Performance of confocal scanning laser tomograph Topographic Change Analysis (TCA) for assessing glaucomatous progression.

PURPOSE To determine the sensitivity and specificity of confocal scanning laser ophthalmoscope's Topographic Change Analysis (TCA; Heidelberg Retina Tomograph [HRT]; Heidelberg Engineering, Heidelberg, Germany) parameters for discriminating between progressing glaucomatous and stable healthy eyes. METHODS The 0.90, 0.95, and 0.99 specificity cutoffs for various (n=70) TCA parameters were developed by using 1000 permuted topographic series derived from HRT images of 18 healthy eyes from Moorfields Eye Hospital, imaged at least four times. The cutoffs were then applied to topographic series from 36 eyes with known glaucomatous progression (by optic disc stereophotograph assessment and/or standard automated perimetry guided progression analysis, [GPA]) and 21 healthy eyes from the University of California, San Diego (UCSD) Diagnostic Innovations in Glaucoma Study (DIGS), all imaged at least four times, to determine TCA sensitivity and specificity. Cutoffs also were applied to 210 DIGS patients' eyes imaged at least four times with no evidence of progression (nonprogressed) by stereophotography or GPA. RESULTS The TCA parameter providing the best sensitivity/specificity tradeoff using the 0.90, 0.95, and 0.99 cutoffs was the largest clustered superpixel area within the optic disc margin (CAREA(disc) mm(2)). Sensitivities/specificities for classifying progressing (by stereophotography and/or GPA) and healthy eyes were 0.778/0.809, 0.639/0.857, and 0.611/1.00, respectively. In nonprogressing eyes, specificities were 0.464, 0.570, and 0.647 (i.e., lower than in the healthy eyes). In addition, TCA parameter measurements of nonprogressing eyes were similar to those of progressing eyes. CONCLUSIONS TCA parameters can discriminate between progressing and longitudinally observed healthy eyes. Low specificity in apparently nonprogressing patients' eyes suggests early progression detection using TCA.

[1]  Nicholas G Strouthidis,et al.  Monitoring glaucomatous progression using a novel Heidelberg Retina Tomograph event analysis. , 2007, Ophthalmology.

[2]  Christopher A Girkin,et al.  Effect of glaucomatous damage on repeatability of confocal scanning laser ophthalmoscope, scanning laser polarimetry, and optical coherence tomography. , 2007, Investigative ophthalmology & visual science.

[3]  A. Sommer,et al.  Race-, age-, gender-, and refractive error-related differences in the normal optic disc. , 1994, Archives of ophthalmology.

[4]  A Heijl,et al.  Early Manifest Glaucoma Trial: design and baseline data. , 1999, Ophthalmology.

[5]  David P Crabb,et al.  A new statistical approach for quantifying change in series of retinal and optic nerve head topography images. , 2005, Investigative ophthalmology & visual science.

[6]  Jasjit S. Suri,et al.  Image modeling of the human eye , 2008 .

[7]  A C Viswanathan,et al.  Detection of optic disc change with the Heidelberg retina tomograph before confirmed visual field change in ocular hypertensives converting to early glaucoma , 1999, The British journal of ophthalmology.

[8]  B C Chauhan,et al.  Technique for detecting serial topographic changes in the optic disc and peripapillary retina using scanning laser tomography. , 2000, Investigative ophthalmology & visual science.

[9]  F W Fitzke,et al.  Use of sequential Heidelberg retina tomograph images to identify changes at the optic disc in ocular hypertensive patients at risk of developing glaucoma , 2000, The British journal of ophthalmology.

[10]  H A Quigley,et al.  The effect of age on normal human optic nerve fiber number and diameter. , 1989, Ophthalmology.

[11]  J. Jonas,et al.  Histomorphometry of the human optic nerve. , 1990, Investigative ophthalmology & visual science.

[12]  Wirtschafter Jd Optic nerve axons and acquired alterations in the appearance of the optic disc. , 1983 .

[13]  R. Varma,et al.  Early changes in optic disc compliance and surface position in experimental glaucoma. , 1995, Ophthalmology.

[14]  J. G. Babu,et al.  Normal age-related decay of retinal nerve fiber layer thickness. , 2007, Ophthalmology.

[15]  Douglas R. Anderson Automated Static Perimetry , 1992 .

[16]  B. Chauhan,et al.  Longitudinal changes in the visual field and optic disc in glaucoma , 2005, Progress in Retinal and Eye Research.

[17]  Roger A Hitchings,et al.  Approach for identifying glaucomatous optic nerve progression by scanning laser tomography. , 2003, Investigative ophthalmology & visual science.

[18]  D. Kourkoutas,et al.  Comparison of glaucoma progression evaluated with Heidelberg retina tomograph II versus optic nerve head stereophotographs. , 2007, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[19]  F. Medeiros,et al.  Optic Nerve Imaging: Recent Advances , 2004 .

[20]  Robert N Weinreb,et al.  Imaging of the optic disc and retinal nerve fiber layer: the effects of age, optic disc area, refractive error, and gender. , 2002, Journal of the Optical Society of America. A, Optics, image science, and vision.

[21]  B C Chauhan,et al.  Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma: comparison of scanning laser tomography with conventional perimetry and optic disc photography. , 2001, Archives of ophthalmology.

[22]  B. Lindblom,et al.  Glaucoma follow-up by the Heidelberg Retina Tomograph , 2006, Graefe's Archive for Clinical and Experimental Ophthalmology.

[23]  M. Nicolela,et al.  Visual field and optic disc progression in patients with different types of optic disc damage: a longitudinal prospective study. , 2003, Ophthalmology.

[24]  Nicholas G Strouthidis,et al.  New developments in Heidelberg retina tomograph for glaucoma , 2008, Current opinion in ophthalmology.

[25]  Douglas R. Anderson,et al.  Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. , 2007, Ophthalmology.

[26]  R A Hitchings,et al.  Aging changes of the optic nerve head in relation to open angle glaucoma , 1997, The British journal of ophthalmology.

[27]  Nicholas G Strouthidis,et al.  Optic disc and visual field progression in ocular hypertensive subjects: detection rates, specificity, and agreement. , 2006, Investigative ophthalmology & visual science.