Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Department of Ophthalmology, Tuen Mun Eye Center and Tuen Mun Hospital, Hong Kong, People's Republic of China.
JAMA Ophthalmol. 2018 Aug 1;136(8):866-874. doi: 10.1001/jamaophthalmol.2018.1627.
Whether optical coherence tomography angiography (OCT-A) outperforms OCT to detect glaucoma remains inconclusive.
To compare (1) the diagnostic performance for detection of glaucoma and (2) the structure-function association between inner macular vessel density and inner macular thickness.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 115 patients with glaucoma and 35 healthy individuals for measurements of retinal thickness and retinal vessel density, segmented between the anterior boundary of internal limiting membrane and the posterior boundary of the inner plexiform layer, over the 3 × 3-mm2 macula using swept-source OCT. All participants were Chinese. Visual sensitivity corresponding to the 3 × 3-mm2 macular region was expressed in unlogged 1/lambert for investigation of the structure-function associations. Diagnostic performance was evaluated with area under the receiver operating characteristic curves (AUCs). The study was conducted between January 12, 2016, and December 12, 2016.
Area under the receiver operating characteristic curve and R2 analysis.
Of the 115 patients with glaucoma, 42 (36.5%) were women (mean [SD] age, 53.5 [13.4] years); of the 35 individuals with healthy eyes, 25 (71.4%) were women (age, 60.6 [5.9] years). Inner macular vessel density and thickness were 4.3% (95% CI, 2.4%-6.1%) and 21.1 μm (95% CI, 17.4-24.9 μm) smaller, respectively, in eyes with glaucoma compared with healthy eyes. The AUC of mean inner macular thickness for glaucoma detection was greater than that of mean inner macular vessel density (difference, 0.17; 95% CI, 0.01-0.31; P = .03). At 90% specificity, the sensitivity of mean inner macular thicknesses for detection of glaucoma was greater than that of mean inner macular vessel densities (difference, 29.2%; 95% CI, 11.5%-64.6%; P = .02). The strength of the structure-function association was stronger for mean inner macular thickness than mean inner macular vessel density in the linear (difference in R2 = 0.38; 95% CI, 0.22-0.54; P < .001) and nonlinear (difference in R2 = 0.36; 95% CI, 0.21-0.51; P < .001) regression models.
In this study, OCT measurement of inner macular thickness shows a higher diagnostic performance to detect glaucoma and a stronger structure-function association than the currently used OCT-A measurement of inner macular vessel density. These findings may suggest that OCT-A of the macula has a limited role in the diagnostic evaluation of glaucoma.
OCT-A 检测青光眼的性能是否优于 OCT 仍不确定。
比较（1）检测青光眼的诊断性能，以及（2）内黄斑血管密度与内黄斑厚度之间的结构-功能关联。
设计、设置和参与者：本横断面研究纳入了 115 名青光眼患者和 35 名健康个体，以使用扫频源 OCT 测量视网膜厚度和视网膜血管密度。在 3×3mm2 的黄斑区内，将视网膜从前界内界膜到内丛状层后界进行分段。所有参与者均为中国人。为了研究结构-功能关联，用未经对数转换的 1/lambert 表示对应于 3×3mm2 黄斑区域的视觉灵敏度。使用受试者工作特征曲线（AUC）下面积来评估诊断性能。该研究于 2016 年 1 月 12 日至 2016 年 12 月 12 日进行。
受试者工作特征曲线下面积和 R2 分析。
115 名青光眼患者中，42 名（36.5%）为女性（平均[标准差]年龄 53.5[13.4]岁）；35 名健康个体中，25 名（71.4%）为女性（年龄 60.6[5.9]岁）。与健康眼相比，青光眼眼中的内黄斑血管密度和厚度分别低 4.3%（95%CI，2.4%-6.1%）和 21.1μm（95%CI，17.4-24.9μm）。平均内黄斑厚度检测青光眼的 AUC 大于平均内黄斑血管密度（差值为 0.17；95%CI，0.01-0.31；P=0.03）。在 90%特异性时，平均内黄斑厚度检测青光眼的敏感性大于平均内黄斑血管密度（差值为 29.2%；95%CI，11.5%-64.6%；P=0.02）。在线性（R2 差值为 0.38；95%CI，0.22-0.54；P<0.001）和非线性（R2 差值为 0.36；95%CI，0.21-0.51；P<0.001）回归模型中，平均内黄斑厚度的结构-功能关联强度均大于平均内黄斑血管密度。
在这项研究中，OCT 对内黄斑厚度的测量在检测青光眼方面具有较高的诊断性能，与目前使用的 OCT-A 对内黄斑血管密度的测量相比，其结构-功能相关性更强。这些发现可能表明，黄斑 OCT-A 在青光眼的诊断评估中作用有限。
