Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
Ophthalmol Glaucoma. 2020 Mar-Apr;3(2):90-96. doi: 10.1016/j.ogla.2019.11.008. Epub 2019 Nov 27.
To compare retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening minimum rim width (BMO-MRW) measured by spectral domain optical coherence tomography (SDOCT) for diagnosing glaucoma in those suspected of having the disease.
Observational cohort study.
113 eyes from 81 patients suspected of having glaucoma based on optic nerve appearance.
Participants were imaged using SDOCT and RNFLT and BMO-MRW were measured. All participants had normal visual fields at the time of imaging, but were considered suspects based on the appearance of the optic disc during clinical examination. Eyes were classified as glaucomatous or non-glaucomatous based on documented stereophotographic evidence of progressive glaucomatous change in the appearance of the optic nerve or retinal nerve fiber layer occurring before the imaging session. For each parameter, we calculated the area under the receiver operating characteristic (ROC) curve and the sensitivity with fixed specificities of 80% and 95%.
Areas under the ROC curves.
Of the 113 eyes suspected of having glaucoma, 52 (46.0%) eyes had progressive glaucomatous optic nerve changes and were classified as having pre-perimetric glaucoma and 61 (54.0%) eyes did not have progressive glaucomatous optic nerve changes (followed untreated for an average of 9.4±3.2 years) and were classified as normal. The areas under the ROC curves were 0.89 (95% CI: 0.84-0.95) for global RNFLT and 0.75 (95% CI: 0.65-0.85) for global BMO-MRW (p=0.006). The sensitivity at 95% specificity was 60% for the global RNFLT parameter and 40% for the global BMO-MRW parameter. The RNFLT parameters that achieved areas under ROC curve ≥0.80 were global (0.89), supero-temporal (0.80), infero-temporal (0.87), and supero-nasal (0.81). The only BMOBRW parameter that achieved area under ROC curve ≥0.80 was infero-temporal (0.82).
Our findings suggest that RNFLT parameters may be better able to identify pre-perimetric glaucomatous damage in glaucoma suspects than BMO-MRW.
比较应用谱域光学相干断层扫描（SDOCT）测量的视网膜神经纤维层厚度（RNFLT）和 Bruch 膜开口最小边缘宽度（BMO-MRW）诊断疑似青光眼患者的青光眼。
观察性队列研究。
81 例疑似青光眼患者的 113 只眼，依据视神经外观。
应用 SDOCT 对参与者进行成像，测量 RNFLT 和 BMO-MRW。所有参与者在成像时的视野均正常，但基于临床检查中视盘的外观，被认为是疑似病例。根据在成像前发生的视神经或视网膜神经纤维层外观的进行性青光眼改变的有记录的立体照相证据，将眼睛分类为青光眼或非青光眼。对于每个参数，我们计算了接收者操作特征（ROC）曲线下的面积和固定特异性为 80%和 95%时的灵敏度。
ROC 曲线下的面积。
在 113 只疑似青光眼的眼中，52 只（46.0%）眼有进行性青光眼视神经改变，被分类为有前期青光眼，61 只（54.0%）眼无进行性青光眼视神经改变（未经治疗随访平均 9.4±3.2 年），被分类为正常。全局 RNFLT 的 ROC 曲线下面积为 0.89（95%CI：0.84-0.95），全局 BMO-MRW 的 ROC 曲线下面积为 0.75（95%CI：0.65-0.85）（p=0.006）。在特异性为 95%时，全局 RNFLT 参数的灵敏度为 60%，全局 BMO-MRW 参数的灵敏度为 40%。ROC 曲线下面积≥0.80 的 RNFLT 参数为全局（0.89）、上颞（0.80）、下颞（0.87）和上鼻（0.81）。达到 ROC 曲线下面积≥0.80 的唯一 BMOBRW 参数是下颞（0.82）。
我们的研究结果表明，与 BMO-MRW 相比，RNFLT 参数可能更能识别疑似青光眼患者的前期青光眼损伤。
