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From the Jules Stein Eye Institute, University of California Los Angeles Medical School, Los Angeles, California.
PURPOSE. To compare the ability of qualitative assessment of optic nerve head stereophotographs (ONHPs), confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT) to distinguish normal eyes from those with early to moderate glaucomatous visual field defects.
METHODS. Eighty-nine eyes (63 normal, 63 age-matched with glaucoma) of 89
subjects more than 40 years of age were studied. Receiver operating
characteristic (ROC) curves were generated from discriminant analysis
of CSLO, SLP, and OCT measurements and from ONHP scores. Sensitivity at
80% and specificity at 90% were calculated. Differences between
individual methods and combinations of methods were assessed for
statistical significance. Agreement on categorization between methods
(
) was assessed.
RESULTS. The average visual field mean deviation (MD ± SD) in patients
with glaucoma was -3.9 ± 2.2 dB, and the average pattern
standard deviation (PSD) was 4.7 ± 3.4 dB. In normal subjects the
average MD was 0.1 ± 0.9 dB and the average PSD was 1.5 ±
0.3 dB. Optimal sensitivities, specificities, and areas under ROC
curves were, respectively: ONHP (0.94, 0.87, 0.93), CSLO (0.84, 0.90,
0.92), SLP (0.89, 0.87, 0.94), and OCT (0.82, 0.84, 0.88). Best
agreement on categorization () was between ONHPs and CSLO (0.70).
The ROC area for the combination of methods was 0.99, higher than for
any method alone. The ROC area for the combination of methods was
significantly better than the CLSO rim area (P =
0.012) and the OCT retinal nerve fiber layer (RNFL) thickness
(P = 0.002).
CONCLUSIONS. The quantitative methods CSLO, SLP, and OCT were no better than qualitative assessment of disc ONHPs by experienced observers at distinguishing normal eyes from those with early to moderate glaucoma. A combination of the imaging methods significantly improves this capability.
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