Department of Ophthalmology, University Medical Center Munster, Albert-Schweitzer-Campus 1, Building D15, 48149, Munster, Germany.
Graefes Arch Clin Exp Ophthalmol. 2024 Jun;262(6):1899-1910. doi: 10.1007/s00417-024-06375-3. Epub 2024 Jan 19.
BACKGROUND/AIM: The aim of this paper is to compare retinal nerve fiber layer thickness (RNFL) and Bruch's membrane opening-based minimum rim width (BMO-MRW) in terms of their performance in detecting early and moderate/advanced glaucoma using receiver operating characteristics (ROC) analysis and the classification using the 5th percentile as a cut-off.
One hundred eyes from 100 patients with early glaucoma (mean deviation (MD): < -5.0 dB) and 100 eyes from 100 patients with moderate/advanced glaucoma (MD: > -5.0 dB) were carefully matched to healthy controls based on optic disc size. Then, the dataset was divided, based on the 50th percentile of the measured Bruch's membrane opening area (BMO-A), into small (BMO-A < 1.95 mm) and large optic discs (BMO-A > 1.95 mm). Finally, the discriminative performance of BMO-MRW and RNFL between glaucoma and controls using ROC analysis and the manufacturer's classification based on the 5th percentile was analyzed.
In discriminating between glaucoma and matched healthy controls, global BMO-MRW and global RNFL thickness had comparable areas under the ROC curve for eyes with early glaucoma and both small BMO-As (ROC ± confidence interval [CI] 0.91 [0.87 to 0.95] and 0.88 [0.83 to 0.93]) and large BMO-As (0.86 [0.82 to 0.92] and 0.84 [0.79 to 0.90]), as well as in moderate/advanced glaucoma with small BMO-As (0.99 [0.98 to 1.00] and 0.97 [0.95 to 1.00]) and large BMO-As (0.94 [0.91 to 0.98] and 0.97 [0.94 to 1.00]). Using the calculated 5th percentile as a threshold value, the sensitivities for the detection of early and moderate/advanced glaucoma were comparable for BMO-MRW and RNFL in eyes with small optic discs (early glaucoma: fifty-two percent and 61%; moderate/advanced glaucoma: ninety-one percent and 92%). In eyes with large optic discs, the sensitivity of BMO-MRW was inferior to that of RNFL for both early (38% versus 51%) and moderate/advanced (80% versus 91%) glaucoma.
Based on an ROC analysis, the discriminative performance of BMO-MRW and RNFL between patients with early and moderate/advanced glaucoma and a healthy control group matched based on optic disc size is comparable in eyes with BMO-As smaller and larger 1.95 mm. Using a classification based on the 5th percentile, as used in clinical practice, RNFL is shown to be superior to BMO-MRW regarding sensitivity in glaucoma detection with large optic discs. This study underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma, especially in cases of large optic discs.
背景/目的：本文旨在通过接收者操作特征（ROC）分析和使用第 5 百分位数作为截断值的分类，比较视网膜神经纤维层厚度（RNFL）和基于 Bruch 膜开口最小边缘宽度（BMO-MRW）在检测早期和中/晚期青光眼方面的性能。
根据视盘大小，将 100 例早期青光眼患者（平均偏差（MD）：< -5.0 dB）和 100 例中/晚期青光眼患者（MD：> -5.0 dB）的 100 只眼与健康对照组仔细匹配。然后，根据测量的 Bruch 膜开口面积（BMO-A）的第 50 百分位数，将数据集分为小（BMO-A < 1.95 mm）和大视盘（BMO-A > 1.95 mm）。最后，使用 ROC 分析和制造商基于第 5 百分位数的分类，分析 BMO-MRW 和 RNFL 在青光眼患者和对照组之间的判别性能。
在区分青光眼患者和匹配的健康对照组方面，早期青光眼患者的全局 BMO-MRW 和全局 RNFL 厚度的 ROC 曲线下面积具有可比性，并且对于小的 BMO-A（ROC ±置信区间 [CI] 0.91 [0.87 至 0.95] 和 0.88 [0.83 至 0.93]）和大的 BMO-A（0.86 [0.82 至 0.92] 和 0.84 [0.79 至 0.90]），以及中/晚期青光眼患者的小 BMO-A（0.99 [0.98 至 1.00] 和 0.97 [0.95 至 1.00]）和大 BMO-A（0.94 [0.91 至 0.98] 和 0.97 [0.94 至 1.00]）也具有可比性。使用计算出的第 5 百分位数作为阈值，在小视盘（早期青光眼：52%和 61%；中/晚期青光眼：91%和 92%）中，BMO-MRW 和 RNFL 检测早期和中/晚期青光眼的敏感性相当。在大视盘的情况下，BMO-MRW 的敏感性低于 RNFL，无论是早期（38%比 51%）还是中/晚期（80%比 91%）青光眼。
基于 ROC 分析，基于视盘大小匹配的早期和中/晚期青光眼患者与健康对照组之间的 BMO-MRW 和 RNFL 的判别性能在 BMO-A 较小和较大 1.95 mm 时是可比的。使用基于第 5 百分位数的分类，如临床实践中使用的分类，在大视盘的青光眼检测中，RNFL 的敏感性优于 BMO-MRW。本研究强调了 RNFL 成像和测量在青光眼诊断评估中的重要性，特别是在大视盘的情况下。
