Combining Optical Coherence Tomography and Fundus Photography to Improve Glaucoma Screening

Area of Science:

• Ophthalmology
• Medical Imaging
• Diagnostic Accuracy

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Early detection through screening is crucial for managing glaucoma and preventing vision loss.
• Fundus photography is a common screening tool, but its diagnostic accuracy can be limited.

Purpose of the Study:

• To evaluate the diagnostic accuracy of glaucoma screening using fundus photography combined with optical coherence tomography (OCT).
• To compare the agreement between experienced ophthalmologists and ophthalmology residents in diagnosing glaucoma using different screening strategies.
• To determine the added value of OCT in enhancing glaucoma screening performance.

Main Methods:

• A dataset of 1006 eyes from 503 cases, with 132 confirmed glaucoma diagnoses, was analyzed.
• Three screening strategies were evaluated: fundus photography alone, fundus photography + OCT, and fundus photography + OCT + comprehensive examination.
• Twenty-four doctors (12 ophthalmologists, 12 residents) assessed the diagnostic accuracy (sensitivity and specificity) for each strategy.

Main Results:

• Glaucoma screening accuracy significantly increased with the addition of OCT to fundus photography.
• Sensitivity improved from 55.4% (fundus photography alone) to 80.0% (fundus photography + OCT).
• Ophthalmologists demonstrated a more substantial improvement in diagnostic accuracy compared to residents when OCT was incorporated.

Conclusions:

• Optical coherence tomography significantly enhances the diagnostic accuracy of glaucoma screening when combined with fundus photography.
• The integration of OCT benefits both ophthalmologists and residents, with a more pronounced impact on experienced ophthalmologists' performance.
• Fundus photography combined with OCT represents a more effective strategy for glaucoma screening and diagnosis.