Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Ophthalmology. 2019 Jul;126(7):980-988. doi: 10.1016/j.ophtha.2019.03.003. Epub 2019 Mar 8.
To determine if OCT angiography (OCTA)-derived vessel density measurements can extend the available dynamic range for detecting glaucoma compared with spectral-domain (SD) OCT-derived thickness measurements.
Observational, cross-sectional study.
A total of 509 eyes from 38 healthy participants, 63 glaucoma suspects, and 193 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study.
Relative vessel density and tissue thickness measurement floors of perifoveal vessel density (pfVD), circumpapillary capillary density (cpCD), circumpapillary retinal nerve fiber (cpRNFL) thickness, ganglion cell complex (GCC) thickness, and visual field (VF) mean deviation (MD) were investigated and compared with a previously reported linear change point model (CPM) and locally weighted scatterplot smoothing curves.
Estimated vessel density and tissue thickness measurement floors and corresponding dynamic ranges.
Visual field MD ranged from -30.1 to 2.8 decibels (dB). No measurement floor was found for pfVD, which continued to decrease constantly until very advanced disease. A true floor (i.e., slope of approximately 0 after observed CPM change point) was detected for cpRNFL thickness only. The post-CPM estimated floors were 49.5±2.6 μm for cpRNFL thickness, 70.7±1.0 μm for GCC thickness, and 31.2±1.1% for cpCD. Perifoveal vessel density reached the post-CPM estimated floor later in the disease (VF MD, -25.8±3.8 dB) than cpCD (VF MD, -19.3±2.4 dB), cpRNFL thickness (VF MD, -17.5±3.3 dB), and GCC thickness (VF MD, -13.9±1.8 dB; P < 0.001). The number of available measurement steps from normal values to the CPM estimated floor was greatest for cpRNFL thickness (8.9), followed by GCC thickness (7.4), cpCD (4.5), and pfVD (3.8).
In late-stage glaucoma, particularly when VF MD is worse than -14 dB, OCTA-measured pfVD is a promising tool for monitoring progression because it does not have a detectable measurement floor. However, the number of steps within the dynamic range of a parameter also needs to be considered. Although thickness parameters reached the floor earlier than OCTA-measured pfVD, there are more such steps with thickness than OCTA parameters.
确定与谱域（SD）OCT 衍生的厚度测量相比，OCT 血管造影（OCTA）衍生的血管密度测量是否可以扩展检测青光眼的可用动态范围。
观察性、横断面研究。
共有 38 名健康参与者、63 名青光眼疑似患者和 193 名青光眼患者的 509 只眼纳入了诊断性青光眼研究中的创新研究。
研究了中心凹旁血管密度（pfVD）、周边毛细血管密度（cpCD）、周边视网膜神经纤维（cpRNFL）厚度、神经节细胞复合体（GCC）厚度和视野（VF）平均偏差（MD）的相对血管密度和组织厚度测量下限，并与之前报道的线性变化点模型（CPM）和局部加权散点平滑曲线进行了比较。
估计的血管密度和组织厚度测量下限及其相应的动态范围。
VF MD 范围为-30.1 至 2.8 分贝（dB）。pfVD 未发现测量下限，其持续不断地下降，直到疾病非常晚期。仅 cpRNFL 厚度检测到真正的下限（即，观察到 CPM 变化点后斜率约为 0）。CPM 后估计的下限分别为 cpRNFL 厚度 49.5±2.6μm、GCC 厚度 70.7±1.0μm和 cpCD 31.2±1.1%。pfVD 在疾病后期（VF MD，-25.8±3.8dB）比 cpCD（VF MD，-19.3±2.4dB）、cpRNFL 厚度（VF MD，-17.5±3.3dB）和 GCC 厚度（VF MD，-13.9±1.8dB）达到 CPM 后估计的下限晚；P<0.001）。从正常到 CPM 估计下限的测量步骤数量最多的是 cpRNFL 厚度（8.9），其次是 GCC 厚度（7.4）、cpCD（4.5）和 pfVD（3.8）。
在晚期青光眼，特别是当 VF MD 差于-14dB 时，OCTA 测量的 pfVD 是监测进展的有前途的工具，因为它没有可检测的测量下限。然而，参数的动态范围内的步骤数量也需要考虑。尽管厚度参数比 OCTA 测量的 pfVD 更早地达到下限，但厚度参数的步骤数量比 OCTA 参数更多。
