A simplified combined index of structure and function for detecting and staging glaucomatous damage

AbstractGlaucomatous damage results in characteristics structural and functional changes on optical coherence tomography (OCT) imaging and standard automated perimetry (SAP) testing. The clinical utility of these measures differs based on disease severity, as they are evaluated along different measurement scales. This study therefore sought to examine if a simplified combined structure–function index (sCSFI) could improve the detection and staging of glaucomatous damage, compared to the use of average retinal nerve fiber layer thickness (RNFL) measurements from OCT and mean deviation (MD) values from SAP alone, and also an estimated retinal ganglion cell counts (eRGC) measure derived using empirical formulas described previously. Examining 577 eyes from 354 participants with perimetric glaucoma and 241 normal eyes from 138 healthy participants, we found that the sCSFI performed significantly better than average RNFL, MD and eRGC count for discriminating between glaucoma and healthy eyes (P ≤ 0.008 for all). The sCSFI also performed significantly better than RNFL and eRGC count at discriminating between different levels of visual field damage in glaucoma eyes (P < 0.001 for both). These findings highlight the clinical utility of combining structural and functional information for detecting and staging glaucomatous damage using the simplified index developed in this study.

Download Full-text

Correlation of Structural and Functional Changes in Ocular Hypertension and Early Glaucoma

QJM ◽

10.1093/qjmed/hcaa058.019 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

W O Noureldin ◽

H M Ebiary ◽

R G Zaki

Keyword(s):

Ocular Hypertension ◽

Open Angle Glaucoma ◽

Automated Perimetry ◽

Fiber Layer ◽

Temporal Area ◽

Early Glaucoma ◽

Functional Changes ◽

Rnfl Thickness ◽

Group I

Abstract Purpose To estimate the link between the thickness of retinal nerve fiber layer (RNFL); utilizing optical coherence tomography (OCT) and corresponding retinal sensitivity changes; utilizing visual field (VF) perimetry, in cases of ocular hypertension and early glaucoma. Methods Thirty patients (60 eyes) were gathered for this prospective, cross-sectional study. They were categorized into two groups. Group I comprised 30 eyes (15 patients) having ocular hypertension. Group II comprised 30 eyes (15 patients) early recognized as primary open angle glaucoma. Each patient underwent a thorough ophthalmologic examination, OCT for RNFL thickness estimation using quick RNFL thickness protocol and VF testing using automated perimetry (G2 program, central 30–2 threshold protocol). Pearson’s correlation was premediated between thickness of RNFL and VF indices. Results Significant connections between the thickness of temporal area of RNFL and mean sensitivity (MS), mean defect (MD) and loss of variance (LV) indices of VF (r = 0.533, -0.431, -0.388; P < 0.01, respectively) were noticed in patients having ocular hypertension. Additionally, a significant link between the thickness of the temporal area of RNFL and MS index of VF (0.441; P < 0.05) was noticed in patients with early POAG. Otherwise, there were no significant links between indices of VF and other areas of RNFL thickness in both groups. Conclusion Average RNFL thickness is certifiably not a dependable index for early determination of glaucoma or for the follow-up of ocular hypertension and POAG. Segmental RNFL thickness (especially temporal) appears to be a more dependable index. Profound structural modification with OCT test comprises an imperative sign of early utilitarian changes, regardless of whether they are not yet recognized with perimetry. The MS index of VF is by all accounts sensitive for the follow-up of ocular hypertension.

Download Full-text

Rate of Change in Bruch’s Membrane Opening-Minimum Rim Width and Peripapillary RNFL in Early Normal Tension Glaucoma

Journal of Clinical Medicine ◽

10.3390/jcm9082321 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2321

Author(s):

Hyun-kyung Cho ◽

Changwon Kee

Keyword(s):

