Diagnostic capability of a linear discriminant function applied to a novel Spectralis OCT glaucoma-detection protocol

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Diagnosis

Background:

• Bruch membrane opening-minimum rim width (BMO-MRW) is a novel diagnostic metric for glaucoma using Spectralis optical coherence tomography (OCT).
• Current glaucoma diagnosis relies on peripapillary retinal nerve fibre layer (pRNFL) assessment.

Purpose of the Study:

• To evaluate the diagnostic utility of BMO-MRW and pRNFL measurements from Spectralis OCT in differentiating healthy eyes from mild primary open-angle glaucoma (POAG).
• To compare the diagnostic performance of BMO-MRW with standard pRNFL analysis.
• To investigate if a linear discriminant function (LDF) combining BMO-MRW and pRNFL parameters improves diagnostic accuracy.

Main Methods:

• A prospective, cross-sectional study included 136 eyes (68 mild POAG, 68 healthy controls) matched by propensity score.
• MRW and pRNFL thickness were measured using the BMO-MRW protocol and standard glaucoma application on Spectralis OCT.
• Receiver operating characteristic (ROC) curves were analyzed to determine the area under the curve (AUC) for diagnostic accuracy.

Main Results:

• Both BMO-MRW parameters and pRNFL thickness were significantly reduced in the POAG group (p < 0.001).
• The BMO-MRW parameters demonstrated good diagnostic accuracy, with AUCs up to 0.879 for global RNFL thickness (standard application) and 0.875 for the LDF.
• No statistically significant difference was found between the AUCs of the tested methods.

Conclusions:

• BMO-MRW parameters exhibit significant capability in differentiating mild glaucoma from healthy eyes.
• The developed LDF using the BMO-MRW OCT protocol did not outperform isolated BMO-MRW or pRNFL parameters in diagnostic accuracy.