Diagnostic Accuracy of the Optical Coherence Tomography in Assessing Glaucoma Among Filipinos. Part 2: Optic Nerve Head and Retinal Nerve Fiber Layer Parameters
Noel de Jesus Atienza, MD, MSc and Joseph Anthony Tumbocon, MD
Objective
To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in the diagnosis of glaucoma and to determine the validity of these measurements.
Methods
Glaucoma suspects undergoing glaucoma diagnostic tests were recruited consecutively. The numerical results of the Stratus OCT fast optic disc and fast RNFL protocols were analyzed against an independent assessment by glaucoma experts who were blinded as to the results of the OCT. An ROC curve analysis was applied to derive estimates of diagnostic accuracy and multi-level likelihood ratios.
Results
A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included. All ONH and RNFL OCT parameters showed statistically significant differences in mean values between the 2 groups. The ROC curve identified the vertical integrated rim area (AUC: 0.822), the cup-disc area ratio (AUC: 0.816), and the horizontal integrated rim width (AUC: 0.794) as the best optic disc parameters; and the RNFL average thickness (AUC: 0.827), the superior quadrant (AUC: 0.807), and the inferior quadrant (AUC: 0.804) as the best RNFL parameters. Multi-level likelihood ratios for ONH and RNFL parameters were calibrated using a projected posttest probability of 70% for a positive test result (therapeutic threshold) and a 10% posttest probability for a negative result (diagnostic threshold).
Conclusions
The results showed that statistically significant mean differences in ONH and RNFL parameters did not translate into a high predictive ability for each individual parameter. Single cut-off value for each OCT parameter based on the best sensitivity and specificity combination did not result in high predictive values for any single parameter. Multi-level likelihood ratios for the best ONH and RNFL parameters were derived to increase the diagnostic capability of the Stratus OCT.
Keywords: Optical coherence tomography, Standard automatic perimetry, Glaucoma, Optic nerve head, Retinal nerve fiber layer