Normal Tension Glaucoma ◽

Rate Of Change ◽

Mean Deviation ◽

Bruch's Membrane ◽

Bruch’S Membrane ◽

Fiber Layer ◽

Acceptable Quality ◽

Bruch’S Membrane Opening ◽

Better Than

Background: to investigate the rate of change (ROC) of Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in early normal tension glaucoma (NTG) patients. Methods: in this longitudinal cohort study, 115 subjects (115 eyes) diagnosed as early NTG (mean deviation > −6.0 dB) and who had completed more than five times of spectral-domain optical coherence tomography (OCT) tests with acceptable quality were included. Measurement of BMO-MRW and RNFL were performed at 3-month intervals by OCT. Linear mixed-effects model was employed to calculate the ROC in global region and six Garway-Heath sectors with adjusting age, sex, and BMO area. Results: Average follow-up was 20.99 ± 6.99 months with OCT number of 7.54 ± 2.12. Baseline intraocular pressure was 14.72 ± 2.70 mmHg and MD was −2.73 ± 2.26 dB. ROC of global BMO-MRW was −2.06 ± 0.65 µm/yr and RNFL was −0.96 ± 0.16 µm/yr (p = 0.098). The most rapid ROC was in inferotemporal sector (BMO-MRW: −3.02 ± 0.88 µm/yr, RNFL: −1.96 ± 0.36 µm/yr) followed by superotemporal sector. Conclusion: The ROC of BMO-MRW, the new parameter along with that of RNFL should be considered in the management of early NTG. BMO-MRW may show visible reduction ROC better than RNFL to detect early progression in early NTG when visual field may not show significant change.

Download Full-text

Comparison of multifocal visual evoked potential, standard automated perimetry and optical coherence tomography in assessing visual pathway in multiple sclerosis patients

Multiple Sclerosis Journal ◽

10.1177/1352458509359782 ◽

2010 ◽

Vol 16 (4) ◽

pp. 412-426 ◽

Cited By ~ 32

Author(s):

Michal Laron ◽

Han Cheng ◽

Bin Zhang ◽

Jade S Schiffman ◽

Rosa A Tang ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optical Coherence Tomography ◽

Mean Deviation ◽

Automated Perimetry ◽

Optical Coherence ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Field Of Vision ◽

Multiple Sclerosis Patients ◽

Visual Evoked

Background: Multifocal visual evoked potentials (mfVEP) measure local response amplitude and latency in the field of vision. Objective: To compare the sensitivity of mfVEP, Humphrey visual field (HVF) and optical coherence tomography (OCT) in detecting visual abnormality in multiple sclerosis (MS) patients. Methods: mfVEP, HVF, and OCT (retinal nerve fiber layer [RNFL]) were performed in 47 MS-ON eyes (last optic neuritis [ON] attack ≥6 months prior) and 65 MS-no-ON eyes without ON history. Criteria to define an eye as abnormal were: (1) mfVEP amplitude/latency — either amplitude or latency probability plots meeting cluster criteria with 95% specificity; (2) mfVEP amplitude or latency alone (specificity: 97% and 98%, respectively); and (3) HVF and OCT, mean deviation and RNFL thickness meeting p < 0.05, respectively. Results: MfVEP (amplitude/latency) identified more abnormality in MS-ON eyes (89%) than HVF (72%), OCT (62%), mfVEP amplitude (66%) or latency (67%) alone. Eighteen percent of MS-no-ON eyes were abnormal for both mfVEP (amplitude/latency) and HVF compared with 8% with OCT. Agreement between tests ranged from 60% to 79%. mfVEP (amplitude/latency) categorized an additional 15% of MS-ON eyes as abnormal compared with HVF and OCT combined. Conclusions: mfVEP, which detects both demyelination (increased latency) and neural degeneration (reduced amplitude), revealed more abnormality than HVF or OCT in MS patients.

Download Full-text

Can Variability of Pattern ERG Signal Help to Detect Retinal Ganglion Cells Dysfunction in Glaucomatous Eyes?

BioMed Research International ◽

10.1155/2015/571314 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Alberto Mavilio ◽

Francesca Scrimieri ◽

Donato Errico

Keyword(s):

