Applicability of automatic spectral domain optical coherence tomography for glaucoma mass screening

Figures & data

Figure 1 An example of the location pattern of 10×10 grids in the 6×6 mm analysis area and 3.4 mm diameter circle centered on the disc.

Abbreviations: S, superior; N, nasal; I, inferior; T, temporal.

Figure 2 Distribution of four measurements between glaucoma-positive and glaucoma-negative (normal) subjects.

Notes: Thicknesses of the macular retinal nerve fiber layer (mRNFL), disc retinal nerve fiber layer (dRNFL), ganglion cell-inner plexiform layer (GCL + IPL; GCL+), and ganglion cell complex (GCL + IPL + RNFL; GCL++) were measured in 245 eyes of 123 glaucomatous subjects and in 1,454 eyes of 727 normal subjects. The grade of thickness in each grid was scored as follows: 2= within 95% of the normal database, 1= within 5%, and 0= within 1%. The distribution of the sum of each grid (dRNFLs (A), GCL+s (B), GCL++s (C), and mRNFLs (D)) is shown.

Figure 3 Receiver operating characteristic (ROC) curve using four measurements.

Notes: Thicknesses of macular retinal nerve fiber layer (mRNFL), disc retinal nerve fiber layer (dRNFL), ganglion cell-inner plexiform layer (GCL + IPL; GCL+), and ganglion cell complex (GCL + IPL + RNFL; GCL++) were measured in 245 eyes of 123 glaucomatous subjects and in 1,454 eyes of 727 normal subjects. In all four measurements, each grid was scored as follows: 2= within 95% of normal database; 1= within 5%; 0= within 1%). The ROC curve was made using the four measurements of the sum of each grid (mRNFLs, dRNFLs, GCL+s, and GCL++s).

Table 1 The area under the receiver operating characteristic curve (AUC-ROC)

Index	AUC-ROC	95% confidence interval
mRNFLs	0.927	0.903	0.950
dRNFLs	0.919	0.899	0.940
GCL+s	0.972	0.958	0.986
GCL++s	0.972	0.957	0.986

Abbreviations: mRNFLs, sum of the score in macular retinal nerve fiber layer; dRNFLs, sum of the score in disk retinal nerve fiber layer; GCL+s, sum of the score in ganglion cell-inner plexiform layer; GCL++s, sum of the score in ganglion cell complex.

Table 2 Performance of automatic spectral domain-optical coherence tomography (ASD-OCT) screening in a case–control setting

ASD-OCT screening	Normal	Glaucoma	Total
Negative (GCL+s >=160)	1,452	45	1,497
	(97.0%)	(3.0%)	(100%)
	(99.9%)	(18.4%)	(88.1%)
Positive (GCL+s <=160)	2	200	202
	(1.0%)	(99.0%)	(100%)
	(0.1%)	(81.6%)	(11.9%)
Total	1,454	245	1,699
	(85.6%)	(14.4%)	(100%)
	(100%)	(100%)	(100%)

Notes: GCL+s: sum of the score in ganglion cell-inner plexiform layer. Upper and lower values in parenthesis represent the percentage in each row and column, respectively.

Table 3 Results of automatic spectral domain-optical coherence tomography (ASD-OCT) screening in a population setting of the general workers

	ASD-OCT screening		Total
	Negative	Positive
FDT test
Negative	8,349 (87)	1,252 (13)	9,601 (100)
Positive	138 (25.4)	406 (74.6)	544 (100)
Fundus test
Negative	8,464 (85.2)	1,471 (14.8)	9,935 (100)
Positive	23 (11)	187 (89)	210 (100)
Total	8,487 (83.7)	1,658 (16.3)	10,145 (100)

Note: Data are expressed as n (%).

Abbreviation: FDT, frequency doubling technology perimetry.

Figure S1 The distribution of dRNFLs (A), GCL+s (B), GCL++s (C), and mRNFLs (D), stratified by FDT results.

Notes: According to FDT results, each grade in a field was scored as follows: 0= normal, 1= mild relative loss, 2= moderate relative loss, and 3= severe loss. Total score was summed among 17 areas and was classified into four grades as an FDT score: 0, 1–10, 11–20, and 21–. The distribution of the sum of each grid (dRNFLs (A), GCL+s (B), GCL++s (C) and, mRNFLs (D)) is shown.

Abbreviations: dRNFLs, sum of the score in disc retinal nerve fiber layer; FDT, frequency-doubling technology; GCL+s, sum of the score in ganglion cell-inner plexiform layer; GCL++s, sum of the score in ganglion cell complex; mRNFLs, sum of the score in macular retinal nerve fiber layer.