Donald C. Hood

Efficacy of a Deep Learning System for Detecting Glaucomatous Optic Neuropathy Based on Color Fundus Photographs.

Improving our understanding, and detection, of glaucomatous damage: An approach based upon optical coherence tomography (OCT).

The approach is summarized in a single-page report, which can be generated from a single wide-field scan. The superiority of this approach, as opposed to the typical reliance on summary metrics, is described.

Hybrid Deep Learning on Single Wide-field Optical Coherence tomography Scans Accurately Classifies Glaucoma Suspects.

The HDLM protocol outperforms standard OCT and VF clinical metrics in distinguishing healthy suspect eyes from eyes with early glaucoma.

24-2 Visual Fields Miss Central Defects Shown on 10-2 Tests in Glaucoma Suspects, Ocular Hypertensives, and Early Glaucoma.

Central visual field damage seen on the 10-2 test is often missed with the 24-2 strategy in all groups. This finding has implications for the diagnosis of glaucoma and classification of severity.

Association Between Undetected 10-2 Visual Field Damage and Vision-Related Quality of Life in Patients With Glaucoma.

The 10-2 VF model showed a stronger association with NEI VFQ-25 score than the 24-2 VF model.

Detecting glaucoma with only OCT: Implications for the clinic, research, screening, and AI development.

In section 5, the model helps account for the success of an AI deep learning model, which in turn validates our focus on the RNFL p-map.

A Single Wide-Field OCT Protocol Can Provide Compelling Information for the Diagnosis of Early Glaucoma.

A single-page report based upon a single, wide-field OCT scan has the information needed to diagnose early glaucoma with excellent sensitivity/specificity.

Structure-Function Agreement Is Better Than Commonly Thought in Eyes With Early Glaucoma.

There is good agreement between structural and functional damage, even in eyes with confirmed early glaucomatous damage, if both 24-2 and 10-2 VFs are obtained, and abnormal locations on the VFs are compared to abnormal regions seen on OCT macular and disc scans.

Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields.

In principle, the CCP could be modified easily. In practice, change is facing a number of impediments.

Association of Glaucoma-Related, Optical Coherence Tomography-Measured Macular Damage With Vision-Related Quality of Life.

Characteristic patterns of glaucoma-related macular RGC+IPL loss appeared to be more important predictors of vision-related quality of life than thickness measures, with diffuse RGC+IPL loss as an indicator for diminished vision-related quality of life.

Macular Damage, as Determined by Structure-Function Staging, Is Associated With Worse Vision-related Quality of Life in Early Glaucoma.

Early glaucomatous macular damage, as detected by abnormal topographic regions on measures of structure and function, is associated with decreased VRQoL.

Four Questions for Every Clinician Diagnosing and Monitoring Glaucoma.

Finally, the fourth question is: "When do you look at OCT images?

Association of Macular Visual Field Measurements With Glaucoma Staging Systems.

These findings suggest that current glaucoma staging systems based on 24-2 (or 30-2) visual fields underestimate disease severity and the presence of macular damage.

Does Retinal Ganglion Cell Loss Precede Visual Field Loss in Glaucoma?

Further, a case can be made that the evidence in the key articles better supports the opposite conclusion.

An Automated Method for Assessing Topographical Structure-Function Agreement in Abnormal Glaucomatous Regions.

The method described here can automatically and objectively evaluate aS-aF agreement with a direct comparison of abnormal regions of function and structure.

Diffuse Macular Damage in Mild to Moderate Glaucoma Is Associated With Decreased Visual Function Scores Under Low Luminance Conditions.

Mild diffuse glaucomatous macular damage, as detected by abnormal topographic regions on measures of structure and function, is associated with decreased LLQ scores.

Macular Damage in Glaucoma is Associated With Deficits in Facial Recognition.

Even with good central visual acuity, patients with glaucomatous macular damage exhibit diminished facial recognition, which is partly mediated through diminished CS.

Effectiveness of a Qualitative Approach Toward Evaluating OCT Imaging for Detecting Glaucomatous Damage.

Qualitative evaluation of OCT imaging results allows glaucoma eyes with repeatable visual field abnormalities to be detected with a high level of accuracy, performing better than a conventional summary metric of global cpRNFL thickness.

