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Estimating Visual Field Mean Deviation using Optical Coherence Tomographic Nerve Fiber Layer Measurements in Glaucoma
Ou Tan1, David S Greenfield2, Brian A Francis3
1Casey Eye Institute, Oregon Health & Science University, Portland, USA.
Scientific Reports
|December 8, 2019
Summary
A new optical coherence tomography (OCT) nerve fiber layer (NFL) parameter, NFL_MD, shows stronger correlation and agreement with visual field (VF) mean deviation (MD) than standard NFL thickness. This OCT parameter improves glaucoma detection sensitivity and reproducibility.
Area of Science:
- Ophthalmology
- Medical Imaging
- Glaucoma Research
Background:
- Glaucoma diagnosis and monitoring rely on correlating structural optic nerve head and nerve fiber layer (NFL) damage with functional visual field (VF) deficits.
- Optical coherence tomography (OCT) provides high-resolution imaging of the peripapillary NFL thickness, but its direct correlation with VF mean deviation (MD) can be variable.
Purpose of the Study:
- To develop and validate a novel OCT-derived nerve fiber layer parameter (NFL_MD) that maximizes correlation and agreement with visual field mean deviation (MD).
- To assess the diagnostic sensitivity and reproducibility of the new NFL_MD parameter compared to standard NFL thickness and VF_MD.
Main Methods:
- A new NFL_MD parameter was calculated using nonlinear transformation of peripapillary NFL thickness profiles and VF area-weighted averaging.
- Data from the Advanced Imaging for Glaucoma study, including 245 normal, 420 pre-perimetric glaucoma (PPG), and 289 perimetric glaucoma (PG) eyes, were analyzed.
- Pearson correlation coefficients and diagnostic sensitivity at 99% specificity were calculated and compared between NFL_MD, standard NFL thickness, and VF_MD.
Main Results:
- NFL_MD demonstrated significantly higher correlation with VF_MD (R=0.68) compared to overall NFL thickness (R=0.55).
- NFL_MD exhibited superior sensitivity in detecting PPG (14% vs 8%) and PG (60% vs 43%) at 99% specificity.
- NFL_MD showed better reproducibility (0.35 dB) than VF_MD (0.69 dB), though it tended to underestimate damage in moderate to advanced glaucoma stages.
Conclusions:
- The OCT-based NFL_MD parameter offers improved correlation and diagnostic sensitivity for glaucoma detection compared to average NFL thickness.
- NFL_MD's enhanced reproducibility may aid in tracking glaucoma progression, with good agreement in early stages but a tendency to underestimate severity in later stages.
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