber layer; AVG = average.
jkos-57-941f2.tif
Table 1.
Characteristic per groups
Variable Normal Early Glaucoma Advanced Glaucoma Total Comparison (p-value)
Demographic characteristic N = 37 N = 35 N = 37 N = 109  
Age (years) 51.0 ± 11.5 57.6 ± 16.3 58.6 ± 9.4 54.7 ± 12.9 0.054
Sex (n, %)          
 Male 21 (56.8) 19 (54.3) 26 (70.3) 66 (60.6) 0.102
 Female 16 (43.2) 16 (46.7) 11 (29.7) 43 (39.4)  
Ocular characteristic N = 37 N = 35 N = 37 N = 109  
IOP (mm Hg) 15.8 ± 3.6 16.3 ± 3.5 15.3 ± 3.3 15.8 ± 3.5 0.489
MD (dB) −0.7 ± 1.5 −4.5 ± 0.9 −13.2 ± 5.4 −6.6 ± 5.3 <0.0011–2,1–3,2–3
PSD (dB) 1.2 ± 0.9 5.2 ± 1.3 10.9 ± 2.9 6.1 ± 3.7 <0.0011–2,1–3,2–3

Values are presented as mean ± SD unless otherwise indicated. p-values were calculated by analysis of variance (ANOVA) assuming unequal variance for continuous variables and Chi-square test for categorical variables. Posthoc comparison by Scheffe's method: i-j means that i-th group and j-th group had significant differences (i, j = 1, 2, 3; Group 1 = Normal, Group 2 = Early glaucoma, Group 3 = Advanced glaucoma).

IOP = intraocular pressure; MD = mean deviation; PSD = pattern standard deviation.

Table 2.
Circumpapillary retinal nerve fiber layer (cpRNFL), macular ganglion cell inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) thickness (μ m) per groups
Variable Normal (n = 37) Early glaucoma (n = 35) Advanced glaucoma (n = 37) Total (n = 109) Comparison by ANOVA* (p-value) Posthoc comparison (p-value)†
Normal vs. Early glaucoma Normal vs. Advanced glaucoma Early glaucoma vs. Advanced glaucoma
cpRNFL thickness (μ m)                
 Average 100.3 ± 11.2 85.9 ± 9.5 57.8 ± 13.2 81.3 ± 21.2 <0.001 <0.001 <0.001 <0.001
 Superior 125.1 ± 15.4 100.4 ± 17.1 65.6 ± 18.9 97.0 ± 30.1 <0.001 <0.001 <0.001 <0.001
 Inferior 128.8 ± 22.2 107.4 ± 22.5 65.8 ± 19.1 100.5 ± 33.9 <0.001 <0.001 <0.001 <0.001
 Nasal 68.3 ± 13.7 65.9 ± 13.3 44.5 ± 15.1 59.5 ± 17.6 <0.001 0.772 <0.001 <0.001
 Temporal 79.4 ± 14.2 71.5 ± 14.3 54.5 ± 19.9 68.4 ± 19.4 <0.001 0.134 <0.001 <0.001
mGCIPL thickness (μ m)                
 Average 69.9 ± 5.4 65.4 ± 6.5 49.2 ± 10.4 61.4 ± 11.8 <0.001 0.054 <0.001 <0.001
 Superior 69.2 ± 7.1 66.0 ± 9.1 48.1 ± 15.5 61.0 ± 14.5 <0.001 0.497 <0.001 <0.001
 Superonasal 72.6 ± 8.2 66.6 ± 11.6 50.7 ± 17.1 63.2 ± 15.8 <0.001 0.145 <0.001 <0.001
 Superotemporal 70.5 ± 7.2 66.1 ± 8.9 49.9 ± 17.4 62.1 ± 14.9 <0.001 0.310 <0.001 <0.001
 Inferior 65.2 ± 6.0 63.9 ± 8.9 48.6 ± 13.9 59.2 ± 12.6 <0.001 0.862 <0.001 <0.001
 Inferonasal 70.2 ± 7.7 64.3 ± 9.0 48.7 ± 14.3 61.0 ± 14.0 <0.001 0.076 <0.001 <0.001
 Inferotemporal 71.6 ± 9.7 65.2 ± 9.4 49.2 ± 17.2 62.0 ± 15.8 <0.001 0.112 <0.001 <0.001
mGCC thickness (μ m)                
 Average 106.2 ± 9.4 95.4 ± 11.5 73.7 ± 15.5 91.7 ± 18.4 <0.001 0.002 <0.001 <0.001
 Superior 106.5 ± 9.2 96.1 ± 12.1 73.8 ± 21.6 92.1 ± 20.6 <0.001 0.019 <0.001 <0.001
 Superonasal 118.0 ± 11.5 104.6 ± 16.1 79.3 ± 18.2 100.5 ± 22.4 <0.001 0.002 <0.001 <0.001
 Superotemporal 94.8 ± 9.2 87.0 ± 11.1 67.8 ± 21.1 83.1 ± 18.7 <0.001 0.087 <0.001 <0.001
 Inferior 103.8 ± 10.4 94.3 ± 17.2 73.9 ± 18.1 90.6 ± 19.9 <0.001 0.038 <0.001 <0.001
 Inferonasal 117.7 ± 12.7 103.4 ± 16.2 79.6 ± 16.1 100.2 ± 21.8 <0.001 <0.001 <0.001 <0.001
 Inferotemporal 96.4 ± 11.0 87.1 ± 12.6 67.8 ± 24.4 83.7 ± 20.9 <0.001 0.080 <0.001 <0.001

