Elsevier

Ophthalmology

Volume 116, Issue 12, December 2009, Pages 2305-2314.e2
Ophthalmology

Original article
Detection of Macular Ganglion Cell Loss in Glaucoma by Fourier-Domain Optical Coherence Tomography

https://doi.org/10.1016/j.ophtha.2009.05.025Get rights and content

Purpose

To map ganglion cell complex (GCC) thickness with high-speed Fourier-domain optical coherence tomography (FD-OCT) and compute novel macular parameters for glaucoma diagnosis.

Design

Observational, cross-sectional study.

Participants

One hundred seventy-eight participants in the Advanced Imaging for Glaucoma Study, divided into 3 groups: 65 persons in the normal group, 78 in the perimetric glaucoma group (PG), and 52 in the preperimetric glaucoma group (PPG).

Methods

The RTVue FD-OCT system was used to map the macula over a 7×6 mm region. The macular OCT images were exported for automatic segmentation using software we developed. The program measured macular retinal (MR) thickness and GCC thickness. The GCC was defined as the combination of nerve fiber, ganglion cell, and inner plexiform layers. Pattern analysis was applied to the GCC map and the diagnostic powers of pattern-based diagnostic parameters were investigated. Results were compared with time-domain (TD) Stratus OCT measurements of MR and circumpapillary nerve fiber layer (NFL) thickness.

Main Outcome Measures

Repeatability was assessed by intraclass correlation, pooled standard deviation, and coefficient of variation. Diagnostic power was assessed by the area under the receiver operator characteristic (AROC) curve. Measurements in the PG group were the primary measures of performance.

Results

The FD-OCT measurements of MR and GCC averages had significantly better repeatability than TD-OCT measurements of MR and NFL averages. The FD-OCT GCC average had significantly (P = 0.02) higher diagnostic power (AROC = 0.90) than MR (AROC = 0.85 for both FD-OCT and TD-OCT) in differentiating between PG and normal. One GCC pattern parameter, global loss volume, had significantly higher AROC (0.92) than the overall average (P = 0.01). The diagnostic powers of the best GCC parameters were statistically equal to TD-OCT NFL average.

Conclusions

The higher speed and resolution of FD-OCT improved the repeatability of macular imaging compared with standard TD-OCT. Ganglion cell mapping and pattern analysis improved diagnostic power. The improved diagnostic power of macular GCC imaging is on par with, and complementary to, peripapillary NFL imaging. Macular imaging with FD-OCT is a useful method for glaucoma diagnosis and has potential for tracking glaucoma progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Clinical Study

Participants in the prospective, longitudinal Advanced Imaging for Glaucoma Study (AIGS) between 2003 and 2007 were included. The earliest available FD-OCT scans for each participant, along with the TD-OCT taken at the same visit, were used in the analysis. Participants in the following 3 groups were analyzed: normal, perimetric glaucoma (PG), and preperimetric glaucoma (PPG). The eligibility criteria for the 3 groups analyzed are briefly described below, but were also described in our previous

Results

A total of 183 participants (328 eyes) with available RTVue GCC and Stratus scans were identified from the AIG central database. A total of 849 GCC scans were screened, 48 were excluded for low signal and 41 were excluded owing to segmentation error. The average SSI of the accepted GCC scans was 39.8. A total of 622 Stratus scans were screened; 12 scans were excluded owing to low SS. The average SS of the accepted Stratus scans was 8.3. Stratus scans that had segmentation error were rejected

Discussion

Although glaucoma is clinically defined as optic disc cupping with corresponding VF defects, the underlying disease process in glaucoma is the loss of RGC.1, 2, 3 Approximately one third of the RGC population resides within the posterior pole. In the macula, the RGC layer is >1 cell layer thick with an RGC body diameter 10 to 20 times larger compared with their axons. In addition, the central retina has less variability in cell density compared with peripheral retina.41 Thus, detecting RGC loss

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    Available online: September 10, 2009.

    Manuscript no. 2008-820.

    Financial Disclosure(s): David Huang - Patent royalty, stock options, travel support, and grant support - Optovue, Inc.; Patent royalty - Zeiss Meditec, Inc.

    Joel S. Schuman – Lecturer - Optovue, Inc.; Patent royalty, travel support, and grant - Carl Zeiss Meditec, Inc.

    Ou Tan - Patent royalty, grant support - Optovue, Inc.

    Vikas Chopra - Travel support - Optovue, Inc.

    Supported by NIH grants R01 EY013516 and P30 EY03040, a grant from Research to Prevent Blindness, and a grant from Optovue, Inc.

    Vikas Chopra and Ake Lu made equal contributions to the manuscript.

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