The Role of Multimodal Approach in the Assessment of Glaucomatous Damage in High Myopes

Figures & data

Figure 1 Example of a print-out from the papillary anatomic and vascular assessments (RTVue XR Avanti, with AngioVue system, Optovue^®).

Figure 2 Example of a print-out from the circumpapillary microperimetric assessment (MP-3 microperimeter, Nidek^®).

Table 1 Overall and per Group Analysis

	All Sample	Glaucoma	Non-Glaucoma	p (Between Groups)
	N= 60	N= 30	N=30
Age (years)	47.9 ± 14.2	58.0 ± 12.9	37.8 ± 6.0	<0.001
BCVA (Snellen)	0.74 ± 0.33	0.54 ± 0.34	0.94 ± 0.12	<0.001
GAT-IOP (mmHg)	14.95 ± 2.7	16.25 ± 2.8	13.73 ± 1.8	<0.001
CCT (µm)	540.3 ± 36.9	539.57 ± 40.8	540.93 ± 33.6	0.890
AL (mm)	27.99 ± 2.6	29.74 ± 2.7	26.4 ± 1.2	<0.001
Optic disc anatomical data
Total mean ppRNFLT (µm)	124.3 ± 16.9	107.29 ± 19.8	141.31 ± 13.9	<0.001
Inferior ppRNFLT (µm)	143.22 ± 22.0	121.76 ± 34.6	164.68 ± 18.9	<0.001
Superior ppRNFLT (µm)	146.47 ± 25.5	120.80 ± 37.3	172.14 ± 24.1	<0.001
Nasal ppRNFLT (µm)	100.31 ± 19.2	88.41 ± 31.4	112.20 ± 14.5	<0.001
Temporal ppRNFLT (µm)	106.85 ± 17.6	95.71 ± 29.2	117.99 ± 20.4	0.002
CDR	0.38 ± 0.2	0.43 ± 0.2	0.33 ± 0.2	0.077
NRRA (mm^2)	1.24 ± 0.6	1.18 ± 0.7	1.29 ± 0.4	0.524
Papillary retinal small vessel density (SVD, %)
Whole image	41.47 ± 8.0	34.35 ± 5.4	47.46 ± 3.9	<0.001
Inside disc	55.22 ± 6.0	55.69 ± 7.0	54.83 ± 5.2	0.638
Peripapillary	41.95 ± 10.9	32.22 ± 7.2	50.07 ± 4.9	<0.001
Inferior	42.80 ± 13.0	31.81 ± 10.5	52.04 ± 5.7	<0.001
Superior	39.89 ± 14.5	27.10 ± 9.3	51.08 ± 6.8	<0.001
Nasal	39.91 ± 11.1	30.70 ± 8.7	47.28 ± 6.1	<0.001
Temporal	44.98 ± 9.7	39.2 ± 9.4	50.26 ± 6.4	<0.001
Circumpapillary microperimetric assessment (cpMP, dB)
Total mean	24.44 ± 8.3	18.39 ± 8.5	29.8 ± 2.4	<0.001
Inferior quadrant	24.52 ± 8.2	19.31 ± 9.3	29.14 ± 2.6	<0.001
Superior quadrant	24.96 ± 8.4	19.23 ± 9.2	30.02 ± 2.0	<0.001
Nasal quadrant	23.89 ± 9.7	17.087 ± 10.2	29.90 ± 2.7	<0.001
Temporal quadrant	24.35 ± 9.2	17.87 ± 9.6	30.08 ± 2.9	<0.001
Static Automated Perimetry
Visual Field Index (%)	·	68.9 ± 24.4	·	·
Mean deviation (dB)	·	13.3 ± 7.7	·	·
Pattern Standard Deviation (dB)	·	7.8 ± 3.4	·	·

Note: Statistical significance at p<0.05.

Abbreviations: BCVA, best corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; GAT-IOP, pachymetry-adjusted Goldmann applanation intraocular pressure; CCT, central corneal thickness; AL, axial length; ppRNFLT, peripapillary retinal nerve fiber layer thickness; CDR, cup-to-disc ratio; NRRA, neuroretinal rim area.