Retinal Ganglion Cells ◽

Ganglion Cells ◽

Second Harmonic ◽

Pattern Electroretinogram ◽

Mean Deviation ◽

Automated Perimetry ◽

Pattern Erg ◽

Retinal Ganglion ◽

Standard Automated Perimetry ◽

Fiber Layer

Objective. To evaluate variability of steady-state pattern electroretinogram (SS-PERG) signal in normal, suspected, and glaucomatous eyes.Methods. Twenty-one subjects with suspected glaucoma due to disc abnormalities (GS), 37 patients with early glaucoma (EG), and 24 normal control (NC) were tested with spectral-domain optical coherence tomography (SD-OCT), standard automated perimetry (SAP), and SS-PERG. Mean deviation (MD), pattern standard deviation (PSD), retinal nerve fiber layer (RNFL), and ganglionar complex cells (GCC) were evaluated. The SS-PERG was recorded five consecutive times and the amplitude and phase of second harmonic were measured. PERG amplitude and coefficient of variation of phase (CVphase) were recorded, and correlation with structural and functional parameters of disease, by means of one-way ANOVA and Pearson’s correlation, was analysed.Results. PERG amplitude was reduced, as expression of retinal ganglion cells (RGCs) dysfunction, in EG patients and GS subjects compared to NC patients (P<0.0001). CVphase was significantly increased in EG patients and GS subjects, compared to healthy (P<0.0001), and it was also correlated with PSD (P=0.0009), GCC (P=0.028), and RNFL (P=0.0078) only in EG patients.Conclusions. Increased intrasession variability of phase in suspected glaucomatous eyes may be a sign of RGCs dysfunction.

Download Full-text

The Assessment of Morphological and Functional Changes in the Detection of the Initial Stage of Primary Glaucoma

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-4-857-865 ◽

2021 ◽

Vol 18 (4) ◽

pp. 857-865

Author(s):

N. I. Kurysheva ◽

L. V. Lepeshkina

Keyword(s):

Open Angle Glaucoma ◽

Angle Closure ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Glaucoma Progression ◽

Functional Changes ◽

Primary Glaucoma ◽

Sd Oct

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.

Download Full-text

Effects of OSA Surgery on Ophthalmological Microstructures

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419849082 ◽

2019 ◽

Vol 128 (10) ◽

pp. 938-948 ◽

Cited By ~ 1

Author(s):

Pei-Wen Lin ◽

Hsin-Ching Lin ◽

Michael Friedman ◽

Hsueh-Wen Chang ◽

Anna M. Salapatas ◽

...

Keyword(s):

Academic Medical Center ◽

Upper Airway ◽

Visual Sensitivity ◽

Mean Deviation ◽

Apnea Hypopnea Index ◽

Automated Perimetry ◽

Fiber Layer ◽

Upper Airway Surgery ◽

Airway Surgery ◽

Obstructive Sleep

Objective: Obstructive sleep apnea/hypopnea syndrome (OSA) could compromise oxygenation of the optic nerve and cause glaucomatous optic neuropathy; however, there were no studies to investigate the changes of visual function and retinal microstructures in OSA patients after upper airway surgery. We aim to assess the changes in the visual sensitivity and retinal fiber layer thickness in OSA patients before and after surgery. Methods: This prospective single-blind study enrolled patients with OSA from a tertiary academic medical center who had unsuccessful conservative therapy and then underwent surgery. The patients were referred for comprehensive ophthalmologic evaluation at baseline and 6 months after OSA surgery. The polysomnographic findings were collected pre- and postoperatively. Visual sensitivities on standard automated perimetry (SAP) were assessed. Peripapillary retinal nerve fiber layer (RNFL) thickness and macular layer (ML) thickness parameters were measured by spectral-domain optical coherence tomography (OCT). Results: A total of 108 OSA patients were enrolled. Six months after surgery, the major parameters of polysomnography (PSG), mean deviation, and pattern standard deviation of SAP significantly improved in these OSA patients. Regarding the OCT parameters, thickness of ML in the nasal-outer, superior-inner, temporal-inner, inferior-inner, nasal-inner sectors, and total ML thickness significantly increased 6 months after upper airway surgery in the severe OSA group (apnea/hypopnea index ⩾30 per hour). Conclusion: The visual sensitivities on SAP, ML thickness on OCT, and oxygenation status on PSG significantly improved 6 months after upper airway surgery in patients with severe OSA. Upper airway surgery may ameliorate the microstructures of the retina in patients with severe OSA.

Download Full-text

RetiNerveNet: using recursive deep learning to estimate pointwise 24-2 visual field data based on retinal structure

Scientific Reports ◽

10.1038/s41598-021-91493-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shounak Datta ◽

Eduardo B. Mariottoni ◽

David Dov ◽

Alessandro A. Jammal ◽

Lawrence Carin ◽

...

