Morejon Angela, Mayo-Iscar Agustin, Martin Raul, Ussa Fernando
IOBA-Eye Institute, Universidad de Valladolid, Valladolid, Spain,
Department of Statistics and Operational Research and IMUVA, Universidad de Valladolid, Valladolid, Spain.
Clin Ophthalmol. 2018 Dec 27;13:33-42. doi: 10.2147/OPTH.S177581. eCollection 2019.
The purpose of this study was to develop an objective algorithm to discriminate the earliest stages of glaucoma using frequency doubling technology (FDT) Matrix perimetry and spectral domain-optical coherence tomography (OCT) technology to improve primary care detection.
Three hundred six eyes (mean age 58.67±15.12) from 161 patients were included and classified in the following three groups: 101 nonglaucoma (GI-NG), 100 glaucoma suspect (GII-SG), and 105 open-angle glaucoma (GIII-OAG). All participants underwent a visual field exploration using the Humphrey Matrix visual field instrument and retinal nerve fiber layer evaluation using the Topcon 3D OCT-2000. Pattern deviation plot was divided into 19 areas and five aggrupation or quadrants and ranked with a value between 0 and 4 according to its likelihood of normality, and differences among three groups were analyzed. Principal component analysis (PCA) was also used to extract the most notable features of FDT and OCT, and a logistic regression analysis was applied to obtain the classification rules.
Only area numbers 7 and 12 and the central zone of FDT Matrix showed statistical differences (<0.05) between GI-NG and GII-SG. The classification rules were estimated by the four PCA obtained from FDT Matrix and 3D OCT-2000 in a separate and combined use. Area under the receiver operating characteristic curve was 78.88% with FDT-PCA, 82.09% with OCT-PCA, and 94.27% with combined use of FDT and OCT-PCA to discriminate GI-NG and GII-SG.
The predictive rules based on FDT-PCA or OCT-PCA provide a high sensitivity and specificity to detect the earliest stages of glaucoma and even better in combined use. These predictive rules may help the future development of software for FDT Matrix perimetry and 3D OCT-2000, which will greatly improve their diagnostic ability, making them useful in daily practice in a primary care setting.
本研究旨在开发一种客观算法，利用频率加倍技术（FDT）矩阵视野检查和光谱域光学相干断层扫描（OCT）技术来鉴别青光眼的最早阶段，以改善初级保健检测。
纳入161例患者的306只眼（平均年龄58.67±15.12岁），并分为以下三组：101例非青光眼（GI-NG）、100例青光眼可疑（GII-SG）和105例开角型青光眼（GIII-OAG）。所有参与者均使用Humphrey矩阵视野仪进行视野检查，并使用Topcon 3D OCT-2000进行视网膜神经纤维层评估。模式偏差图分为19个区域和5个聚集区或象限，并根据其正常可能性在0至4之间进行评分，分析三组之间的差异。还使用主成分分析（PCA）提取FDT和OCT的最显著特征，并应用逻辑回归分析获得分类规则。
仅FDT矩阵的7区、12区和中心区域在GI-NG和GII-SG之间显示出统计学差异（<0.05）。通过分别和联合使用从FDT矩阵和3D OCT-2000获得的四个主成分分析来估计分类规则。用于鉴别GI-NG和GII-SG时，FDT-PCA的受试者操作特征曲线下面积为78.88%，OCT-PCA为82.09%，FDT和OCT-PCA联合使用时为94.27%。
基于FDT-PCA或OCT-PCA的预测规则对检测青光眼的最早阶段具有高灵敏度和特异性，联合使用时效果更佳。这些预测规则可能有助于FDT矩阵视野检查和3D OCT-2000软件的未来开发，这将大大提高它们的诊断能力，使其在初级保健环境的日常实践中有用。