Values are presented as mean ± SD unless otherwise indicated.

* Posthoc comparison by Scheffe's method

† p-values were calculated by analysis of variance (ANOVA) assuming unequal variance.

Table 3.
Multinomial logistic regression for glaucoma with normal as a reference
Variable Early glaucoma
 Advanced glaucoma
OR 95% CI of OR p-value OR 95% CI of OR p-value
cpRNFL thickness (μ m)            
 Average 0.87 0.82–0.93 <0.001 0.61 0.50–0.74 <0.001
 Superior 0.91 0.87–0.95 <0.001 0.81 0.76–0.87 <0.001
 Inferior 0.95 0.93–0.98 0.001 0.83 0.77–0.89 <0.001
 Nasal 0.99 0.95–1.02 0.432 0.89 0.84–0.93 <0.001
 Temporal 0.96 0.93–1.00 0.032 0.90 0.87–0.94 <0.001
mGCIPL thickness (μ m)            
 Average 0.87 0.79–0.96 0.005 0.68 0.60–0.79 <0.001
 Superior 0.95 0.90–1.01 0.113 0.82 0.76–0.89 <0.001
 Superonasal 0.93 0.88–0.99 0.016 0.87 0.81–0.92 <0.001
 Superotemporal 0.94 0.88–1.00 0.036 0.82 0.76–0.88 <0.001
 Inferior 0.99 0.94–1.03 0.583 0.82 0.76–0.89 <0.001
 Inferonasal 0.92 0.86–0.98 0.008 0.82 0.76–0.89 <0.001
 Inferotemporal 0.93 0.88–0.99 0.016 0.83 0.77–0.89 <0.001
mGCC thickness (μ m)            
 Average 0.89 0.84–0.95 <0.001 0.77 0.70–0.84 <0.001
 Superior 0.91 0.86–0.96 0.001 0.83 0.77–0.88 <0.001
 Superonasal 0.93 0.89–0.97 0.001 0.85 0.81–0.9 <0.001
 Superotemporal 0.92 0.86–0.97 0.005 0.82 0.77–0.89 <0.001
 Inferior 0.95 0.92–0.99 0.013 0.88 0.83–0.92 <0.001
 Inferonasal 0.92 0.88–0.97 0.001 0.84 0.80–0.90 <0.001
 Inferotemporal 0.95 0.92–0.99 0.013 0.88 0.84–0.92 <0.001

OR = odds ratio; CI = confidence interval; cpRNFL = circumpapillary retinal nerve fiber layer; mGCIPL = macular ganglion cell inner plexiform layer; mGCC = macular ganglion cell complex.

