Wu Zhichao, Saunders Luke J, Zangwill Linda M, Daga Fábio B, Crowston Jonathan G, Medeiros Felipe A
Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Am J Ophthalmol. 2017 Sep;181:106-113. doi: 10.1016/j.ajo.2017.06.017. Epub 2017 Jun 29.
To evaluate the specificity of current definitions used to identify progressive change of the average peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained on optical coherence tomography (OCT) imaging.
Prospective observational cohort study.
Setting: University of California, San Diego.
Seventy-five eyes from 45 normal participants.
Patients were seen at an average of 5.7 visits over 3.2 years, to determine the age-related average RNFL thickness changes and longitudinal measurement variability. Slope and variability estimates were used to reconstruct "real-world" OCT imaging measurements with computer simulations.
False-positive rates for progression in normal eyes using different definitions.
The estimated normal average RNFL thickness change over time was -0.54 ± 0.23 μm/year (P < .001). Even with a recent definition of progression that appeared to guarantee a high level of specificity by accounting for normal aging (requiring a significant negative slope that was more negative than the 5% lower limit of aging), 18% simulated normal eyes were still falsely identified as having progressed after 5 years of annual testing in a clinical practice scenario. However, this was reduced to 8% and 4% when trend-based analysis of progression was performed after adjustments using the mean and 5% lower limit of normal rates of aging, respectively.
This study highlights how current definitions for detecting RNFL thinning have an unacceptably poor level of specificity, and that more stringent definitions are required to avoid misleading interpretations of progression on OCT imaging in clinical practice.
评估当前用于识别光学相干断层扫描（OCT）成像上获得的平均视盘周围视网膜神经纤维层（RNFL）厚度测量值的进行性变化的定义的特异性。
前瞻性观察队列研究。
地点：加利福尼亚大学圣地亚哥分校。
45名正常参与者的75只眼睛。
患者在3.2年中平均接受5.7次就诊，以确定与年龄相关的平均RNFL厚度变化和纵向测量变异性。使用斜率和变异性估计值通过计算机模拟重建“真实世界”的OCT成像测量值。
使用不同定义的正常眼进展的假阳性率。
估计正常情况下RNFL厚度随时间的平均变化为-0.54±0.23μm/年（P<.001）。即使采用最近的进展定义，该定义似乎通过考虑正常衰老来保证高特异性水平（要求显著的负斜率，该斜率比衰老的5%下限更负），在临床实践场景中进行年度测试5年后，仍有18%的模拟正常眼被错误地识别为进展。然而，当分别使用衰老正常率的平均值和5%下限进行调整后进行基于趋势的进展分析时，这一比例分别降至8%和4%。
本研究强调了当前检测RNFL变薄的定义的特异性水平低得令人无法接受，并且需要更严格的定义以避免在临床实践中对OCT成像上的进展进行误导性解释。