Optical Coherence Tomography Can Be Used to Assess Glaucomatous Optic Nerve Damage in Most Eyes With High Myopia.

For most eyes with high myopia, there is sufficient information in OCT scans to allow for accurate diagnosis of GON.

Evaluation of a Qualitative Approach for Detecting Glaucomatous Progression Using Wide-Field Optical Coherence Tomography Scans.

Qualitative evaluation of OCT imaging information more frequently detected change consistent with known patterns of glaucomatous progression than global cpRNFL thickness, warranting further studies to evaluate its value.

The Association Between Clinical Features Seen on Fundus Photographs and Glaucomatous Damage Detected on Visual Fields and Optical Coherence Tomography Scans.

Focal and diffuse signs of glaucoma damage seen on stereophotographs often match damage shown on VFs and sdOCT.

Rationale and Development of an OCT-Based Method for Detection of Glaucomatous Optic Neuropathy.

A decision tree was devised for testing and implementation in clinical practice and research that can be used by reading centers, researchers, and clinicians.

Evaluation of a Region-of-Interest Approach for Detecting Progressive Glaucomatous Macular Damage on Optical Coherence Tomography.

Progressive glaucomatous macular GCC changes were optimally detected with a manual ROI approach.

Association of Patterns of Glaucomatous Macular Damage With Contrast Sensitivity and Facial Recognition in Patients With Glaucoma.

In this cohort study, diffuse rather than focal glaucomatous macular damage was associated with diminished facial recognition and contrast sensitivity.

Progression of Local Glaucomatous Damage Near Fixation as Seen with Adaptive Optics Imaging.

Progressive changes in RNF bundles associated with deep defects on 10-2 VFs can be seen within about 1 year with AO-SLO imaging.

Detection of Progression With 10-2 Standard Automated Perimetry: Development and Validation of an Event-Based Algorithm.

A new event-based progression algorithm using the 10-2 VF can identify eyes experiencing more rapid MD progression and may be used as a tool to assess progressive macular functional changes in glaucoma.

Disc Hemorrhages Are Associated With the Presence and Progression of Glaucomatous Central Visual Field Defects.

DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.

OCT Circle Scans Can Be Used to Study Many Eyes with Advanced Glaucoma.

OCT scans can be used to assess and potentially follow the preserved regions of cpRNFL associated with the macula in eyes with advanced glaucoma if there is a preserved region on the 10-2 VF better…

The OCT RNFL Probability Map and Artifacts Resembling Glaucomatous Damage.

Glaucoma-like artifacts on RNFL p-maps are relatively common and can masquerade as arcuate and/or widespread/temporal damage.

Strategies to Improve Convolutional Neural Network Generalizability and Reference Standards for Glaucoma Detection From OCT Scans.

CNN generalizability can be improved with data augmentation, multiple input image modalities, and training on images with confident ratings.

Reasons why OCT Global Circumpapillary Retinal Nerve Fiber Layer Thickness is a Poor Measure of Glaucomatous Progression.

Local defects and segmentation errors are the primary reasons for the poor performance of cpRNFL thickness G metric.

Improving the Detection of Glaucoma and Its Progression: A Topographical Approach.

Together, the RNF bundle model and the automated structure-function method should improve the power of topographical methods for detecting glaucoma and its progression.

A Topographic Comparison of OCT Minimum Rim Width (BMO-MRW) and Circumpapillary Retinal Nerve Fiber Layer (cRNFL) Thickness Measures in Eyes With or Suspected Glaucoma.

Although BMO-MRW and cRNFL measures agreed in the majority of hemidiscs, they still disagreed in over 25% of the EG hemidiscs.

An Examination of the Frequency of Paravascular Defects and Epiretinal Membranes in Eyes With Early Glaucoma Using En-face Slab OCT Images.

Eyes with early glaucoma have a higher frequency of PDs and ERMs than suspects or controls and exhibit PDs even in the absence of ERMs or high myopia.

Detecting Glaucomatous Progression With a Region-of-Interest Approach on Optical Coherence Tomography: A Signal-to-Noise Evaluation.

A manual ROI approach was the optimal method for detecting progressive cpRNFL loss compared with an automatic ROI approach and the global cpRNFL thickness measure.

An Evaluation of a New 24-2 Metric for Detecting Early Central Glaucomatous Damage.

