Comparison of retinal nerve fiber layer and optic disc imaging for diagnosing glaucoma in patients suspected of having the disease
Comparison of retinal nerve fiber layer and optic disc imaging for diagnosing glaucoma in patients suspected of having the disease
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DOI：
10.1016/j.ophtha.2007.11.008
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发表时间：
2008-08-01
期刊：
影响因子：
13.7
通讯作者：
Weinreb, Robert N.
中科院分区：
文献类型：
--
作者：
Medeiros, Felipe A.;Vizzeri, Gianmarco;Weinreb, Robert N.
目的：比较视网膜神经纤维层 (RNFL) 和视盘地形成像用于检测疑似青光眼患者的视神经损伤。设计：观察性队列研究。参与者：根据视神经外观疑似青光眼的 82 名患者。方法：所有患者均使用 GDx VCC 扫描激光偏振计和 HRT（软件版本 3.0）共焦扫描激光进行成像检眼镜。所有患者在成像时均具有正常的标准自动视野检查视野，并根据成像前记录的视神经外观进行性青光眼性改变的立体摄影证据进行分类。主要结果指标：使用受试者工作特征 (ROC) 曲线下面积来评估 GDx VCC 和 HRT 的诊断准确性。结果：40 只患有进行性青光眼性视神经改变的眼睛被纳入青光眼中正常组包括 42 只眼睛，没有任何视神经进行性损伤的证据，平均随访时间为 8.97 +/- 3.08 年，未接受治疗。 GDx VCC（神经纤维指标 [NFI]）最佳参数的 ROC 曲线下面积显着大于 HRT（边缘体积）最佳参数的 ROC 曲线下面积（0.83 vs. 0.70；P = 0.044）。 NFI 参数的 ROC 曲线面积也比与轮廓线无关的参数青光眼概率评分的 ROC 曲线面积更大（0.83 vs. 0.68；P = 0.023）。假设边界结果正常，Moorfields 回归分析分类的敏感性为 48%，特异性为 69%。对于类似的特异性 (70%)，参数 NFI 具有显着更高的敏感性 (83%) (P = 0.003)。 结论：在检测疑似青光眼患者的早期损伤方面，使用 GDx VCC 进行的视网膜神经纤维层成像比使用 HRT 进行的视盘地形评估具有更优越的性能。对于青光眼诊断，这些结果表明，当这些测试与视神经的临床检查相结合时，GDx VCC 可能比 HRT 更具优势。
Purpose: To compare retinal nerve fiber layer (RNFL) and optic disc topographic imaging for detection of optic nerve damage in patients suspected of having glaucoma.Design: Observational cohort study.Participants: A cohort of 82 patients suspected of having glaucoma based on the appearance of the optic nerve.Methods: All patients were imaged using the GDx VCC scanning laser polarimeter and HRT (software version 3.0) confocal scanning laser ophthalmoscope. All patients had normal standard automated perimetry visual fields at the time of imaging and were classified based on history of documented stereo photographic evidence of progressive glaucomatous change in the appearance of the optic nerve occurring before the imaging sessions.Main Outcome Measures: Areas under the receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracies of GDx VCC and the HRT.Results: Forty eyes with progressive glaucomatous optic nerve change were included in the glaucoma group, and 42 eyes without any evidence of progressive damage to the optic nerve followed untreated for an average time of 8.97 +/- 3.08 years were included in the normal group. The area under the ROC curve for the best parameter from GDx VCC (nerve fiber indicator [NFI]) was significantly larger than that of the best parameter from the HRT (rim volume) (0.83 vs. 0.70; P = 0.044). The NFI parameter also had a larger ROC curve area than that of the contour line-independent parameter glaucoma probability score (0.83 vs. 0.68; P = 0.023). Assuming borderline results as normal, the Moorfields regression analysis classification had a sensitivity of 48% for specificity of 69%. For a similar specificity (70%), the parameter NFI had a significantly larger sensitivity (83%) (P = 0.003).Conclusions: Retinal nerve fiber layer imaging with GDx VCC had a superior performance versus topographic optic disc assessment with the HRT for detecting early damage in patients suspected of having glaucoma. For glaucoma diagnosis, these results suggest that GDx VCC may offer advantage over the HRT when these tests are combined with clinical examination of the optic nerve.