Racial Differences in Diagnostic Accuracy of Retinal Nerve Fiber Layer Thickness in Primary Open-Angle Glaucoma

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Research

Background:

• Primary open-angle glaucoma (POAG) diagnosis relies on detecting structural changes.
• Retinal nerve fiber layer thickness (RNFLT) measured by spectral-domain optical coherence tomography (OCT) is a key diagnostic indicator.
• Racial differences in glaucoma prevalence and presentation are known.

Purpose of the Study:

• To compare the diagnostic accuracy of RNFLT measurements using spectral-domain OCT between individuals of African descent (AD) and European descent (ED).
• To evaluate RNFLT diagnostic performance in primary open-angle glaucoma (POAG) across different ethnicities.

Main Methods:

• A comparative diagnostic accuracy analysis was performed based on race.
• Data from 379 healthy eyes (125 AD, 254 ED) and 442 glaucomatous eyes (226 AD, 216 ED) were analyzed.
• Spectralis and Cirrus OCT devices were used to obtain RNFLT measurements.

Main Results:

• Spectralis OCT showed significantly lower diagnostic accuracy for RNFLT in AD eyes (AUROC: 0.85) compared to ED eyes (AUROC: 0.91, P=0.04).
• Cirrus OCT results were similar, though not statistically significant (AUROC: 0.86 in AD vs. 0.90 in ED, P=0.33).
• Adjustments for confounders like age, CCT, AL, disc area, MD, and IOP did not alter these findings.

Conclusions:

• OCT-based RNFLT measurements demonstrate reduced diagnostic accuracy in individuals of African descent compared to European descent.
• This ethnic disparity in diagnostic performance was consistent across two OCT instruments and robust to adjustments for multiple confounding factors.
• Further investigation is warranted to elucidate the underlying reasons for this observed difference in diagnostic accuracy.