Neither the PSD(C24-2) nor the PSD(10-2) metric is good measure of early CD. Instead we recommend a topographic approach based upon OCT probability maps and a 10-2 VF.

Comparison of Widefield and Circumpapillary Circle Scans for Detecting Glaucomatous Neuroretinal Thinning on Optical Coherence Tomography.

Progressive RNFL thickness changes were more effectively detected on widefield optical coherence tomography (OCT) scans using a manual ROI approach compared to conventional derived circumpapillary circle scans.

Optical Coherence Tomography and Glaucoma Progression: A Comparison of a Region of Interest Approach to Average Retinal Nerve Fiber Layer Thickness.

In this population, RNFL thinning in a ROI is a better measure of progression than is average cpRNFL thickness change.

A Model of Progression to Help Identify Macular Damage Due to Glaucoma.

Second, the patterns of progression predicted by the model suggest alternative end points for clinical trials. Finally, the model provides a heuristic for future research concerning the anatomic basis of glaucomatous damage.

Variability and Power to Detect Progression of Different Visual Field Patterns.

Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability.

The 24-2 Visual Field Guided Progression Analysis Can Miss the Progression of Glaucomatous Damage of the Macula Seen Using OCT.

In eyes with early glaucoma (i.e., 24-2 MD, > -6 dB) in this study, the 24-2 GPA missed progression seen using OCT and exhibited a relatively high rate of false positives.

Interindividual Variations in Foveal Anatomy and Artifacts Seen on Inner Retinal Probability Maps from Spectral Domain OCT Scans of the Macula.

Fovea morphology, as measured based upon width, depth, and slope, has a minor role in explaining artifacts seen on macular scans.

Deep Defects Seen on Visual Fields Spatially Correspond Well to Loss of Retinal Nerve Fiber Layer Seen on Circumpapillary OCT Scans.

Although studies relating local structural (OCT) and functional (VF) measures typically show poor to moderate correlations, there is good qualitative agreement between the location of deep cpRNFL loss and deep defects on VFs.

The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage.

The ICD-10 system relies solely on damage seen on the 24-2 and as provides a 24-2 functional score rather than a "glaucoma" severity score.

A Pattern-Based OCT Metric for Glaucoma Detection.

The new metric outperformed other OCT metrics for detecting glaucomatous damage.

Progression of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry.

Although relying solely on metrics is not recommended for clinical purposes, in situations requiring very high specificity and precision, combinations of OCT-OCT metrics can be used.

Distinguishing Healthy From Glaucomatous Eyes With Optical Coherence Tomography Global Circumpapillary Retinal Nerve Fiber Thickness in the Bottom 5th Percentile.

Quantitative metrics can distinguish between most of the healthy and glaucomatous eyes with low global cpRNFL thickness. However, even the most successful metric, RMS cpRNFL, missed some glaucomatous eyes.

Did the OCT Show Progression Since the Last Visit?

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.

A Deep Learning Model Detects Glaucoma Based on an OCT Report, but Where Should the Clinician Look to Identify Glaucomatous Damage?

Although the DLM heat maps are flagging clinically meaningful elements of the report, in their existing form, they are not optimal for guiding the clinician to relevant locations of damage.

A Deep Learning Model for Glaucoma Detection Outperforms Conventional Metrics.

The DLM achieved high specificity and sensitivity and outperformed conventional metrics.

Glaucoma Detection Using Optical Coherence Tomography: Reviewing the Pitfalls of Comparison to Normative Data.

This review describes various artifacts that originate from using a normative database to compare the individual's scans.

Detecting Established Glaucoma Using OCT Alone: Utilizing an OCT Reading Center in a Real-World Clinical Setting.

An OCT-based reading center is able to identify eyes with established glaucoma using OCT alone with high sensitivity and specificity.

Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study.

There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data.

Association of Macular Optical Coherence Tomography Measures and Deficits in Facial Recognition in Patients With Glaucoma.

This study investigates the association between facial recognition and macular structural damage, as measured by spectral-domain ocular coherence tomography retinal ganglion cell and inner plexiform layer.

Local Glaucomatous Defects of the Circumpapillary Retinal Nerve Fiber Layer Show a Variety of Patterns of Progression.

