Performance of Optic Disc Optical Coherence Tomography Normative Database in a Large, Diverse, Real-World Cohort

Area of Science:

• Ophthalmology
• Medical Imaging
• Optometry

Background:

• Optical coherence tomography (OCT) is crucial for diagnosing glaucoma by analyzing optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters.
• Existing normative databases for OCT may lack diversity, potentially impacting diagnostic accuracy in various populations.

Purpose of the Study:

• To compare ONH measurements from a diverse cohort with existing OCT normative database values.
• To assess the representativeness of current OCT normative data for classifying healthy individuals.

Main Methods:

• Compared ONH parameters from the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program with the Topcon Maestro-1 normative cohort.
• Utilized chi-squared tests and multinomial logistic regression to analyze RNFL color-code distributions and influencing factors.

Main Results:

• The MI-SIGHT cohort (n=1084) was older, more racially diverse (61% Black), and had different refractive error compared to the Topcon cohort (n=399).
• Significant differences in ONH parameters (cup-to-disc ratio, cup volume, rim area) were observed between racial groups within the MI-SIGHT cohort compared to Topcon.
• MI-SIGHT RNFL color codes deviated from expected distributions, with higher rates of 'white' and 'red' codes in superior and inferior quadrants, respectively.

Conclusions:

• Current OCT normative databases may not adequately represent diverse optic nerve anatomy.
• The lack of diversity in normative data can lead to misclassification of RNFL thickness, potentially impacting glaucoma diagnosis.
• Larger, more inclusive datasets are essential to capture the full spectrum of healthy ONH anatomy for accurate clinical application.