Keyword(s):

Visual Field ◽

Optic Disc ◽

Severe Disease ◽

Nerve Fibers ◽

Mean Deviation ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Floor Effect ◽

Trade Offs

AbstractGlaucoma is the leading cause of irreversible blindness in the world, affecting over 70 million people. The cumbersome Standard Automated Perimetry (SAP) test is most frequently used to detect visual loss due to glaucoma. Due to the SAP test’s innate difficulty and its high test-retest variability, we propose the RetiNerveNet, a deep convolutional recursive neural network for obtaining estimates of the SAP visual field. RetiNerveNet uses information from the more objective Spectral-Domain Optical Coherence Tomography (SDOCT). RetiNerveNet attempts to trace-back the arcuate convergence of the retinal nerve fibers, starting from the Retinal Nerve Fiber Layer (RNFL) thickness around the optic disc, to estimate individual age-corrected 24-2 SAP values. Recursive passes through the proposed network sequentially yield estimates of the visual locations progressively farther from the optic disc. While all the methods used for our experiments exhibit lower performance for the advanced disease group (possibly due to the “floor effect” for the SDOCT test), the proposed network is observed to be more accurate than all the baselines for estimating the individual visual field values. We further augment the proposed network to additionally predict the SAP Mean Deviation values and also facilitate the assignment of higher weightage to the underrepresented groups in the data. We then study the resulting performance trade-offs of the RetiNerveNet on the early, moderate and severe disease groups.

Download Full-text

Optic Nerve Head Hemoglobin Levels in Glaucoma: A Structural and Functional Correlation Study

Journal of Ophthalmology ◽

10.1155/2021/9916102 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Janaina A. G. Rocha ◽

Diego T. Dias ◽

Maria Betânia C. Lemos ◽

Fábio N. Kanadani ◽

Augusto Paranhos ◽

...

Keyword(s):

Optic Nerve ◽

Optic Nerve Head ◽

Correlation Study ◽

Mean Deviation ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Wide Range ◽

Disease Stages ◽

Sd Oct

Purpose. To investigate structural and functional correlations in glaucoma patients using optic nerve head hemoglobin (ONH Hb) measurements as determined by automated colorimetric analysis of conventional retinography. Methods. We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (standard automated perimetry, SAP), color fundus imaging (mydriatic retinography), and peripapillary retinal nerve fiber layer (pRNFL) assessment through spectral-domain optical coherence tomography (SD-OCT). Software Laguna ONhE was used to estimate the amount of ONH Hb and to determine the glaucoma discriminant function (GDF) index. Scatter plots were constructed, and regression analysis was used to investigate the correlations between GDF, average pRNFL thickness, and VF mean deviation (VFMD) index values. A secondary analysis was performed to compare each parameter between three different glaucoma groups divided according to VFMD values (mild, >−6 dB; moderate, −6 to −12 dB; and advanced, <−12 dB). Results. One hundred ninety-six eyes from 123 participants (69 with glaucoma and 54 controls) were enrolled. Overall, all parameters evaluated differed significantly between glaucomatous and control eyes ( p ≤ 0.001 ). The comparison of each parameter according to groups of disease stages revealed significant differences between controls and each of the glaucomatous groups ( p < 0.001 ). More pronounced changes in GDF values were observed in early disease stages. We found significant nonlinear correlations between GDF and VFMD values (R2 = 0.295, p < 0.001 ) and between pRNFL thickness and VFMD (R2 = 0.598, p < 0.001 ). A linear correlation was found between GDF and pRNFL thickness values (R2 = 0.195, p < 0.001 ). Conclusion. Our results showed significant associations between ONH Hb values and both structural and functional damage in glaucoma obtained by SD-OCT and SAP, respectively. The nonlinear correlation we found and the GDF behavior along different disease stages suggest that ONH Hb levels’ reduction may precede visual function changes in early glaucoma stages.

