Badalà Federico, Nouri-Mahdavi Kouros, Raoof Duna A, Leeprechanon Narakorn, Law Simon K, Caprioli Joseph
Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Am J Ophthalmol. 2007 Nov;144(5):724-32. doi: 10.1016/j.ajo.2007.07.010. Epub 2007 Sep 14.
To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes.
Retrospective, cross-sectional study.
In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters.
The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs (+/- standard error) were: average RNFL thickness for StratusOCT (0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area with CART produced a sensitivity of 91% and specificity of 96%.
StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.
比较视盘和视网膜神经纤维层（RNFL）成像方法，以区分早期青光眼患者与正常受试者的眼睛。
回顾性横断面研究。
在一家三级医疗学术性青光眼中心，对92名受试者的92只眼睛（46例早期视野性开角型青光眼患者和46例对照）进行研究。比较了光学相干断层扫描（StratusOCT；卡尔蔡司医疗技术公司，美国加利福尼亚州都柏林）、扫描激光偏振仪（GDx VCC；激光诊断技术公司，美国加利福尼亚州圣地亚哥）、共焦激光眼底镜检查（海德堡视网膜断层扫描仪[HRT]III；海德堡工程有限公司，德国海德堡）以及对视盘立体照片的定性评估的诊断性能。观察指标为受试者操作特征曲线下面积（AUC）以及固定特异性下的敏感度。使用分类回归树（CART）分析来评估定量参数的组合。
青光眼患者的平均（±标准差）视野平均缺损为-4.0±2.5 dB（分贝）。AUC最大（±标准误）的参数分别为：StratusOCT的平均RNFL厚度（0.96±0.02）、GDx VCC的神经纤维指数（0.92±0.03）、HRT III的Frederick S. Mikelberg（FSM）判别函数（0.91±0.03）以及视盘照片评估的0.97±0.02。在95%特异性时，视盘照片评估的敏感度（90%）高于GDx VCC（P = 0.05）和HRT III（P = 0.002）的结果，但与StratusOCT的结果无显著差异（P>0.05）。StratusOCT平均RNFL厚度和HRT III杯盘面积的组合经CART分析后，敏感度为91%，特异性为96%。
在检测早期视野性青光眼方面，StratusOCT、GDx VCC和HRT III的表现与视盘立体照片的定性评估相当，但并不优于后者。StratusOCT平均RNFL厚度和HRT III杯盘面积比的组合具有较高的诊断精度。
