A. Schulze

Diagnostic ability of retinal ganglion cell complex, retinal nerve fiber layer, and optic nerve head measurements by Fourier-domain optical coherence tomography

PurposeTo evaluate the diagnostic ability of Fourier-domain optical coherence tomography (FD-OCT) measurements in glaucoma patients, patients with ocular hypertension, and normal subjects.MethodsNinety-three participants with open-angle glaucoma (OAG), 58 patients with ocular hypertension (OHT), and 60 healthy control subjects were included in the study. All study participants underwent FD-OCT imaging. Retinal ganglion cell complex (GCC), macular thickness, peripapillary retinal nerve fiber layer thickness (RFNL), and optic nerve head parameters (ONH) were measured in each participant. The diagnostic ability was evaluated using area under the receiver operating characteristics curves (AUROC).ResultsGlaucoma patients showed a significant reduction in GCC and macular retinal thickness compared to patients with OHT and normal subjects. No differences in GCC were found between the patients with OHT and normal subjects. The best diagnostic ability in the comparison between glaucoma and normal subjects after adjusting for age was found for cup-to-disc ratio (AUROC = 0.848), RNFL average thickness (AUROC = 0.828), and GCC global loss volume (AUROC = 0.805). The diagnostic power of the best GCC, RNFL, and ONH parameter did not show differences beyond random variation (p > 0.05).ConclusionsImaging of the GCC using FD-OCT (RTVue-100) has a comparable diagnostic ability to RNFL and ONH measurements in distinguishing between glaucoma patients and healthy subjects. No differences were found between patients with OHT and normal subjects with regard to ONH, RNFL, and GCC parameters.

Structure-function relationship between FDF, FDT, SAP, and scanning laser ophthalmoscopy in glaucoma patients.

PURPOSE Flicker defined form perimetry (FDF) and frequency doubling technology perimetry (FDT) are alleged to detect glaucoma at an earlier stage than standard automated perimetry (SAP). It is the purpose of this study to investigate the structure-function relationship between FDF, FDT, SAP, and confocal scanning laser ophthalmoscopy (cSLO) in patients with glaucoma. METHODS Seventy-six patients with glaucoma were included in the study. Patients were tested with SAP, Matrix-FDT, FDF perimetry, and cSLO. Structure-function relationships between global and sectoral cSLO parameters and global and sectoral mean sensitivity (MS) of SAP, Matrix-FDT, and FDF were calculated using Spearmans rank correlation and linear regression. RESULTS Overall, FDF perimetry showed the strongest structure-function relationship (GLOBAL correlation with rim area: 0.44; range of significant sectoral FDF values: 0.23-0.69), followed by FDT (global correlation with rim area: 0.35; range of significant sectoral FDT values: 0.25-0.60). SAP presented with the weakest structure-function relationship and fewer statistically significant results (global correlation with rim volume: 0.32; range of significant sectoral SAP values: 0.23-0.58). Sector-by-sector, the structure-function relationship was greatest in the superotemporal and inferotemporal regions. Weakest correlations were found in the inferonasal and nasal sectors. CONCLUSIONS The correlation between structure and function is stronger in FDF and FDT compared with SAP. Correlations are strongest in temporal areas where glaucomatous damage tends to occur first. A better understanding of the structure-function relationship should allow for improved detection and management of glaucoma patients.

Learning Curve and Fatigue Effect of Flicker Defined Form Perimetry

PURPOSE To evaluate the learning curve and fatigue effect of flicker defined form (FDF) perimetry. DESIGN Prospective cross-sectional study. MATERIAL AND METHODS One hundred forty-one eyes of 75 healthy subjects were included in the study. Every subject was measured 3 times on 3 different days within 3 months. Differences among the tests were analyzed for mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), reliability indices, test duration, and test points <5% and <0.5% in 75 right eyes on the basis of linear mixed models for repeated measurements. To assess the effect of fatigue, differences of MS, MD, and PSD values between 66 left and right eyes were evaluated regarding alterations between these 3 examinations. RESULTS After 3 test sessions, significant improvements were found in MS and MD among all 3 tests (P ≤ .01), and in PSD between test 1 and test 3 (P = .02). Test duration decreased significantly between tests 1 and 3 (P = .01); fixation-loss errors decreased significantly between tests 2 and 3 and between tests 1 and 3 (P = .02, respectively). Test points with p < 0.5% decreased significantly between tests 1 and 2 (P = .04) and 1 and 3 (P = .01) When comparing both eyes, MS, MD, and PSD were significantly better in first than in second eyes examined. CONCLUSIONS There exist significant learning and fatigue effects for repeated flicker defined form perimetry. For good and reliable results on FDF perimetry, at least 3 tests should be performed in an individual. Between the tests of both eyes, a rest should be offered.