All eyes showed a widening and deepening of the ROP, but a variety of different patterns of progressive cRNFL loss.

The Role of Intraocular Pressure and Systemic Hypertension in the Progression of Glaucomatous Damage to the Macula.

Macular structural and functional parameters are more sensitive to IOP in terms of glaucomatous progression when compared with more conventional parameters.

Larger Real-World OCT Reference Database Improves Accuracy of Glaucoma Flagging Using Summary Metrics.

There is a difference in the eyes flagged, and this difference is largely due to the greater size of the RW-RDB.

Nicotinamide and Pyruvate in Open-Angle Glaucoma: A Randomized Controlled Trial on Neuroprotection-Design and Methodology.

This novel trial design may deliver valuable data on the neuroprotective potential of nicotinamide and pyruvate supplementation in glaucoma and improve our understanding of optimal study design for longitudinal randomized clinical trials focused on glaucoma neuroprotection.

A Morphologic Model of Glaucomatous Damage to the Macular Ganglion Cell Layer in Myopic Eyes.

The proposed model of glaucomatous damage patterns in macula GCL is applicable to myopic eyes, even with coexisting macular pathology. In cases deviating from the model, clinicians are advised to seek causes besides glaucoma.

Understanding Patterns of Preserved Retinal Ganglion Cell Layer in Advanced Glaucoma as Seen With Optical Coherence Tomography.

All eyes with advanced glaucoma had damage to the critically important central, donut-shaped GCL region.

Improving glaucoma staging in clinical practice by combining the ICD-10 glaucoma severity classification system and optical coherence tomography.

Combining OCT and VF data provides better staging of glaucoma severity than VF data alone.

Author Response: Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields.

Reply.

Technology and the Glaucoma Suspect.

Compared to VF and disc photography, SD-OCT, when used alone, had better internal agreement as well as better agreement with the consensus of clinicians using all available data.

Defects Along Blood Vessels in Glaucoma Suspects and Patients.

Holes seen on circumpapillary OCT scans of glaucoma patients and suspects are associated with local glaucomatous damage, as well as with PIRDs associated with high myopia and ERMs.

The 24-2 Visual Field Test Misses Central Macular Damage Confirmed by the 10-2 Visual Field Test and Optical Coherence Tomography.

Eyes with macular glaucomatous damage may be classified as normal based on the 24-2 VF alone.

A Region-of-Interest Approach for Detecting Progression of Glaucomatous Damage With Optical Coherence Tomography.

For detecting progression of local RNFL damage in patients with glaucoma, an OCT ROI approach appears superior to the OCT global RNFL thickness measure typically used.

Central Glaucomatous Damage of the Macula Can Be Overlooked by Conventional OCT Retinal Nerve Fiber Layer Thickness Analyses.

Conventional cpRNFL analyses on commercial OCT reports can miss macular (central field) damage.

Details of Glaucomatous Damage Are Better Seen on OCT En Face Images Than on OCT Retinal Nerve Fiber Layer Thickness Maps.

Details of local glaucomatous damage, missing or easily overlooked on traditional OCT RNFL thickness analysis used in clinical OCT reports, were seen on OCT en face images based on the average reflectance intensity.

Evaluation of the Structure-Function Relationship in Glaucoma Using a Novel Method for Estimating the Number of Retinal Ganglion Cells in the Human Retina.

The novel method for estimating RGCs yields values that are closer to histological estimates than prior methods, while relying on considerably fewer assumptions.

Confocal Adaptive Optics Imaging of Peripapillary Nerve Fiber Bundles: Implications for Glaucomatous Damage Seen on Circumpapillary OCT Scans.

Relatively similar 10-2 defects with similar fdOCT RNFL thickness profiles can have very different degrees of RNF bundle damage as seen on fdOCT and AO-SLO.

Evaluation of a Method for Estimating Retinal Ganglion Cell Counts Using Visual Fields and Optical Coherence Tomography.

Several of the assumptions underlying the H-NLM should be revisited. Studies and models relying on the RGC estimates of the H-NLM should be interpreted with caution.

Adaptive optics imaging of healthy and abnormal regions of retinal nerve fiber bundles of patients with glaucoma.

The AO-SLO images revealed details of glaucomatous damage that are difficult, if not impossible, to see with current OCT technology.