检测晚期青光眼的进展：光学相干断层扫描全局指标是否可行的测量方法？

Detecting Progression in Advanced Glaucoma: Are Optical Coherence Tomography Global Metrics Viable Measures?

机构信息

Columbia Vagelos College of Physicians and Surgeons, New York, New York.

Department of Psychology, Columbia University, New York, New York.

出版信息

Optom Vis Sci. 2021 May 1;98(5):518-530. doi: 10.1097/OPX.0000000000001697.

DOI:10.1097/OPX.0000000000001697

PMID:33973920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8673437/

Abstract

SIGNIFICANCE

Optical coherence tomography (OCT) summary measures have been suggested as a way to detect progression in eyes with advanced glaucoma. Here, we show that these measures have serious flaws largely due to segmentation errors. However, inspection of the images and thickness maps can be clinically useful.

PURPOSE

This study aimed to test the hypothesis that recently suggested global OCT measures for detecting progression in eyes with advanced progression are seriously affected by segmentation mistakes and other errors that limit their clinical utility.

METHODS

Forty-five eyes of 38 patients with a 24-2 mean deviation worse than -12 dB had at least two spectral domain OCT sessions (0.8 to 4.4 years apart) with 3.5-mm circle scans of the disc and cube scans centered on the fovea. Average (global) circumpapillary retinal nerve fiber layer thickness, GcRNFL, and ganglion cell plus inner plexiform layer thickness, GGCLP, were obtained from the circle and cube scan, respectively. To evaluate progression, ΔGcRNFL was calculated for each eye as the GcRNFL value at time 2 minus the value at time 1, and ΔGGCLP was calculated in a similar manner. The b-scans of the six eyes with the highest and lowest ΔGcRNFL and ΔGGCLP values were examined for progression as well as segmentation, alignment, and centering errors.

RESULTS

Progression was a major factor in only 7 of the 12 eyes with the most negative values of either ΔGcRNFL or ΔGGCLP, whereas segmentation played a role in 8 eyes and was the major factor in all 12 eyes with the largest positive values. In addition, alignment (one eye) and other (three eyes) errors played a secondary role in four of the six eyes with the most negative ΔGcRNFL values.

CONCLUSIONS

For detecting the progression of advanced glaucoma, common summary metrics have serious flaws largely due to segmentation errors, which limit their utility in clinical and research settings.

摘要

意义

光学相干断层扫描（OCT）总结测量已被建议作为一种检测晚期青光眼患者进展的方法。在这里，我们表明这些措施存在严重缺陷，主要是由于分割错误。然而，对图像和厚度图的检查在临床上可能是有用的。

目的

本研究旨在检验以下假设：最近提出的用于检测晚期进展性青光眼进展的全球 OCT 测量值，由于分割错误以及限制其临床实用性的其他错误，受到严重影响。

方法

45 只眼睛，38 名患者，平均（全球）视盘周围视网膜神经纤维层厚度（circumpapillary retinal nerve fiber layer thickness，GCcRNFL）平均缺损（mean deviation，MD）为-12 dB 以下，最差为-24-2 dB，至少有两次光谱域 OCT 检查（相隔 0.8 至 4.4 年），使用 3.5-mm 圆扫描视盘和以黄斑为中心的立方扫描。从圆扫描和立方扫描中分别获得平均（GCcRNFL）和节细胞加内丛状层厚度（ganglion cell plus inner plexiform layer thickness，GGCLP）。为了评估进展，计算每只眼的 ΔGcRNFL，即时间 2 的 GcRNFL 值减去时间 1 的值，以类似的方式计算 ΔGGCLP。检查了 6 只眼睛中 b 扫描，这些眼睛的 ΔGcRNFL 和 ΔGGCLP 值最高和最低，以评估进展以及分割、对准和居中误差。

结果

在 12 只眼睛中，只有 7 只眼睛的 ΔGcRNFL 或 ΔGGCLP 值为负，进展是一个主要因素，而在 8 只眼睛中，分割起作用，在所有 12 只眼睛中，ΔGGCLP 值为正，分割是主要因素。此外，在 6 只眼睛中，有 4 只眼睛的 ΔGcRNFL 值最低，对准（一只眼睛）和其他（三只眼睛）误差起次要作用。