Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
JAMA Ophthalmol. 2023 Jul 1;141(7):631-639. doi: 10.1001/jamaophthalmol.2023.1717.
Diagnosis of glaucoma in highly myopic eyes is challenging. This study compared the glaucoma detection utility of various optical coherence tomography (OCT) parameters for high myopia.
To compare the diagnostic accuracy of single OCT parameters, the University of North Carolina (UNC) OCT Index, and the temporal raphe sign for discrimination of glaucoma in patients with high myopia.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study conducted from January 1, 2014, and January 1, 2022. Participants with high myopia (axial length ≥26.0 mm or spherical equivalent ≤-6 diopters) plus glaucoma and participants with high myopia without glaucoma were recruited from a single tertiary hospital in South Korea.
Macular ganglion cell-inner plexiform layer (GCIPL) thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters were measured in each participant. The UNC OCT scores and the temporal raphe sign were checked to compare diagnostic utility. Decision tree analysis with single OCT parameters, the UNC OCT Index, and the temporal raphe sign were also applied.
Area under the receiver operating characteristic curve (AUROC).
A total of 132 individuals with high myopia and glaucoma (mean [SD] age, 50.0 [11.7] years; 78 male [59.1%]) along with 142 individuals with high myopia without glaucoma (mean [SD] age, 50.0 [11.3] years; 79 female [55.6%]) were included in the study. The AUROC of the UNC OCT Index was 0.891 (95% CI, 0.848-0.925). The AUROC of temporal raphe sign positivity was 0.922 (95% CI, 0.883-0.950). The best single OCT parameter was inferotemporal GCIPL thickness (AUROC, 0.951; 95% CI, 0.918-0.973), and its AUROC difference from the UNC OCT Index, temporal raphe sign, mean RNFL thickness, and ONH rim area was 0.060 (95% CI, 0.016-0.103; P = .007); 0.029 (95% CI, -0.009 to 0.068; P = .13), 0.022 (95% CI, -0.012-0.055; P = .21), and 0.075 (95% CI, 0.031-0.118; P < .001), respectively.
Results of this cross-sectional study suggest that in discriminating glaucomatous eyes in patients with high myopia, inferotemporal GCIPL thickness yielded the highest AUROC value. The RNFL thickness and GCIPL thickness parameters may play a greater role in glaucoma diagnosis than the ONH parameters in high myopia.
重要性：在高度近视的眼中诊断青光眼具有挑战性。本研究比较了各种光学相干断层扫描（OCT）参数在高度近视中的青光眼检测效用。
目的：比较单一 OCT 参数、北卡罗来纳大学（UNC）OCT 指数和 temporal raphe 征在区分高度近视患者青光眼方面的诊断准确性。
设计、地点和参与者：这是一项回顾性横断面研究，于 2014 年 1 月 1 日至 2022 年 1 月 1 日进行。参与者为高度近视（眼轴长度≥26.0 毫米或等效球镜度数≤-6 屈光度）伴青光眼和高度近视不伴青光眼的患者，均来自韩国的一家三级医院。
暴露因素：在每个参与者中测量了黄斑神经节细胞内丛状层（GCIPL）厚度、视盘周围视网膜神经纤维层（RNFL）厚度和视神经头（ONH）参数。检查了 UNC OCT 评分和 temporal raphe 征以比较诊断效用。还应用了基于决策树分析的单一 OCT 参数、UNC OCT 指数和 temporal raphe 征。
主要结果和测量指标：受试者工作特征曲线下面积（AUROC）。
结果：共有 132 名高度近视伴青光眼（平均[标准差]年龄，50.0[11.7]岁；78 名男性[59.1%]）和 142 名高度近视不伴青光眼（平均[标准差]年龄，50.0[11.3]岁；79 名女性[55.6%]）的患者纳入研究。UNC OCT 指数的 AUROC 为 0.891（95%置信区间，0.848-0.925）。temporal raphe 征阳性的 AUROC 为 0.922（95%置信区间，0.883-0.950）。最佳的单一 OCT 参数是下颞侧 GCIPL 厚度（AUROC，0.951；95%置信区间，0.918-0.973），其与 UNC OCT 指数、temporal raphe 征、平均 RNFL 厚度和 ONH 边缘面积的 AUROC 差异为 0.060（95%置信区间，0.016-0.103；P=0.007）；0.029（95%置信区间，-0.009 至 0.068；P=0.13）；0.022（95%置信区间，-0.012 至 0.055；P=0.21）；0.075（95%置信区间，0.031 至 0.118；P<0.001）。
结论：这项横断面研究的结果表明，在区分高度近视患者的青光眼眼中，下颞侧 GCIPL 厚度产生的 AUROC 值最高。在高度近视中，RNFL 厚度和 GCIPL 厚度参数在青光眼诊断中的作用可能大于 ONH 参数。
