Abstract
Purpose
To describe a new method, the Optical Coherence Tomography (OCT) Glaucoma Staging System, for classifying retinal nerve fiber layer (RNFL) damage assessed with OCT.
Patients and methods
The OCT Glaucoma Staging System was created based on data obtained from Nidek RS 3000 spectral-domain (sd)-OCT. This system uses the superior and inferior quadrant RNFL thickness values, plotted on an x–y diagram for staging structural damage severity in glaucoma. A non-linear equation and two regression lines describe the boundary lines which separate the different sectors of the diagram. These mathematical formulas have been used to create a software, which provides a quick classification of the RNFL damage. Sensitivity and specificity of the system were assessed in a different cohort including 64 patients with early OAG, and 62 normal subjects.
Results
Three hundred and two OCT tests from 98 healthy controls and 284 patients affected by either ocular hypertension or chronic open-angle glaucoma were considered in order to design the new classification system. The OCT Glaucoma Staging System classifies RNFL defects into 6 stages of increasing severity ranging from borderline to stage 5, and 3 groups according to defect localization (superior, inferior, or diffuse). Sensitivity and specificity in discriminating between healthy and glaucomatous eyes were 95.2 and 91.9%, respectively, considering borderline results as abnormal.
Conclusions
The OCT Glaucoma Staging System appears to provide a standardized and objective classification of glaucomatous RNFL damage. It can be used in day-to-day clinical practice for an easy and fast interpretation of RNFL measurements obtained with OCT.
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References
Schuman JS, Hee MR, Puliafito CA, Wong C, Pedut-Kloizman T, Lin CP et al. Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography. Arch Ophthalmol 1995; 113: 586–596.
Pieroth L, Schuman JS, Hertzmark E, Hee MR, Wilkins JR, Coker J et al. Evaluation of focal defects of the nerve fiber layer using optical coherence tomography. Ophthalmology 1999; 106: 570–579.
Hoh ST, Greenfield DS, Mistlberger A, Liebmann JM, Ishikawa H, Ritch R . Optical coherence tomography and scanning laser polarimetry in normal, ocular hypertensive, and glaucomatous eyes. Am J Ophthalmol 2000; 129: 129–135.
Park SB, Sung KR, Kang SY, Kim KR, Kook MS . Comparison of glaucoma diagnostic Capabilities of Cirrus HD and Stratus optical coherence tomography. Arch Ophthalmol 2009; 127: 1603–1609.
Chang RT, Knight OJ, Feuer WJ, Budenz DL . Sensitivity and specificity of time-domain versus spectral-domain optical coherence tomography in diagnosing early to moderate glaucoma. Ophthalmology 2009; 116: 2294–2299.
Sung KR, Kim DY, Park SB, Kook MS . Comparison of retinal nerve fiber layer thickness measured by Cirrus HD and Stratus optical coherence tomography. Ophthalmology 2009; 116: 1264–1270.
Bengtsson B, Andersson S, Heijl A . Performance of time-domain and spectral-domain Optical Coherence Tomography for glaucoma screening. Acta Ophthalmol 2012; 90: 310–315.
Wu H, De Boer JF, Chen TC . Diagnostic capability of spectral-domain optical coherence tomography for glaucoma. Am J Ophthalmol 2012; 153: 815–826.
Huang L, Fan N, Shen X, He J . Comparison of the diagnostic ability of retinal nerve fiber layer thickness measured using time domain and spectral domain optical coherence tomography in primary open angle glaucoma. Eye Sci 2011; 26: 132–137.
Töteberg-Harms M, Sturm V, Knecht PB, Funk J, Menke MN . Repeatability of nerve fiber layer thickness measurements in patients with glaucoma and without glaucoma using spectral-domain and time-domain OCT. Graefes Arch Clin Exp Ophthalmol 2012; 250: 279–287.
Ghasia FF, El-Dairi M, Freedman SF, Rajani A, Asrani S . Reproducibility of spectral-domain optical coherence tomography measurements in adult and pediatric glaucoma. J Glaucoma 2015; 24: 55–63.
Cremasco F, Massa G, Gonçalves Vidotti V, Pedroso de Carvalho Lupinacci Á, Costa VP . Intrasession, intersession, and interexaminer variabilities of retinal nerve fiber layer measurements with spectral-domain OCT. Eur J Ophthalmol 2011; 21: 264–270.
Wu H, de Boer JF, Chen TC . Reproducibility of retinal nerve fiber layer thickness measurements using spectral domain optical coherence tomography. J Glaucoma 2011; 20: 470–476.
Lee SH, Kim SH, Kim TW, Park KH, Kim DM . Reproducibility of retinal nerve fiber thickness measurements using the test-retest function of spectral OCT/SLO in normal and glaucomatous eyes. J Glaucoma 2010; 19: 637–642.
Brusini P, Johnson CA . Staging functional damage in glaucoma: review of different classification methods. Surv Ophthalmol 2007; 52: 156–179.
Brusini P . GDx Staging System: a new method for retinal nerve fiber layer damage classification. J Glaucoma 2011; 20: 287–293.
Anderson D, Patella V . Automated Static Perimetry. 2nd edn Mosby. Inc: St Louis, MO, USA, 1999.
Brusini P, Filacorda S . Enhanced Glaucoma Staging System (GSS 2) for classifying functional damage in glaucoma. J Glaucoma 2006; 15: 40–46.
Pierro L, Gagliardi M, Iuliano L, Ambrosi A, Bandello F . Retinal nerve fiber layer thickness reproducibility using seven different OCT instruments. Invest Ophthalmol Vis Sci 2012; 53: 5912–5920.
Brusini P, Zeppieri M, Tosoni C, Parisi L, Salvetat ML . Optic Disc Damage Staging System (ODDSS). J Glaucoma 2010; 19: 442–449.
Lisboa R, Leite MT, Zangwill LM, Tafreshi A, Weinreb RN, Medeiros FA . Diagnosing preperimetric glaucoma with spectral domain optical coherence tomography. Ophthalmology 2012; 119: 2261–2269.
Jeoung JW, Kim TW, Weinreb RN, Kim SH, Park KH, Kim DM . Diagnostic ability of spectral-domain versus time-domain optical coherence tomography in preperimetric glaucoma. J Glaucoma 2014; 23: 299–306.
Sung KR, Wollstein G, Bilonick RA, Townsend KA, Ishikawa H, Kagemann L et al. Effects of age on optical coherence tomography measurements of healthy retinal nerve fiber layer, macula, and optic nerve head. Ophthalmology 2009; 116: 1119–1124.
Leung CKS, Yu M, Weinreb RN, Ye C, Liu S, Lai G et al. Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: a prospective analysis of age-related loss. Ophthalmology 2012; 119: 731–737.
Feuer WJ, Budenz DL, Anderson DR, Cantor L, Greenfield DS, Savell J et al. Topographic differences in the age-related changes in the retinal nerve fiber layer of normal eyes measured by Stratus optical coherence tomography. J Glaucoma 2011; 20: 133–138.
Acknowledgements
We would like to thank Dr Maria Letizia Salvetat for her valuable help in statistical analysis of data and Dr Marco Zeppieri for editing this paper. Special thanks to Mr Guido Battarra and Mr Cristiano Balista for their contribution in the creation of the OCT Glaucoma Staging System software.
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Brusini, P. OCT Glaucoma Staging System: a new method for retinal nerve fiber layer damage classification using spectral-domain OCT. Eye 32, 113–119 (2018). https://doi.org/10.1038/eye.2017.159
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DOI: https://doi.org/10.1038/eye.2017.159
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