Yonsei Med J.  2018 Jan;59(1):135-140. 10.3349/ymj.2018.59.1.135.

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method

• Bae HW
• Lee SY
• Kim S
• Park CK
• Lee K
• Kim CY
• Seong GJ

• KMID: 2418860
• DOI: http://doi.org/10.3349/ymj.2018.59.1.135

Abstract

PURPOSE
To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma.
MATERIALS AND METHODS
The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability.
RESULTS
For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC.
CONCLUSION
The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.

Keyword

Glaucoma; diagnosis; optical coherence tomography

MeSH Terms

Area Under Curve
Color
*Early Diagnosis
Female
Glaucoma/*diagnosis
Humans
Male
Mass Screening/*methods
Middle Aged
Nerve Fibers/*pathology
ROC Curve
Reproducibility of Results
Retina/*pathology
Retinal Ganglion Cells
Sensitivity and Specificity

Figure

• 

  Fig. 1 PTR and ATR. (A) Each superior and inferior peak heights of the pRNFL thickness were measured independently in pixels, and the shorter one was divided by the longer one. PTR=α (the shorter pRNFL peak height)/β (the longer pRNFL peak height). (B) Average pRNFL thicknesses of quadrant maps were used to calculate ATR. ATR=S (the thinner quadrant pRNFL average thickness)/I (the thicker quadrant pRNFL average thickness). pRNFL, peripapillary retinal nerve fiber layer; PTR, peak pRNFL thickness ratio; ATR, average pRNFL thickness ratio.

• 

  Fig. 2 Comparison of receiver operating characteristic curves among the PTR and ATR for the Training set. pRNFL, peripapillary retinal nerve fiber layer; PTR, peak pRNFL thickness ratio; ATR, average pRNFL thickness ratio.

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