Did the OCT Show Progression Since the Last Visit?
Hood Donald C, Melchior Bruna, Tsamis Emmanouil, Liebmann Jeffrey M, De Moraes Carlos G
AI Summary
This paper argues that OCT Guided Progression Analysis and summary statistics are insufficient for detecting glaucoma progression between two visits, advocating for topographical comparison of OCT maps and images for better clinical decisions.
Abstract
Identifying progression is of fundamental importance to the management of glaucoma. It is also a challenge. The most sophisticated, and probably the most useful, commercially available clinical tool for identifying progression is the Guided Progression Analysis (GPA), which was initially developed to identify progression using 24-2 visual field tests. More recently, it has been extended to retinal nerve fiber layer (RNFL) and ganglion cell+inner plexiform layer thicknesses measured with optical coherence tomography (OCT). However, the OCT GPA requires a minimum of 3 tests to determine "possible loss (progression)" and a minimum of 4 tests to determine if the patient shows "likely loss (progression)." Thus, it is not designed to answer a fundamental question asked by both the clinician and the patient, namely: Did damage progress since the last visit? Some clinicians use changes in summary statistics, such as global/average circumpapillary RNFL thickness. However, these statistics have poor sensitivity and specificity due to segmentation and alignment errors. Instead of relying on the GPA analysis or summary statistics, one needs to evaluate RNFL and ganglion cell+inner plexiform layer probability maps and circumpapillary OCT B-scan images. In addition, we argue that the clinician can make a better decision about suspected progression between 2 test days by topographically comparing the changes in the different OCT maps and images, in addition to topographically comparing the changes in the visual field with the changes in OCT probability maps.
MeSH Terms
Shields Classification
Key Concepts4
Changes in summary statistics, such as global/average circumpapillary retinal nerve fiber layer (RNFL) thickness, have poor sensitivity and specificity for identifying glaucoma progression due to segmentation and alignment errors.
Clinicians can make a better decision about suspected glaucoma progression between 2 test days by topographically comparing changes in different optical coherence tomography (OCT) maps and images, and by topographically comparing changes in the visual field with changes in OCT probability maps.
The Guided Progression Analysis (GPA) tool, initially developed for 24-2 visual field tests, has been extended to retinal nerve fiber layer (RNFL) and ganglion cell+inner plexiform layer thicknesses measured with optical coherence tomography (OCT) for identifying glaucoma progression.
The optical coherence tomography (OCT) Guided Progression Analysis (GPA) requires a minimum of 3 tests to determine "possible loss (progression)" and a minimum of 4 tests to determine "likely loss (progression)" in glaucoma patients.
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