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Editors Selection IGR 13-1
Optical Coherence Tomography: Diagnostic accuracies of three OCT devices
Comment by Mitra Sehi on:
27924 Comparison of the Diagnostic Accuracies of the Spectralis, Cirrus, and RTVue Optical Coherence Tomography Devices in Glaucoma, Leite MT; Rao HL; Zangwill LM et al., Ophthalmology, 2011; Epub ahead of print
Recent advances in spectral domain optical coherence tomography (SDOCT) imaging technologies have resulted in a new generation of instruments with greater resolution, shorter acquisition time, and three-dimensional imaging capabilities. However, these technical advancements may not necessarily translate into better discriminating ability for glaucoma diagnosis. In an observational case-control study, Leite et al. (187) compared the diagnostic accuracies of Spectralis, Cirrus and RTVue SDOCT technologies for the detection of perimetric glaucoma patients. They examined 107 normal and 126 glaucomatous eyes of 149 participants. The glaucoma group was older, had a higher prevalence of African-American ancestry compared with the normal group, and had mild to moderate glaucoma with an average visual field mean deviation (MD) of -5.85dB and median MD of -3.61dB. A visual field reading center assessed all visual fields for the presence of artifacts and the consistency of the location of field defect in consecutive images. The statistical analysis properly accounted for the potential correlations between the two eyes. The peripapillary retinal nerve fiber layer (RNFL) thickness was measured at the same visit using the three SDOCT instruments. The investigators calculated the raceand age-adjusted area under the receiver operating characteristic curves (AUC) for the global and each of the four RNFL thickness quadrants. The study found that average, superior and inferior RNFL thickness values had the largest AUC (0.85-0.88), and that these three SDOCT technologies had comparable diagnostic capabilities for detection of glaucoma patients with visual field loss, despite their differences in axial resolution and acquisition time. Cirrus RNFL thickness in nasal quadrant had significantly smaller AUC compared with both Spectralis and RTVue. Authors attributed the small AUC of the nasal quadrant in these instruments to the angle of incidence of the laser beam. The authors found that at 80% specificity, the highest sensitivity values were 81.9% for Spectralis superior RNFL thickness, 80.3% for Cirrus global RNFL thickness and 77.9% for RTVue global and inferior RNFL thickness. It should be noted that the ability to discriminate glaucomatous eyes is directly proportional to the severity of disease across the entire spectrum of this condition, and the authors correctly acknowledge that the diagnostic capabilities of these technologies would be higher if the glaucomatous eyes were at a more advanced stage.
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