Table 2 Discriminative Power of Each Variable

	Unadjusted			Adjusted for CCT and AL
	OR (95% CI)	p	AUROC [95% CI]	OR (95% CI)	p	Model AUROC [95% CI]	cvAUROC [95% CI]
CCT (µm)	1.00 (0.98–1.01)	0.887	0.4923 [0.3382–0.6464]
AL (mm)	1.95 (1.36–2.80)	<0.001	0.8127 [0.7051–0.9383]
Optic disc anatomical data
Total mean ppRNFLT (µm)	0.86 (0.81–0.93)	<0.001	0.8897 [0.7824–0.9967]	0.88 (0.81–0.95)	0.002	0.9599 [0.9132–1.0]	0.9528 [0.8422–0.9842]
Inferior ppRNFLT (µm)	0.93 (0.89–0.96)	<0.001	0.8665 [0.7555–0.9775]	0.95 (0.92–0.99)	0.004	0.9228 [0.8550–0.9907]	0.8618 [0.7304–0.9609]
Superior ppRNFLT (µm)	0.93 (0.89–0.97)	<0.001	0.8704 [0.7601–0.9807]	0.96 (0.93–0.98)	0.003	0.9290 [0.8417–1.0]	0.8847 [0.7289–0.9722]
Nasal ppRNFLT (µm)	0.94 (0.90–0.98)	0.004	0.8171 [0.6714–0.9629]	0.93 (0.89–0.98)	0.004	0.9414 [0.8818–10]	0.8736 [0.7061–0.9430]
Temporal ppRNFLT (µm)	0.95 (0.91–0.98)	0.007	0.7809 [0.6410–0.9208]	0.92 (0.87–0.98)	0.006	0.9398 [0.9922–0.9974]	0.9264 [0.7978–0.9697]
CDR	14.72 (0.70–309.33)	0.083	0.6418 [0.4812–0.8025]	158.68 (1.49–16,811.3)	0.033	0.8750 [0.7734–0.9766]	0.8556 [0.6898–0.9388]
NRRA (mm^2)	0.72 (0.27–1.89)	0.51	0.6338 [0.4622–0.8054]	0.33 (0.08–1.43)	0.14	0.8558 [0.7455–0.9660]	0.8488 [0.6476–0.9184]
Papillary retinal small vessel density (SVD, %)
Whole image	0.61 (0.46–0.81)	0.001	0.9695 [0.9307–1.0]	0.62 (0.46–0.84)	0.002	0.9771 [0.9422–1.0]	0.9389 [0.8342–0.9921]
Inside disc	1.02 (0.93–1.13)	0.63	0.5571 [0.3795–0.7348]	0.93 (0.81–1.07)	0.345	0.8152 [0.6755–0.9550]	0.7028 [0.6111–0.9237]
Peripapillary	0.69 (0.56–0.86)	0.001	0.9708 [0.9325–1.0]	0.70 (0.55–0.88)	0.002	0.9708 [0.9325–1.0]	0.9722 [0.8235–0.9824]
Inferior	0.71 (0.57–0.88)	0.002	0.9581 [0.8999–1.0]	0.70 (0.56–0.89)	0.003	0.9581 [0.8999–1.0]	0.9750 [0.7972–0.9868]
Superior	0.77 (0.67–0.89)	<0.001	0.9653 [0.9185–1.0]	0.75 (0.61–0.91)	0.004	0.9702 [0.9274–1.0]	0.9576 [0.8000–1.0]
Nasal	0.76 (0.66–0.89)	<0.001	0.9450 [0.8866–1.0]	0.73 (0.59–0.90)	0.004	0.9600 [0.9009–1.0]	0.9750 [0.7815–1.0]
Temporal	0.85 (0.77–0.94)	0.001	0.8406 [0.7264–0.9548]	0.86 (0.77–0.96)	0.01	0.8861 [7679–1.0]	0.8896 [0.6726–0.9636]
Circumpapillary microperimetric assessment (cpMP, dB)
Total mean	0.73 (0.60–0.87)	0.001	0.8554 [0.7333–0.9774]	0.76 (0.60–0.97)	0.03	0.8963 [0.7850–1.0]	0.8694 [0.6286–0.9357]
Inferior quadrant	0.71 (0.57–0.87)	0.001	0.8537 [0.7354–0.9720]	0.78 (0.60–1.01)	0.058	0.8831 [0.7645–0.9981]	0.8611 [0.6025–0.9339]
Superior quadrant	0.68 (0.52–0.87)	0.003	0.8528 [0.7333–0.9724]	0.77 (0.58–1.01)	0.057	0.8796 [0.7656–0.9936]	0.8486 [0.6548–0.9545]
Nasal quadrant	0.76 (0.64–0.89)	0.001	0.8512 [0.7253–0.9770]	0.77 (0.60–0.99)	0.041	0.9097 [0.8004–1.0]	0.8806 [0.6794–0.9690]
Temporal quadrant	0.77 (0.66–0.90)	0.001	0.8428 [0.7186–0.9671]	0.81 (0.68–98)	0.027	0.8896 [0.7774–1.0]	0.8590 [0.6077–0.9300]

Note: Statistical significance at p<0.05.

Abbreviations: OR, odds ratio; AUROC, area under the receiver operating characteristic curve; cvAUROC, AUROC with cross-validation; CCT, central corneal thickness; AL, axial length; ppRNFLT, peripapillary retinal nerve fiber layer thickness; CDR, cup-to-disc ratio; NRRA, neuroretinal rim area.

Figure 3 Best 2-variable papillary anatomic model to predict the presence of glaucoma in eyes with high myopia, including the peripapillary retinal nerve fiber layer thickness of the temporal and inferior sectors.

Figure 4 Best 2-variable papillary vessel density model to predict the presence of glaucoma in eyes with high myopia, including the en-face papillary retinal small vessel densities of the inferior and superior sectors.