Table 4.
Diagnostic performance of ocular measurements for glaucoma patients from nomal group
Variables Early glaucoma
 Advanced glaucoma
SEN SPE ACC AUC (95% CI) SEN SPE ACC AUC (95% CI)
cpRNFL thickness (μ m)                
 Average 0.74 0.89 0.82 0.84 (0.74–0.94) 1.00 1.00 1.00 1.00 (1.00–1.00)
 Superior 0.94 0.70 0.82 0.87 (0.78–0.96) 1.00 0.92 0.96 0.99 (0.98–1.00)
 Inferior 0.69 0.84 0.76 0.79 (0.68–0.90) 1.00 0.97 0.99 1.00 (0.99–1.00)
 Nasal 0.54 0.68 0.61 0.60 (0.46–0.73) 0.81 0.97 0.89 0.90 (0.83–0.98)
 Temporal 0.46 0.84 0.65 0.65 (0.52–0.78) 0.76 0.86 0.81 0.86 (0.77–0.94)
mGCIPL thickness (μ m)                
 Average 0.89 0.43 0.65 0.70 (0.57–0.82) 0.92 0.97 0.95 0.98 (0.95–1.00)
 Superior 0.54 0.73 0.64 0.60 (0.46–0.73) 0.92 0.81 0.86 0.93 (0.88–0.98)
 Superonasal 0.57 0.78 0.68 0.67 (0.54–0.80) 0.78 0.89 0.84 0.89 (0.81–0.96)
 Superotemporal 0.54 0.78 0.67 0.65 (0.52–0.78) 0.86 0.89 0.88 0.93 (0.87–0.99)
 Inferior 0.46 0.78 0.62 0.58 (0.44–0.72) 0.92 0.95 0.93 0.94 (0.88–1.00)
 Inferonasal 0.80 0.57 0.68 0.71 (0.59–0.83) 0.89 0.84 0.86 0.92 (0.86–0.98)
 Inferotemporal 0.74 0.59 0.67 0.68 (0.56–0.81) 0.81 0.92 0.86 0.93 (0.87–0.98)
mGCC thickness (μ m)                
 Average 0.69 0.78 0.74 0.78 (0.67–0.89) 0.95 0.97 0.96 0.99 (0.98–1.00)
 Superior 0.74 0.68 0.71 0.74 (0.62–0.86) 0.86 0.97 0.92 0.96 (0.93–1.00)
 Superonasal 0.77 0.73 0.75 0.79 (0.67–0.90) 0.89 0.97 0.93 0.95 (0.91–1.00)
 Superotemporal 0.71 0.73 0.72 0.73 (0.61–0.85) 0.86 0.89 0.88 0.95 (0.90–0.99)
 Inferior 0.77 0.65 0.71 0.72 (0.60–0.84) 0.92 0.86 0.89 0.94 (0.88–1.00)
 Inferonasal 0.69 0.73 0.71 0.77 (0.67–0.88) 0.97 0.86 0.92 0.97 (0.94–1.00)
 Inferotemporal 0.69 0.73 0.71 0.72 (0.60–0.84) 0.89 0.89 0.89 0.94 (0.87–1.00)

Sensitivity, specificity and accuracy were computed using the threshold by Youden's index. 95% CI of AUC was calculated by Delong's method.

SEN = sensitivity; SPE = specificity; ACC = accuracy; AUC = area under the curve; CI = confidence interval; cpRNFL = circumpapillary retinal nerve fiber layer; mGCIPL = macular ganglion cell; inner plexiform layer; mGCC = macular ganglion cell complex.

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