Global optical coherence tomography measures for detecting the progression of glaucoma have fundamental flaws.
Global optical coherence tomography measures for detecting the progression of glaucoma have fundamental flaws.
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用于检测青光眼进展的全球光学相干断层扫描措施具有基本缺陷。
DOI：
10.1038/s41433-020-01296-x
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Hood DC
中科院分区：
文献类型：
--
作者：
Sun A;Tsamis E;Eguia MD;Liebmann JM;Blumberg DM;Al-Aswad LA;Cioffi GA;Gustavo De Moraes C;Hood DC
了解使用整体OCT测量检测早期青光眼进展所涉及的问题。76例患者和28例健康对照（HC）的眼睛至少间隔1年进行了两次OCT扫描。为了确定95%置信区间（CI），151只眼（49例HC和102例患者）在6个月内至少进行了两次扫描。24-2眼平均偏差≥-6dB。计算视乳头周围视网膜神经纤维层（cRNFL）的平均（总体）厚度GONH和视网膜神经节细胞层加内丛状层（RGCLP）的平均（总体）厚度Gmac。使用分位数回归，确定95% CI区间。CI之外的眼睛被归类为“进步者”。对于参考标准（RS），四位专家评价了OCT和VF信息。与RS相比，76例患者中的31例（40.8%）眼睛被确定为进展者（RS-P），45例患者和所有28例HC眼睛被确定为非进展者（RS-NP）。该度量错过（假阴性，FN）31个RS-P中的15个（48%）（GONH）和9个（29%）（Gmac）。此外，GONH和/或Gmac错误地将45个患者RS-NP眼睛中的10个（22.2%）和28个HC眼睛中的7个（25%）鉴定为进展（假阳性，FP）。事后分析确定了这些错误的三个原因（分割、居中和局部损伤）。由于OCT扫描中固有的问题（分割和居中），全局度量导致FP和FN，并且由于它们可能错过局部损伤而导致FN。这些问题如果不是不可能的话，也很难纠正，并引起了人们对使用GONH和Gmac检测进展的可重复性的担忧。
To understand the problems involved in using global OCT measures for detecting progression in early glaucoma. Eyes from 76 patients and 28 healthy controls (HC) had a least two OCT scans at least 1 year apart. To determine the 95% confidence intervals (CI), 151 eyes (49 HC and 102 patients) had at least two scans within 6 months. All eyes had 24-2 mean deviation ≥-6dB. The average (global) thicknesses of the circumpapillary retinal nerve fibre layer (cRNFL), GONH, and of the retinal ganglion cell layer plus inner plexiform layer (RGCLP), Gmac, were calculated. Using quantile regression, the 95% CI intervals were determined. Eyes outside the CIs were classified as “progressors.” For a reference standard (RS), four experts evaluated OCT and VF information. Compared to the RS, 31 of the 76 (40.8%) patient eyes were identified as progressors (RS-P), and 45 patient, and all 28 HC, eyes as nonprogressors (RS-NP). The metrics missed (false negative, FN) 15 (48%) (GONH) and 9 (29%) (Gmac) of the 31 RS-P. Further, GONH and/or Gmac falsely identified (false positive, FP) 10 (22.2%) of 45 patient RS-NP eyes and 7 (25%) of the 28 HC eyes as progressing. Post-hoc analysis identified three reasons (segmentation, centring, and local damage) for these errors. Global metrics lead to FPs and FNs because of problems inherent in OCT scanning (segmentation and centring), and to FNs because they can miss local damage. These problems are difficult, if not impossible, to correct, and raise concerns about the advisability of using GONH and Gmac for detecting progression.
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影响因子：
4.4
作者：
Medeiros FA;Zangwill LM;Alencar LM;Bowd C;Sample PA;Susanna R Jr;Weinreb RN
通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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