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SD-OCT, TD-OCT have similar diagnostic abilities with high myopia
Spectral-domain optical coherence tomography and/or time-domain OCT diagnostics are useful in discriminating between highly myopic eyes with confirmed and suspected glaucoma, according to researchers in Optometry and Vision Science.
Researchers studied 72 highly myopic eyes, of which 41 had perimetric glaucoma and 31 were suspected to have glaucoma. All eyes underwent spectral-domain optical coherence tomography (SD-OCT, Spectralis, Heidelberg) and time-domain OCT (TD-OCT, Stratus, Carl Zeiss Meditec).
Researchers said they found the highest TD-OCT area under the receiver operating characteristic (AUROC) curves using outer inferior sector macular thickness (AUROC curve, 0.911) and volume (AUROC curve, 0.909). The highest SD-OCT AUROC curves were found using outer inferior region thickness (AUROC curve, 0.836) and volume (AUROC curve, 0.834).
Although not statistically significant, the AUROC curves for macular thickness and volume parameters were, on average, higher for the Stratus OCT than the Spectralis OCT. The Stratus OCT generally had higher sensitivities at fixed specificities (>80.0% and >90.0%) for macular thickness and volume measurements, the researchers wrote.
Artifacts were identified in 17.5% of Stratus OCT and 23.8% of Spectralis OCT scans, they reported. Hung and colleagues suggest that further assessments of macular OCT imaging artifacts in highly myopic eyes are needed.
Overall, the Stratus OCT had higher sensitivities than the Spectralis OCT, but the differences between the OCT devices were not significant, the researchers concluded. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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In fall 2015, two consecutive Optometric Glaucoma Society perspectives focused on myopia and glaucoma, identifying the “dose-response” relationship between the two conditions and the unique challenges posed by the structure and function of myopic eyes in establishing a diagnosis and monitoring for disease progression.
In demonstrating that outer inferior macular thickness aids in differentiating between suspect and glaucomatous myopic eyes, Hung and colleagues have provided another valuable tool for the increasingly common clinical dilemma of diagnosing open angle glaucoma in myopic individuals. There is a growing population of young patients who often present with statistically normal intraocular pressure and anomalous nerves that confound imaging yet appear to be more susceptible to initial field defects that threaten fixation.
Now, if all you have is a hammer, everything looks like a nail, and the authors rightly emphasize the inadvisability of using any single tool in isolation, particularly given the embarrassment of riches at our disposal. Gathering as much reliable structural and functional data as possible, as early as possible, allows clinicians to leverage reference databases when appropriate and longitudinally monitor patients through all stages of the glaucoma continuum, comparing present to past.