Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
Br J Ophthalmol. 2022 Dec;106(12):1703-1709. doi: 10.1136/bjophthalmol-2020-318677. Epub 2021 Jun 28.
To assess the effects of algorithms and covariates in glaucoma diagnosis with optical coherence tomography angiography (OCTA).
In this prospective cross-sectional study, one eye each of 36 normal controls and 64 patients with glaucoma underwent 4.5 mm disc-centred and 6 mm macula-centred OCTA scans. The peripapillary nerve fibre layer plexus capillary density (NFLP-CD) and macular superficial vascular complex vessel density (SVC-VD) were measured using both a commercial algorithm (AngioAnalytics) and a custom algorithm (Center for Ophthalmic Optics & Lasers Angiography Reading Toolkit (COOL-ART)). The nerve fibre layer and ganglion cell complex thicknesses were measured on structural OCT.
The overall peripapillary NFLP-CD and macular SVC-VD measured with the two algorithms were highly correlated but poorly agreed. Among the normal controls, the perfusion measurements made by both algorithms were significantly correlated with age. AngioAnalytics measurements were also correlated with signal strength index, while COOL-ART measurements were not. These covariates were adjusted. The diagnostic accuracy, measured as the area under the receiver operating characteristic curve for glaucoma detection, was not significantly different between algorithms, between structural and perfusion parameters and between the peripapillary and macular regions (All p>0.05). The macular SVC-VD in the 6 mm square had a significantly higher diagnostic accuracy than that of the central 3 mm square area (p=0.005).
AngioAnalytics and COOL-ART vessel density measurements are not interchangeable but potentially interconvertible. Age and signal strength are significant covariates that need to be considered. Both algorithms and both peripapillary and macular perfusion parameters have similarly good diagnostic accuracy comparable to structural OCT. A larger macular analytic area provides higher diagnostic accuracy.
评估光学相干断层扫描血管造影（OCTA）中算法和协变量在青光眼诊断中的作用。
在这项前瞻性的横断面研究中，对 36 名正常对照者和 64 名青光眼患者的每只眼进行了 4.5mm 视盘中心和 6mm 黄斑中心 OCTA 扫描。使用商业算法（AngioAnalytics）和定制算法（眼科光学与激光血管造影解读工具包（COOL-ART））测量了神经纤维层丛毛细血管密度（NFLP-CD）和黄斑浅层血管复合体血管密度（SVC-VD）。结构 OCT 测量了神经纤维层和节细胞复合体的厚度。
两种算法测量的整体视盘周围 NFLP-CD 和黄斑 SVC-VD 高度相关但一致性差。在正常对照组中，两种算法的灌注测量均与年龄显著相关。AngioAnalytics 测量值与信号强度指数相关，而 COOL-ART 测量值则不相关。调整了这些协变量。以青光眼检测的接收者操作特征曲线下面积（AUC）衡量的诊断准确性，在算法之间、结构和灌注参数之间以及视盘周围和黄斑区域之间均无显著差异（均 P>0.05）。6mm 正方形黄斑 SVC-VD 的诊断准确性明显高于中央 3mm 正方形区域（P=0.005）。
AngioAnalytics 和 COOL-ART 血管密度测量值不可互换，但可相互转换。年龄和信号强度是需要考虑的重要协变量。两种算法以及视盘周围和黄斑灌注参数均具有相似的良好诊断准确性，与结构 OCT 相当。较大的黄斑分析区域可提供更高的诊断准确性。