Download Full-text

Prediction of glaucoma severity using parameters from the electroretinogram

Scientific Reports ◽

10.1038/s41598-021-03421-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marc Sarossy ◽

Jonathan Crowston ◽

Dinesh Kumar ◽

Anne Weymouth ◽

Zhichao Wu

Keyword(s):

Linear Models ◽

Ganglion Cells ◽

Objective Assessment ◽

Multivariate Adaptive Regression Splines ◽

Photopic Negative Response ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Functional Changes ◽

Significant Difference ◽

Better Than

AbstractGlaucoma is an optic neuropathy that results in the progressive loss of retinal ganglion cells (RGCs), which are known to exhibit functional changes prior to cell loss. The electroretinogram (ERG) is a method that enables an objective assessment of retinal function, and the photopic negative response (PhNR) has conventionally been used to provide a measure of RGC function. This study sought to examine if additional parameters from the ERG (amplitudes of the a-, b-, i-wave, as well the trough between the b- and i-wave), a multivariate adaptive regression splines (MARS; a non-linear) model and achromatic stimuli could better predict glaucoma severity in 103 eyes of 55 individuals with glaucoma. Glaucoma severity was determined using standard automated perimetry and optical coherence tomography imaging. ERGs targeting the PhNR were recorded with a chromatic (red-on-blue) and achromatic (white-on-white) stimulus with the same luminance. Linear and MARS models were fitted to predict glaucoma severity using the PhNR only or all ERG markers, derived from chromatic and achromatic stimuli. Use of all ERG markers predicted glaucoma severity significantly better than the PhNR alone (P ≤ 0.02), and the MARS performed better than linear models when using all markers (P = 0.01), but there was no significant difference between the achromatic and chromatic stimulus models. This study shows that there is more information present in the photopic ERG beyond the conventional PhNR measure in characterizing RGC function.

Download Full-text

Evaluation of Macular and Retinal Ganglion Cell Count Estimates for Detecting and Staging Glaucoma

Frontiers in Medicine ◽

10.3389/fmed.2021.740761 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yali Wu ◽

Qing Cun ◽

Yijin Tao ◽

Wenyan Yang ◽

Jia Wei ◽

...

Keyword(s):

Visual Field ◽

Ganglion Cell ◽

Retinal Ganglion Cell ◽

Roc Curve ◽

Structural Parameters ◽

Mean Deviation ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Retinal Ganglion ◽

Fiber Layer

Purpose: To investigate the clinical significance of macular estimated retinal ganglion cell (mRGC) and estimated retinal ganglion cell (eRGC) in the diagnosis and staging of glaucoma.Methods: This is a cross-section study. All enrolled subjects underwent standard automated perimetry (SAP) and optical coherence tomography (OCT) examination. Swedish Interactive Threshold Algorithm (SITA)-FAST detection strategy and 24-2, 10-2 detection programs were employed in SAP assessment. The visual-field parameters and OCT parameters were calculated according to three formulas to obtain the eRGC and mRGC1 or mRGC2. The efficiency of eRGC, mRGC1, and mRGC2 estimates for the staging of glaucoma was compared. The sensitivity and specificity of each parameter for diagnosis of glaucoma were analyzed using the receiver operating characteristic (ROC) curve.Results: A total of 119 eyes were included in the analysis. Compared with the healthy controls, eRGC, mRGC1, and mRGC2 estimates were significantly decreased in patients with glaucoma. As glaucoma progressed, eRGC, mRGC1, and mRGC2 estimates were gradually reduced. In preperimetric glaucoma, mRGC1, mRGC2, and eRGC were reduced by 13.2, 14.5, and 18%, respectively. In the mild stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 28, 34, and 38%, respectively. In the advanced stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 81, 85, and 92% respectively. The proportion of retinal ganglion cell (RGC) loss in the macula was close to that outside the macula. The specificity at 95% gave a sensitivity of 95.51, 86.52, and 87.64% for eRGC, mRGC1, and mRGC2, respectively. The sensitivity of structural parameters macular ganglion cell complex thickness and retinal nerve fiber layer (RNFL) were 98.88 and 95.51%, respectively. The sensitivity of functional parameters mean deviation (24-2) and visual field index (VFI) were 80.90 and 73.03%, respectively. The area under ROC curve of mRGC1, mRGC2, and eRGC were 0.982, 0.972, and 0.995 (P < 0.0001), respectively.Conclusion: Estimated retinal ganglion cell, mRGC1, and mRGC2 provide value to the staging of glaucoma and better diagnostic performance. Macular RGC estimatesthat integration of both structural and functional damages in macular may serve as a sensitive indicator for assessing macular damage in glaucoma and are of importance for the diagnosis and progression management of glaucoma.

Download Full-text