Dataset Information

Optic Disc Image Subtraction as an Aid to Detect Glaucoma Progression.

ABSTRACT: To present a digital image subtraction technique to alert clinicians to signs of glaucomatous optic disc progression.Ninety-two glaucomatous eyes (65 patients) were included. Thirty-three eyes were identified as progressive and 59 as stable based on comparison of baseline and follow-up stereoscopic disc photographs by three masked glaucoma specialists. The disc images were aligned and converted to gray scale and underwent histogram matching to enhance contrast and account for illumination differences. The difference in image intensity between baseline and follow-up images was shown as a colormap superimposed on the grayscale follow-up image. A graded scale (1, no progression, to 5, definitive progression) was used by three masked glaucoma experts to score progression probability on the colormap images. Sensitivity, specificity, and accuracy of the classification were computed. Weighted ? statistics summarized agreement of categorical gradings.Median time interval between two visits was 4.4 years (range: 1.0-16.8). Clinicians detected glaucoma deterioration in 25 to 27 of the progressive group and 8 to 10 of stable eyes based on subtraction maps. Sensitivities/specificities of the clinicians were 0.76 to 0.82 and 0.86 to 0.89, respectively. Classification accuracy ranged from 81.5% to 84.8%. Agreement among clinicians was good (weighted ? = 0.68; 95% confidence interval [CI]: 0.60-0.77) for progression grades (1-5 scales) and was substantial (weighted ? = 0.81; 95% CI: 0.74-0.85) for binary scores.The proposed software provides a single static image that clinicians can use with other structural/functional tests to detect glaucoma progression.Provision of a subtraction colormap in the setting of electronic medical records can improve monitoring of glaucoma by alerting clinicians to possible signs of progression.

SUBMITTER: Amini N

PROVIDER: S-EPMC5661381 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Optic Disc Image Subtraction as an Aid to Detect Glaucoma Progression.

Amini Navid N Alizadeh Reza R Parivisutt Nucharee N Kim EunAh E Nouri-Mahdavi Kouros K Caprioli Joseph J

Translational vision science & technology 20171027 5

<h4>Purpose</h4>To present a digital image subtraction technique to alert clinicians to signs of glaucomatous optic disc progression.<h4>Methods</h4>Ninety-two glaucomatous eyes (65 patients) were included. Thirty-three eyes were identified as progressive and 59 as stable based on comparison of baseline and follow-up stereoscopic disc photographs by three masked glaucoma specialists. The disc images were aligned and converted to gray scale and underwent histogram matching to enhance contrast and ...[more]

PMID: 29090107

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Project description:PurposeTo compare the diagnostic performance of automated imaging for glaucoma.DesignProspective, direct comparison study.ParticipantsAdults with suspected glaucoma or ocular hypertension referred to hospital eye services in the United Kingdom.MethodsWe evaluated 4 automated imaging test algorithms: the Heidelberg Retinal Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany) glaucoma probability score (GPS), the HRT Moorfields regression analysis (MRA), scanning laser polarimetry (GDx enhanced corneal compensation; Glaucoma Diagnostics (GDx), Carl Zeiss Meditec, Dublin, CA) nerve fiber indicator (NFI), and Spectralis optical coherence tomography (OCT; Heidelberg Engineering) retinal nerve fiber layer (RNFL) classification. We defined abnormal tests as an automated classification of outside normal limits for HRT and OCT or NFI ≥ 56 (GDx). We conducted a sensitivity analysis, using borderline abnormal image classifications. The reference standard was clinical diagnosis by a masked glaucoma expert including standardized clinical assessment and automated perimetry. We analyzed 1 eye per patient (the one with more advanced disease). We also evaluated the performance according to severity and using a combination of 2 technologies.Main outcome measuresSensitivity and specificity, likelihood ratios, diagnostic, odds ratio, and proportion of indeterminate tests.ResultsWe recruited 955 participants, and 943 were included in the analysis. The average age was 60.5 years (standard deviation, 13.8 years); 51.1% were women. Glaucoma was diagnosed in at least 1 eye in 16.8%; 32% of participants had no glaucoma-related findings. The HRT MRA had the highest sensitivity (87.0%; 95% confidence interval [CI], 80.2%-92.1%), but lowest specificity (63.9%; 95% CI, 60.2%-67.4%); GDx had the lowest sensitivity (35.1%; 95% CI, 27.0%-43.8%), but the highest specificity (97.2%; 95% CI, 95.6%-98.3%). The HRT GPS sensitivity was 81.5% (95% CI, 73.9%-87.6%), and specificity was 67.7% (95% CI, 64.2%-71.2%); OCT sensitivity was 76.9% (95% CI, 69.2%-83.4%), and specificity was 78.5% (95% CI, 75.4%-81.4%). Including only eyes with severe glaucoma, sensitivity increased: HRT MRA, HRT GPS, and OCT would miss 5% of eyes, and GDx would miss 21% of eyes. A combination of 2 different tests did not improve the accuracy substantially.ConclusionsAutomated imaging technologies can aid clinicians in diagnosing glaucoma, but may not replace current strategies because they can miss some cases of severe glaucoma.

