J Korean Ophthalmol Soc.  2011 Apr;52(4):454-461.

False Negative Findings of Optical Coherence Tomography in Eyes with Localized Nerve Fiber Layer Defects

• Kang SM
• Uhm KB

Abstract

PURPOSE
To identify the risk factors associated with false negative findings of optical coherence tomography (Stratus OCT) in patients with photographic localized retinal nerve fiber layer (RNFL) defects.
METHODS
Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects were included in the present study. The patients were divided into 2 groups according to the presence or absence of detection of photographic defects by OCT. Gender, age, refractive error, diabetes, hypertension, central corneal thickness, type of glaucoma, mean deviation, pattern standard deviation, average RNFL thickness, disc area, and photographic RNFL defect related variables (location, number, and angular width) were compared between the 2 groups. Each variable was initially evaluated by univariate analysis and significant variables (p < 0.1) were included in the logistic regression analysis.
RESULTS
Photographic RNFL defects were not detected by OCT in 51 (25.9%) of the 197 eyes. The angular locations and widths of RNFL defects by OCT were significantly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient R = 0.98 and 0.64, respectively). Logistic regression analysis revealed the risk factors for false negative findings of OCT included average RNFL thickness (odds ratio = 1.106, 95% confidence interval [CI] = 1.057-1.156, p < 0.001) and angular width of defect (odds ratio = 0.929, 95% CI = 0.884-0.977, p = 0.004).
CONCLUSIONS
This present study suggests that false negative findings of OCT in patients with photographic localized RNFL defects were associated with thicker RNFL thickness and smaller angular width of RNFL defect.

Keyword

Glaucoma; Optical coherence tomography; Retinal nerve fiber layer defect; Risk factor

MeSH Terms

Eye
Glaucoma
Humans
Hypertension
Logistic Models
Nerve Fibers
Refractive Errors
Retinaldehyde
Risk Factors
Tomography, Optical Coherence
Retinaldehyde

Figure

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  Figure 1. Example of false negative finding. Inferior localized retinal nerve fiber layer defect was observed on the red-free photograph, but optical coherence tomography result was normal at the corresponding location on the sector average analysis.

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  Figure 2. The angular locations of localized retinal nerve fiber layer (RNFL) defects on red-free fundus photography were measured to evaluate the angular width and location of localized RNFL defects. Reference line was from the optic disc center to the temporal margin of the optic disc (0°). The angles between reference line and the line from the center of the disc to the points at which the upper and lower margins of the localized RNFL defect met with the optic disc margin were measured. The directional angle was assessed in a clockwise direction in right eyes and a counter-clockwise direction in left eyes.

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  Figure 3. The number of eyes (total = 197) and retinal nerve fiber layer (RNFL) defects (total = 273) by location on red-free RNFL photographs.

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  Figure 4. Frequency distribution of photographic retinal nerve fiber layer (RNFL) defects by clock-hour location on red-free RNFL photographs. Defects were most commonly observed at 7 o’clock and 11 o’clock.

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  Figure 5. Scatterplot of the angular locations of the retinal nerve fiber layer (RNFL) defects detected by red-free RNFL photograph and those of RNFL defects detected by optical coherence tomography (OCT) (R = 0.980).

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  Figure 6. Scatterplot of the angular widths of the retinal nerve fiber layer (RNFL) defects detected by red-free RNFL photograph and those of RNFL defects detected by optical coherence tomography (OCT) (R = 0.642).

Reference

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