Regression-Based Strategies to Reduce Refractive Error-Associated Glaucoma Diagnostic Bias When Using OCT and OCT...

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Diagnostics

Background:

• Optical coherence tomography (OCT) and OCT angiography (OCTA) are crucial for glaucoma diagnosis.
• Refractive errors, particularly myopia, can introduce significant bias in these diagnostic parameters.
• Accurate glaucoma detection relies on mitigating these refractive error-associated biases.

Purpose of the Study:

• To correct refractive error-associated bias in optical coherence tomography (OCT) and OCT angiography (OCTA) glaucoma diagnostic parameters.
• To evaluate the effectiveness of axial length (AL) and spherical equivalent (SE) adjustments in mitigating bias.

Main Methods:

• OCT and OCTA imaging were performed on 1346 eyes from 792 participants in the Hong Kong FAMILY cohort.
• Participants were categorized into high myopia, low myopia, emmetropia, and hyperopia groups.
• Multivariable regression analysis was used to assess the relationship between diagnostic parameters and ocular metrics, followed by regression-based adjustments.

Main Results:

• Most diagnostic parameters (nerve fiber layer thickness, ganglion cell complex thickness, nerve fiber layer plexus capillary density) showed strong dependence on axial eye length (AL), spherical equivalent (SE), and optic disc diameter (DD).
• Myopic eyes exhibited significantly elevated false positive rates for NFLT, NFLP-CD, and GCCT compared to emmetropic eyes.
• Regression-based adjustments using AL or SE significantly reduced these elevated false positive rates.

Conclusions:

• Myopic eyes are prone to underestimation of key glaucoma diagnostic parameters (NFLT, GCCT, NFLP-CD).
• Axial length (AL) and spherical equivalent (SE) based adjustments are effective in mitigating refractive error-associated bias.
• Implementing these adjustments in commercial OCT systems can improve diagnostic accuracy and reduce false positives.