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. 2018 Apr 3;7(2):16.
doi: 10.1167/tvst.7.2.16. eCollection 2018 Apr.

Validation of the UNC OCT Index for the Diagnosis of Early Glaucoma

Jean-Claude Mwanza  1 , Gary Lee  2 , Donald L Budenz  1 , Joshua L Warren  3 , Michael Wall  4 , Paul H Artes  5 , Thomas M Callan  2 , John G Flanagan  6
Affiliations

Validation of the UNC OCT Index for the Diagnosis of Early Glaucoma

Jean-Claude Mwanza et al. Transl Vis Sci Technol. .

Abstract

Purpose: To independently validate the performance of the University of North Carolina Optical Coherence Tomography (UNC OCT) Index in diagnosing and predicting early glaucoma.

Methods: Data of 118 normal subjects (118 eyes) and 96 subjects (96 eyes) with early glaucoma defined as visual field mean deviation (MD) greater than -4 decibels (dB), aged 40 to 80 years, and who were enrolled in the Full-Threshold Testing Size III, V, VI comparison study were used in this study. CIRRUS OCT average and quadrants' retinal nerve fiber layer (RNFL); optic disc vertical cup-to-disc ratio (VCDR), cup-to-disc area ratio, and rim area; and average, minimum, and six sectoral ganglion cell-inner plexiform layer (GCIPL) measurements were run through the UNC OCT Index algorithm. Area under the receiver operating characteristic curve (AUC) and sensitivities at 95% and 99% specificity were calculated and compared between single parameters and the UNC OCT Index.

Results: Mean age was 60.1 ± 11.0 years for normal subjects and 66.5 ± 8.1 years for glaucoma patients (P < 0.001). MD was 0.29 ± 1.04 dB and -1.30 ± 1.35 dB in normal and glaucomatous eyes (P < 0.001), respectively. The AUC of the UNC OCT Index was 0.96. The best single metrics when compared to the UNC OCT Index were VCDR (0.93, P = 0.054), average RNFL (0.92, P = 0.014), and minimum GCIPL (0.91, P = 0.009). The sensitivities at 95% and 99% specificity were 85.4% and 76.0% (UNC OCT Index), 71.9% and 62.5% (VCDR, all P < 0.001), 64.6% and 53.1% (average RNFL, all P < 0.001), and 66.7% and 58.3% (minimum GCIPL, all P < 0.001), respectively.

Conclusions: The findings confirm that the UNC OCT Index may provide improved diagnostic perforce over that of single OCT parameters and may be a good tool for detection of early glaucoma.

Translational relevance: The UNC OCT Index algorithm may be incorporated easily into routine clinical practice and be useful for detecting early glaucoma.

Keywords: UNC OCT Index; early glaucoma; optical coherence tomography.

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Figures

Figure 1
Figure 1
Diagram of steps of the UNC OCT Index algorithm showing all OCT parameters used in the model (left), the latent factors obtained after submitting the original parameters to EFA followed by oblique promax rotation (middle), and the final composite resulting from the multivariable logistic regression (right).
Figure 2
Figure 2
ROC curves of the UNC OCT Index and the best single OCT parameters for each anatomical area in glaucoma patients with visual field MD better than −4 dB (left) and those with MD better than −2 dB (right).
Figure 3
Figure 3
SD-OCT peripapillary RNFL, ONH, and GCIPL profile of two subjects diagnosed as glaucoma suspects. In the first subject (A), OCT data run through the UNC OCT Index yielded a predicted probability for early glaucoma of 0.90, suggesting that this eye was glaucomatous. In the second subject (B), the predicted probability was 0.17, suggesting that the eye was not glaucomatous.
See this image and copyright information in PMC

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