Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma.
Kumar Rajesh S, Anegondi Neha, Chandapura Rachana S, Sudhakaran Suria, Kadambi Sujatha V, Rao Harsha L, Aung Tin, Sinha Roy Abhijit
AI Summary
OCTA vascular parameters effectively discriminate glaucoma severity, including preperimetric stages, often outperforming or matching standard visual field tests. This suggests OCTA is a useful diagnostic adjunct.
Abstract
Purpose
To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma.
Methods
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.
Results
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.
Conclusions
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.
MeSH Terms
Shields Classification
Key Concepts5
In a prospective, observational cross-sectional study of 199 eyes (112 subjects) with glaucoma (28 eyes preperimetric; 83 early, 43 moderate, and 45 severe glaucoma) and 74 normal (54 subjects) eyes, preperimetric and glaucomatous eyes had significantly altered (P < 0.001) global vascular parameters as compared to normal eyes, as measured by optical coherence tomography angiography (OCTA) and local fractal analysis of radial peripapillary capillaries (RPC) layer.
In a prospective, observational cross-sectional study of 199 eyes (112 subjects) with glaucoma and 74 normal (54 subjects) eyes, regional vascular parameters measured by optical coherence tomography angiography (OCTA) and local fractal analysis showed more change in glaucomatous eyes in the superotemporal (ST), then superonasal (SN) and inferotemporal (IT) sectors (in that order).
In a prospective, observational cross-sectional study of 199 eyes (112 subjects) with glaucoma and 74 normal (54 subjects) eyes, vascular parameters derived from optical coherence tomography angiography (OCTA) showed better discriminant ability (area under the curve [AUC], sensitivity, and specificity of 0.70, 69.2%, and 72.9%, respectively) than structural parameters in distinguishing between normal and preperimetric glaucomatous eyes.
In a prospective, observational cross-sectional study of 199 eyes (112 subjects) with glaucoma and 74 normal (54 subjects) eyes, vascular parameters derived from optical coherence tomography angiography (OCTA) had comparable area under the curve (AUC) (P > 0.05) to visual fields for perimetric glaucoma.
In a prospective, observational cross-sectional study of 199 eyes (112 subjects) with glaucoma and 74 normal (54 subjects) eyes, a glaucoma severity score (range, 0-1: 0, normal; 1, severe glaucoma) developed using global and regional vascular parameters from optical coherence tomography angiography (OCTA) identified preperimetric glaucoma and early glaucoma better than did visual fields.
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