Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
Ophthalmol Glaucoma. 2019 Sep-Oct;2(5):336-345. doi: 10.1016/j.ogla.2019.06.003. Epub 2019 Jun 27.
To evaluate the diagnostic accuracy of circumpapillary retinal nerve fiber layer (cRNFL), optic nerve head, and macular parameters for the detection of glaucoma using Heidelberg Spectralis OCT (Heidelberg Engineering, Inc., Heidelberg, Germany).
Cross-sectional study.
Participants of the Northern Ireland Cohort for the Longitudinal Study of Ageing with a vertical cup-to-disc ratio of 0.7 or more, vertical cup-to-disc ratio asymmetry of 0.2 or more, vertical neuroretinal rim ratio of 0.1 or less, intraocular pressure of 25 mmHg or more, or a combination thereof were invited to the study.
Participants underwent clinical examination by a masked glaucoma expert and full-threshold visual field testing to define glaucoma. Five index tests were performed: (1) standard cRNFL thickness, (2) macular Early Treatment Diabetic Retinopathy Study (ETDRS) scans, (3) macular posterior pole asymmetry analysis (PPAA) scans, (4) Bruch's membrane opening minimum rim width (BMO MRW), and (5) Glaucoma Module Premium Edition (GMPE) cRNFL Anatomic Positioning System (APS) scans. We analyzed the eye with more advanced disease per participant.
Analysis of receiver operating characteristic (ROC) curve; area under the ROC curve (AUC); and partial AUC (pAUC) at specificity of 0.80 to 1, 0.90 to 1, and 0.95 to 1. Sensitivity at 0.95 specificity and specificity at 0.95 sensitivity were reported. Primary analysis included all available scans.
One hundred twenty-eight eyes from 128 participants were enrolled (52 eyes with perimetric glaucoma and 76 eyes without glaucoma). One hundred thirteen standard cRNFL thickness scans; 107 GMPE cRNFL APS 3.5-mm, 4.1-mm, and 4.7-mm scans; 107 BMO-MRW scans; 98 ETDRS scans; and 97 PPAA scans were available. Standard cRNFL mean global thickness showed highest AUC (0.869; 95% confidence interval [CI], 0.800-0.938) and the highest pAUC at specificity of 0.80 to 1 (0.815; 95% CI, 0.742-0.887), at specificity of 0.90 to 1 (0.794; 95% CI, 0.713-0.875), and at specificity of 0.95 to 1 (0.765; 95% CI, 0.696-0.861). Standard cRNFL mean global thickness scans provided the highest sensitivity at 0.95 specificity (0.630), whereas ETDRS mGCL outer inferior sector provided the highest specificity at 0.95 sensitivity (0.522).
Macular and optic nerve head OCT parameters were not better than cRNFL measurements to diagnose glaucoma in this population.
评估海德堡光谱光学相干断层扫描仪（海德堡工程公司，德国海德堡）检测青光眼的周边视网膜神经纤维层（cRNFL）、视盘和黄斑参数的诊断准确性。
横断面研究。
具有垂直杯盘比 0.7 或更高、垂直杯盘比不对称 0.2 或更高、垂直神经视网膜边缘比 0.1 或更低、眼压 25mmHg 或更高或其组合的北爱尔兰队列研究纵向老龄化的参与者被邀请参加该研究。
参与者由一名盲法青光眼专家进行临床检查，并进行全阈值视野检查以确定青光眼。进行了五项指数测试：（1）标准 cRNFL 厚度，（2）黄斑早期糖尿病视网膜病变研究（ETDRS）扫描，（3）黄斑后极区不对称分析（PPAA）扫描，（4）Bruch 膜开口最小边缘宽度（BMO MRW）和（5）青光眼模块高级版（GMPE）cRNFL 解剖定位系统（APS）扫描。我们分析了每位参与者中病变更严重的眼睛。
接收者操作特征（ROC）曲线分析；ROC 曲线下面积（AUC）；特异性为 0.80 到 1、0.90 到 1 和 0.95 到 1 时的部分 AUC（pAUC）。报告了特异性为 0.95 时的敏感性和特异性为 0.95 时的特异性。主要分析包括所有可用的扫描。
共有 128 名参与者的 128 只眼入组（52 只眼有周边青光眼，76 只眼没有青光眼）。共有 113 份标准 cRNFL 厚度扫描；107 份 GMPE cRNFL APS 3.5mm、4.1mm 和 4.7mm 扫描；107 份 BMO-MRW 扫描；98 份 ETDRS 扫描；97 份 PPAA 扫描。标准 cRNFL 平均全层厚度显示出最高的 AUC（0.869；95%置信区间[CI]，0.800-0.938）和特异性为 0.80 到 1 时的最高 pAUC（0.815；95%CI，0.742-0.887），特异性为 0.90 到 1 时的 pAUC（0.794；95%CI，0.713-0.875），特异性为 0.95 到 1 时的 pAUC（0.765；95%CI，0.696-0.861）。标准 cRNFL 平均全层厚度扫描在特异性为 0.95 时提供了最高的敏感性（0.630），而 ETDRS mGCL 外下象限在特异性为 0.95 时提供了最高的特异性（0.522）。
在该人群中，黄斑和视盘 OCT 参数不如 cRNFL 测量结果诊断青光眼。
