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Likelihood ratios for glaucoma diagnosis using spectral-domain optical coherence tomography.

ABSTRACT: To present a methodology for calculating likelihood ratios for glaucoma diagnosis for continuous retinal nerve fiber layer (RNFL) thickness measurements from spectral-domain optical coherence tomography (spectral-domain OCT).Observational cohort study.A total of 262 eyes of 187 patients with glaucoma and 190 eyes of 100 control subjects were included in the study. Subjects were recruited from the Diagnostic Innovations Glaucoma Study. Eyes with preperimetric and perimetric glaucomatous damage were included in the glaucoma group. The control group was composed of healthy eyes with normal visual fields from subjects recruited from the general population. All eyes underwent RNFL imaging with Spectralis spectral-domain OCT. Likelihood ratios for glaucoma diagnosis were estimated for specific global RNFL thickness measurements using a methodology based on estimating the tangents to the receiver operating characteristic (ROC) curve.Likelihood ratios could be determined for continuous values of average RNFL thickness. Average RNFL thickness values lower than 86 ?m were associated with positive likelihood ratios (ie, likelihood ratios greater than 1), whereas RNFL thickness values higher than 86 ?m were associated with negative likelihood ratios (ie, likelihood ratios smaller than 1). A modified Fagan nomogram was provided to assist calculation of posttest probability of disease from the calculated likelihood ratios and pretest probability of disease.The methodology allowed calculation of likelihood ratios for specific RNFL thickness values. By avoiding arbitrary categorization of test results, it potentially allows for an improved integration of test results into diagnostic clinical decision making.

SUBMITTER: Lisboa R

PROVIDER: S-EPMC4081013 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Likelihood ratios for glaucoma diagnosis using spectral-domain optical coherence tomography.

Lisboa Renato R Mansouri Kaweh K Zangwill Linda M LM Weinreb Robert N RN Medeiros Felipe A FA

American journal of ophthalmology 20130820 5

<h4>Purpose</h4>To present a methodology for calculating likelihood ratios for glaucoma diagnosis for continuous retinal nerve fiber layer (RNFL) thickness measurements from spectral-domain optical coherence tomography (spectral-domain OCT).<h4>Design</h4>Observational cohort study.<h4>Methods</h4>A total of 262 eyes of 187 patients with glaucoma and 190 eyes of 100 control subjects were included in the study. Subjects were recruited from the Diagnostic Innovations Glaucoma Study. Eyes with prep ...[more]

PMID: 23972303

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Project description:PurposeTo measure choroidal thickness and to determine parameters associated with it.DesignCross-sectional study.ParticipantsSeventy-four glaucoma patients and glaucoma suspects.MethodsSpectral domain optical coherence tomography (SD-OCT) scans were obtained to estimate average choroidal thickness in a group of glaucoma suspects and glaucoma patients. The average thickness was calculated from enhanced depth SD-OCT images and manually analyzed with Image J software. Open-angle glaucoma, open-angle glaucoma suspect, primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspect were defined by published criteria. Glaucoma suspects had normal visual fields bilaterally. Glaucoma was defined by specific criteria for optic disc damage and visual field loss in ?1 eye. The most affected eye was analyzed for comparisons across individuals, and right/left and upper half/lower half comparisons were made to compare thickness against degree of visual field damage.Main outcome measuresAverage macular and peripapillary choroidal thickness measured using SD-OCT.ResultsThe choroidal-scleral interface was visualized in 86% and 96% of the macular and peripapillary scans, respectively. In multivariable linear regression analysis, the macular choroid was significantly thinner in association with 4 features: Longer eyes (22 ?m per mm longer [95% confidence interval (CI), -33, -11]), older individuals (31 ?m thinner per decade older [95% CI, -44, -17]), lower diastolic ocular perfusion pressure (26 ?m thinner per 10 mmHg lower [95% CI, 8, 44]), and thicker central corneas (6 ?m per 10 ?m thicker cornea [95% CI, -10, 0]). The choroid was not significantly thinner in glaucoma patients than in suspects (14 ?m [95% CI, -54, 26]; P = 0.5). Peripapillary choroidal thickness was not significantly different between glaucoma and suspect patients. Thickness was not associated with damage severity as estimated by visual field mean deviation or nerve fiber layer thickness, including comparisons of right with left eye or upper with lower values.ConclusionsAge, axial length, CCT, and diastolic ocular perfusion pressure are significantly associated with choroidal thickness in glaucoma suspects and glaucoma patients. Degree of glaucoma damage was not consistently associated with choroidal thickness.Financial disclosure(s)Proprietary or commercial disclosure may be found after the references.

Dataset Information

Likelihood ratios for glaucoma diagnosis using spectral-domain optical coherence tomography.

Publications

Likelihood ratios for glaucoma diagnosis using spectral-domain optical coherence tomography.

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