Department of Psychology, Columbia University.
Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai.
J Glaucoma. 2020 Oct;29(10):833-845. doi: 10.1097/IJG.0000000000001631.
It is generally assumed that optical coherence tomography (OCT) cannot be used to diagnose glaucomatous optic neuropathy (GON) in high myopes. However, this study presents evidence that there is sufficient information in OCT scans to allow for accurate diagnosis of GON in most eyes with high myopia.
The purpose of this study was to test the hypothesis that glaucomatous damage can be accurately diagnosed in most high myopes via an assessment of the OCT results.
One hundred eyes from 60 glaucoma patients or suspects, referred for OCT scans and evaluation, had corrected spherical refractive errors worse than -6 D and/or axial lengths ≥26.5 mm. An OCT specialist judged whether the eye had GON, based upon OCT circle scans of the disc and cube scans centered on the macula. A glaucoma specialist made the same judgement using all available information (eg, family history, repeat visits, intraocular pressure, 10-2 and 24-2 visual fields, OCT). A reference standard was created based upon the glaucoma specialist's classifications. In addition, the glaucoma specialist judged whether the eyes had peripapillary atrophy (PPA), epiretinal membrane (ERM), tilted disc (TD), and/or a paravascular inner retinal defect (PIRD).
The OCT specialist correctly identified 97 of the 100 eyes using the OCT information. In 63% of the cases, the inner circle scan alone was sufficient. For the rest, additional scans were requested. In addition, 81% of the total eyes had: PPA (79%), ERM (18%), PIRD (26%), and/or TD (48%).
For most eyes with high myopia, there is sufficient information in OCT scans to allow for accurate diagnosis of GON. However, the optimal use of the OCT will depend upon training to read OCT scans, which includes taking into consideration myopia related OCT artifacts and segmentation errors, as well as PPA, ERM, PIRD, and TD.
一般认为，光学相干断层扫描（OCT）无法用于诊断高度近视患者的青光眼视神经病变（GON）。然而，本研究表明，OCT 扫描中存在足够的信息，可用于大多数高度近视患者的 GON 准确诊断。
本研究旨在通过评估 OCT 结果来检验这样一个假设，即通过评估 OCT 结果，可以准确诊断大多数高度近视患者的青光眼损伤。
100 只眼来自 60 名青光眼患者或疑似患者，这些患者被转诊进行 OCT 扫描和评估，他们的矫正球镜屈光度大于-6D 和/或眼轴长度大于等于 26.5mm。一位 OCT 专家根据 OCT 对视盘的圆扫描和以黄斑为中心的立方扫描来判断眼睛是否患有 GON。一位青光眼专家使用所有可用信息（例如家族史、复查、眼压、10-2 和 24-2 视野、OCT）进行同样的判断。根据青光眼专家的分类创建了一个参考标准。此外，青光眼专家判断眼睛是否有视盘周围萎缩（PPA）、视网膜内表面膜（ERM）、倾斜盘（TD）和/或血管旁内层视网膜缺损（PIRD）。
OCT 专家仅使用 OCT 信息正确识别了 100 只眼中的 97 只。在 63%的病例中，仅内圆扫描就足够了。对于其余病例，请求了额外的扫描。此外，81%的总眼有：PPA（79%）、ERM（18%）、PIRD（26%）和/或 TD（48%）。
对于大多数高度近视患者来说，OCT 扫描中存在足够的信息，可以进行 GON 的准确诊断。然而，OCT 的最佳使用将取决于阅读 OCT 扫描的培训，包括考虑与近视相关的 OCT 伪影和分割错误，以及 PPA、ERM、PIRD 和 TD。
