Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma. In this prospective, observational cross-sectional study, all subjects underwent visual fields, retinal nerve fiber layer (RNFL) measurements, and OCTA imaging. Local fractal an...

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Bibliographic Details
Published in:Investigative ophthalmology & visual science Vol. 57; no. 14; pp. 6079 - 6088
Main Authors: Kumar, Rajesh S, Anegondi, Neha, Chandapura, Rachana S, Sudhakaran, Suria, Kadambi, Sujatha V, Rao, Harsha L, Aung, Tin, Sinha Roy, Abhijit
Format: Journal Article
Language:English
Published: United States 01-11-2016
Subjects:
Cross-Sectional Studies
Discriminant Analysis
Early Diagnosis
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Glaucoma - diagnosis
Glaucoma - physiopathology
Humans
Intraocular Pressure - physiology
Male
Middle Aged
Nerve Fibers - pathology
Optic Disk - pathology
Prospective Studies
Retinal Ganglion Cells - pathology
ROC Curve
Severity of Illness Index
Tomography, Optical Coherence - methods
Visual Fields
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Summary:To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma. In this prospective, observational cross-sectional study, all subjects underwent visual fields, retinal nerve fiber layer (RNFL) measurements, and OCTA imaging. Local fractal analysis was applied to OCTA images (radial peripapillary capillaries [RPC] layer). Vessel density en face and inside the disc and spacing between large and small vessels were quantified. Stepwise logistic regression was performed and a glaucoma severity score (range, 0-1: 0, normal; 1, severe glaucoma) was developed by using global and regional (superotemporal [ST], inferotemporal [IT], temporal, superonasal [SN], inferonasal, and nasal) vascular parameters. Glaucoma severity score was compared with visual field and RNFL indices. One hundred ninety-nine eyes (112 subjects) with glaucoma (28 eyes preperimetric; 83 early, 43 moderate, and 45 severe glaucoma) and 74 normal (54 subjects) eyes were enrolled. Preperimetric and glaucomatous eyes had significantly altered (P < 0.001) global vascular parameters as compared to normal; regionally, ST, then SN and IT sectors (in that order) showed more change in glaucomatous eyes. Vascular parameters showed better discriminant ability (area under the curve [AUC], sensitivity, and specificity of 0.70, 69.2%, and 72.9%, respectively) than structural parameters between normal and preperimetric glaucomatous eyes. Vascular parameters had comparable AUC (P > 0.05) to visual fields for perimetric glaucoma. Glaucoma severity score identified preperimetric glaucoma and early glaucoma better than did visual fields. Vascular parameters could be a useful adjunct tool to evaluate/diagnose glaucoma. Longitudinal studies are needed to determine their use in early detection and prognostication.
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ISSN:1552-5783
1552-5783
DOI:10.1167/iovs.16-19984