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Editors Selection IGR 16-4

Basic Research: Diagnostic capability of SD-OCT

Comment by Don Budenz on:

26326 Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography analysis of the retinal nerve fiber layer map for glaucoma detection, Leung CK; Lam S; Weinreb RN et al., Ophthalmology, 2010; 117: 1684-1691

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The study by Leung et al. (1180) was designed to compare the diagnostic capability RNFL deviation map feature of the Cirrus HD-OCT to the circumpapillary RNFL thickness circle of the Stratus and Cirrus OCT. The investigators recruited 102 normal and 121 glaucoma subjects, as defined by a glaucomatous visual field defect with standard automated perimetry. Thus, all of the cases of glaucoma had perimetric glaucoma (the gold standard for glaucoma). The severity of glaucoma was also defined based on perimetric defects and approximately half were categorized as early glaucoma (mean deviation better than or equal to -6dB) and half were categorized as having moderate to severe glaucoma (mean deviation worse than -6dB). These subjects were then subjected to Stratus and Cirrus OCT using the peripapillary scan protocols of each.

Clinicians are largely ignoring the huge amount of data that is obtained with spectral domain OCT

Masked evaluators then graded the RNFL deviation maps from the Cirrus OCT using their own grading scale. The study found that use of the RNFL deviation map score of five improved the sensitivity of glaucoma detection without a loss of specificity compared to traditional RNFL thickness categories with Stratus and Cirrus. However, the sensitivity of the Cirrus RNFL deviation map was no better than the Cirrus RNFL thickness designation if one used one or more clock hours abnormal at the < 5% level, although the specificity of the latter criteria was only 83% compared to the RNFL deviation map. The findings of this study are important because clinicians are largely ignoring the huge amount of data that is obtained with spectral domain OCT and only utilizing the small amount of data obtained by extracting the circumpapillary scan circle. The only difficulty with this study is in applying the investigators' grading scale in clinical practice, which is currently impossible. Perhaps the authors' grading system could be incorporated into future versions of the manufacturer's software to improve the diagnostic capabilities of this new technology.

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