Project description:To investigate optic disc hemorrhage (DH)'s clinical implications to subsequent progression of primary open-angle glaucoma (POAG) in cases of mild-to-moderate myopia.Retrospective comparative study.(1) Fifty-nine (59) myopic (26.5 mm > axial length [AXL] ? 24.0 mm) POAG patients with DH and (2) 59 age-, AXL-, and mean deviation (MD) of visual field (VF)-matched controls without DH were evaluated over the course of a minimum 3.5 years of follow up. For clear assessment of the effect of DH on progression of glaucoma, the patients selected for inclusion in the study were those with stable IOP (i.e., those showing an at least 20% reduction relative to the baseline IOP) whose IOP-lowering medication was not increased, supplemented or changed during the follow-up period.The patients' optic disc/retinal nerve fiber layer (RNFL) photographs were independently evaluated by three glaucoma specialists for structural progression of glaucoma. Event-based analysis with Guided Progression Analysis (GPA) software was used to determine their functional progression. The durations of structural and functional progression were compared by Kaplan-Meier life survival analyses.Optic disc/RNFL progression and VF progression.The mean follow-up periods between the DH and non-DH groups were not significantly different: in the DH group, 5.6±2.7 years; in the non-DH group, 5.4±2.6 years (P = 0.588). In the DH group, 30 (50.8%) of 59 eyes manifested optic disc/RNFL deterioration; in the non-DH group, however, only 17 (28.8%) of 59 eyes showed structural progression. For the DH group, the cumulative probability of structural glaucoma progression was significantly greater than for the non-DH group (P = 0.001; log rank test). Interestingly, the two groups did not significantly differ in the cumulative probability of functional progression (P = 0.79; log rank test): in the DH group, VF progression was observed in 14 eyes (23.7%); in the non-DH group, in 12 eyes (20.3%).DH was associated with a greater probability of structural progression in medically well-controlled-IOP POAG eyes with mild-to-moderate myopia. However, the relevance of DH to VF progression was not clear over the course of the average 5.5-year duration of the study.

Project description:PurposeThe influence of myopia on glaucoma progression remains unknown, possibly because of the multifactorial nature of glaucoma and difficulty in assessing a solo contribution of myopia. The purpose of this study is to investigate the association of myopia with visual field (VF) progression in glaucoma using a paired-eye design to minimize the influence of confounding systemic factors that are diverse among individuals.MethodsThis retrospective study evaluated 144 eyes of 72 subjects with open-angle glaucoma, with similar intra-ocular pressure between paired eyes, spherical equivalent (SE) ≤ -2 diopter (D), and axial length ≥ 24 mm. Paired eyes with faster and slower VF progression were grouped separately, according to the global VF progression rate assessed by automated pointwise linear regression analysis. The SE, axial length, tilt ratio and torsion angle of optic discs, Bruch's membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were compared between the two groups. Factors associated with faster VF progression were determined by logistic regression analysis.ResultsThe mean follow-up duration was 8.9 ± 4.4 years. The mean value of SE and axial length were -6.31 ± 1.88 D and 26.05 ± 1.12 mm, respectively. The mean global visual field progression rate was -0.32 ± 0.38 dB/y. Tilt ratio, BM opening area, and gamma zone PPA width were significantly greater in the eyes with faster VF progression than those with slower progression. In multivariate analysis, these factors were significantly associated with faster VF progression (all P < 0.05), while SE and axial length were not associated with it.ConclusionIn myopic glaucoma subjects, tilt of the optic disc and temporal shifting and enlargement of the BM opening were associated with faster rate of VF progression between paired eyes. This suggests that myopia influences VF progression in glaucomatous eyes via optic disc deformations rather than via refractive error itself.

Dataset Information

Optic Disc Image Subtraction as an Aid to Detect Glaucoma Progression.

Publications

Optic Disc Image Subtraction as an Aid to Detect Glaucoma Progression.

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