Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study
Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study
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DOI：
10.3310/hta22040
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发表时间：
2018-01-01
影响因子：
3.6
通讯作者：
Agiomyrgiannakis, Yannis
中科院分区：
文献类型：
--
作者：
Garway-Heath, David F.;Zhu, Haogang;Agiomyrgiannakis, Yannis
背景：青光眼中进行性视神经损伤导致视力丧失，可通过视野（VF）测试量化。然而，VF测量是高度可变的，使得视力恶化（“进展”）的识别具有挑战性。青光眼性视神经损伤也可以通过光学相干断层扫描（OCT）等成像技术测量。目的：比较结合联合收割机VF和OCT数据与仅VF方法的统计方法，以确定这些方法是否允许（1）更快速地识别青光眼进展和（2）更短或更小的临床试验。设计：方法：在英国青光眼治疗研究（UKGTS）的子集中评估“命中率”（与敏感性相关），并在3个月内进行11次VF和OCT测试的72例稳定性青光眼患者中评估特异性（RAPID数据集）。参考进展检测方法基于Guided Progression Analysis（TM）（GPA）软件（Carl Zeiss Meditec Inc.，都柏林，加利福尼亚州，美国）。指数方法基于先前描述的方法[非平稳威布尔误差回归和空间增强分析（ANSWERS），逐点线性回归排列分析（PoPLR）和结构引导的ANSWERS（sANSWERS）]或基于排列测试（PERM）的新开发的方法，删失值多重插补多变量分层模型（MaHMIC）和多变量广义估计方程，对删失值进行多重插补（MaGIC）。设置：10所大学和普通眼科单位（UKGTS）和1所大学眼科单位（RAPID）。参与者：UKGTS参与者是新诊断的青光眼患者，随机接受降眼压滴剂或安慰剂治疗。干预：用Humphrey场分析仪进行24-2 VF测试，用时域（TD）Stratus OCT（TM）进行视神经成像（Carl Zeiss Meditec Inc.，都柏林，CA，USA）。主要结果测量：标准命中率和特异性，进展时间，未来VF预测误差，UKGTS治疗组中进展的比例，风险比（HR）和研究样本量。GPA的命中率为22.2%，PoPLR为41.6%，ANSWERS为53.8%，sANSWERS为61.3%（所有比较均P
Background: Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision ('progression') challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT).Objective: To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials.Design: Method 'hit rate' (related to sensitivity) was evaluated in subsets of the United Kingdom Glaucoma Treatment Study (UKGTS) and specificity was evaluated in 72 stable glaucoma patients who had 11 VF and OCT tests within 3 months (the RAPID data set). The reference progression detection method was based on Guided Progression Analysis (TM) (GPA) Software (Carl Zeiss Meditec Inc., Dublin, CA, USA). Index methods were based on previously described approaches [Analysis with Non-Stationary Weibull Error Regression and Spatial enhancement (ANSWERS), Permutation analyses Of Pointwise Linear Regression (PoPLR) and structure-guided ANSWERS (sANSWERS)] or newly developed methods based on Permutation Test (PERM), multivariate hierarchical models with multiple imputation for censored values (MaHMIC) and multivariate generalised estimating equations with multiple imputation for censored values (MaGIC).Setting: Ten university and general ophthalmology units (UKGTS) and a single university ophthalmology unit (RAPID).Participants: UKGTS participants were newly diagnosed glaucoma patients randomised to intraocular pressure-lowering drops or placebo. RAPID participants had glaucomatous VF loss, were on treatment and were clinically stable.Interventions: 24-2 VF tests with the Humphrey Field Analyzer and optic nerve imaging with time-domain (TD) Stratus OCT (TM) (Carl Zeiss Meditec Inc., Dublin, CA, USA).Main outcome measures: Criterion hit rate and specificity, time to progression, future VF prediction error, proportion progressing in UKGTS treatment groups, hazard ratios (HRs) and study sample size.Results: Criterion specificity was 95% for all tests; the hit rate was 22.2% for GPA, 41.6% for PoPLR, 53.8% for ANSWERS and 61.3% for sANSWERS (all comparisons p