Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Ophthalmol. 2013 Sep;156(3):511-523.e6. doi: 10.1016/j.ajo.2013.04.028. Epub 2013 Jun 15.
To determine how evaluations of macular structures on spectral-domain optical coherence tomography compare with those of the optic disc and circumpapillary retinal nerve fiber layer (RNFL) in discriminating between highly myopic eyes with and without glaucoma.
Retrospective, comparative study.
The appearances of ganglion cell layer and RNFL on Spectralis macular scans (Heidelberg Engineering) and optic disc on photographs were evaluated by 2 observers. The receiver operating characteristic regression was conducted for macular ganglion cell complex and circumpapillary RNFL measurements on RTVue-100 (Optovue).
Ninety highly myopic eyes (-6.0 to -15.0 diopters; mean deviation [MD], -5.6 ± 5.1 dB) and 91 non-highly myopic eyes (1.0 to -5.5 diopters; MD, -4.9 ± 5.7 dB) were enrolled. In highly myopic eyes (<-6 diopters), the Cohen κ for qualitative decisions by observers was 0.363 for photographs and 0.946 for Spectralis macular scans, and observers' evaluations of Spectralis macular scans were more accurate (94.5% and 94.5%, respectively; P < .0001) than their evaluations of photographs (71.4% and 80.2%, respectively). In the receiver operating characteristic regression analyses assessing the influences of age, sex, MD, and axial length, the better MD (P = .002 to .016) and longer axial length (P = .031 to .041) were associated significantly with diagnostic performances for all or some spectral-domain optical coherence tomography parameters. The receiver operating characteristic curves of average macular ganglion cell complex and circumpapillary RNFL thicknesses were comparable at low MD.
In high myopes, observers' assessments of the spectral-domain optical coherence tomography macular scans may agree better and be more accurate than observers' optic disc assessments. Glaucoma diagnostic performance of the macular ganglion cell complex may be less affected by axial length compared with that of circumpapillary RNFL.
确定在鉴别伴或不伴青光眼的高度近视眼中，基于频域光学相干断层扫描的黄斑结构评估与视盘和环周视网膜神经纤维层（RNFL）评估相比，哪种方法的鉴别效果更好。
回顾性对比研究。
由 2 名观察者评估 Spectralis 黄斑扫描（海德堡工程公司）的神经节细胞层和 RNFL 以及照片上视盘的外观。使用 RTVue-100（Optovue）对黄斑神经节细胞复合体和环周 RNFL 进行接收者操作特征回归。
共纳入 90 只高度近视眼（-6.0 至-15.0 屈光度；平均偏差[MD]，-5.6±5.1 dB）和 91 只非高度近视眼（1.0 至-5.5 屈光度；MD，-4.9±5.7 dB）。在高度近视眼（<-6 屈光度）中，观察者的定性判断的 Cohen κ 值，照片为 0.363，Spectralis 黄斑扫描为 0.946，Spectralis 黄斑扫描的评估更准确（分别为 94.5%和 94.5%；P<0.0001），优于照片评估（分别为 71.4%和 80.2%）。在评估年龄、性别、MD 和眼轴长度影响的接收者操作特征回归分析中，更好的 MD（P=0.002 至 0.016）和更长的眼轴长度（P=0.031 至 0.041）与所有或部分频域光学相干断层扫描参数的诊断性能显著相关。低 MD 时平均黄斑神经节细胞复合体和环周 RNFL 厚度的接收者操作特征曲线相当。
在高度近视眼中，观察者对频域光学相干断层扫描黄斑扫描的评估可能比观察者对视盘的评估更一致、更准确。与环周 RNFL 相比，黄斑神经节细胞复合体的青光眼诊断性能受眼轴长度的影响可能更小。
