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Comparative Study
. 2017 Mar 13;12(3):e0173930.
doi: 10.1371/journal.pone.0173930. eCollection 2017.

A comparison of the diagnostic ability of vessel density and structural measurements of optical coherence tomography in primary open angle glaucoma

Harsha L Rao  1   2 , Zia S Pradhan  1 , Robert N Weinreb  3 , Mohammed Riyazuddin  2 , Srilakshmi Dasari  2 , Jayasree P Venugopal  1 , Narendra K Puttaiah  1   2 , Dhanaraj A S Rao  1 , Sathi Devi  1 , Kaweh Mansouri  4   5 , Carroll A B Webers  6
Affiliations
Comparative Study

A comparison of the diagnostic ability of vessel density and structural measurements of optical coherence tomography in primary open angle glaucoma

Harsha L Rao et al. PLoS One. .

Abstract

Purpose: To compare the diagnostic abilities of vessel density measurements of the optic nerve head (ONH), peripapillary and macular regions on optical coherence tomography (OCT) angiography in eyes with primary open angle glaucoma (POAG) with that of the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (GCC) thickness measurements.

Methods: In a cross sectional study, 78 eyes of 50 control subjects and 117 eyes of 67 POAG patients underwent vessel density and structural measurements with spectral domain OCT. POAG was diagnosed based on the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary and macular regions were compared with rim area, RNFL and GCC thickness.

Results: The AUC (sensitivity at 95% specificity) of average vessel densities within the ONH, peripapillary and macular region were 0.77 (31%), 0.85 (56%) and 0.70 (18%) respectively. The same of ONH rim area, average RNFL and GCC thickness were 0.94 (83%), 0.95 (72%) and 0.93 (62%) respectively. AUCs of vessel densities were significantly lower (p<0.05) than that of the corresponding structural measurements. Pre-treatment IOP (coefficient: 0.08) affected (p<0.05) the AUC of ONH vessel density but not of any other vessel density or structural measurements.

Conclusions: Diagnostic abilities of ONH, peripapillary and the macular vessel densities in POAG were significantly lower than ONH rim area, peripapillary RNFL and macular GCC measurements respectively. At fixed levels of glaucoma severity, the diagnostic ability of the ONH vessel density was significantly greater in eyes with higher pre-treatment IOP.

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Conflict of interest statement

Competing Interests: HLR is a consultant for Pfizer, Santen and Cipla, RNW is a consultant for Aerie Pharmaceuticals, Allergan, Alcon, Bausch & Lomb, Eyenovia, and Unity., KM is a consultant for Santen and Sensimed, and CABW is a consultant for Allergan, MSD and Pfizer. RNW has received financial support in form of instruments or research funding from Topcon, Carl Zeiss, Neurovision, Optos, Heidelberg Engineering, Genentech and Quark, KM has received research funding from Topcon and Alcon, and CABW has received research funding from Alcon. We also confirm that this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Case examples.
Nerve head segment (a), radial peripapillary capillary, RPC segment (b) and macular (c) optical coherence tomography angiography scans of a normal eye (top panel) and an eye with glaucoma (bottom panel). The figure also shows the retinal nerve fiber layer, RNFL (d) and ganglion cell complex, GCC (e) maps of the two eyes. Vessel loss in the eye with glaucoma can be noted in the inferotemporal peripapillary region correlating with the RNFL loss seen on the RNFL map.
Fig 2
Fig 2. Diagnostic abilities of vessel density and structural measurements.
Sensitivity at 95% specificity of (a) optic nerve head vessel density and rim area, (b) peripapillary vessel density and retinal nerve fiber layer (RNFL) thickness and (c) superficial macular vessel density and ganglion cell complex (GCC) thickness according to mean deviation on visual fields.
Fig 3
Fig 3. Effect of pre-treatment intraocular pressure on the diagnostic ability of optic nerve head vessel density and rim area.
Sensitivity at 95% specificity of optic nerve head vessel density and rim area according to the pre-treatment intraocular pressure at a mean deviation on visual fields of -5 dB.
See this image and copyright information in PMC

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