Peripapillary Choroidal Thickness and Choroidal Area in Glaucoma, Ocular Hypertension and Healthy Subjects by SD-OCT

BACKGROUND The exact pathogenesis of open angle glaucoma and ocular hypertension remains unclear. Hemodynamic influences are discussed as potential risk factors and the choroid may play an important role in the pathogenesis of open angle glaucoma or ocular hypertension. The current study investigates peripapillary choroidal thickness and choroidal area in patients with open angle glaucoma, subjects with ocular hypertension and healthy subjects using spectral-domain OCT. It furthermore assesses the association between peripapillary choroidal thickness and age, central corneal thickness, refractive error and intraocular pressure. PATIENTS AND METHODS Prospectively recorded data of 213 eyes of 177 open angle glaucoma patients, 73 eyes of 50 subjects with ocular hypertension and 152 eyes of 116 healthy control subjects were analyzed by fitting a linear mixed model including age and disease. RESULTS Peripapillary choroidal thickness was thinnest in glaucoma patients (125 µm), followed by healthy subjects (127 µm) and ocular hypertensive subjects (135 µm). A marginally significant difference was present between ocular hypertension and glaucoma (p=0.059). Thickest choroids were found superiorly and thinnest choroids inferiorly. Choroidal area was highest in the supero-nasal and lowest in the infero-temporal sectors. Choroidal thickness decreased with age, no significant correlation was evident between peripapillary choroidal thickness and refractive error or intraocular pressure. Peripapillary choroidal thickness and central corneal thickness are significantly negative correlated in healthy subjects. CONCLUSIONS There is a trend towards thicker choroids in ocular hypertensive subjects compared to healthy subjects or glaucoma patients. Thickest choroids are found superiorly, thinnest inferiorly. Interestingly, choroidal area is thinnest in the temporal-inferior sector, one of the regions where glaucomatous damage tends to start.

[Frequency-doubling technology : A new method for determining glaucomatous visual field defects].

Glaucoma is a disease in which death of retinal ganglion cells is associated with loss of visual function. The gold standard for visual field testing has been standard automated perimetry (SAP). However, up to 30-50% of retinal ganglion cells must be lost before a scotoma is detected with SAP. Therefore, investigators have been interested in finding diagnostic techniques that would allow earlier detection of visual field loss than that detected by standard white-on-white perimetry. Frequency-doubling technology (FDT) has been suggested as a promising technique that may detect glaucomatous ganglion cell damage earlier than SAP by targeting a sparsely spaced subsystem of Mgamma retinal ganglion cells where cell damage is less masked by redundancy. The second generation of FDT perimetry, the Matrix FDT, was released with the intention of improving the spatial resolution of visual field defects. In this article we present FDT and discuss data that compare FDT with standard white-on-white perimetry.

[Glaucoma diagnosis and follow-up using the Heidelberg Retina Tomograph].

The Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observers experience.ZusammenfassungDie konfokale Scanning-Laser-Ophthalmoskopie mittels der Heidelberg Retina Tomographie (HRT) bietet ein Diagnoseverfahren, welches schnelle, nichtinvasive topographische Informationen über den Sehnervenkopf, den neuroretinalen Randsaum und über die retinale Nervenfaserschichtdicke liefert. Der HRT ist aktuell eines der führenden Systeme für die Diagnose und Verlaufskontrolle eines Glaukoms. Die Implementation von diversen Auswertestrategien wie der Moorfields Regressionsanalyse (MRA) und des Glaucoma Probability Scores (GPS) sowie Diskriminanzanalysen helfen dem Kliniker, ein Glaukomauge von einem gesunden Auge zu unterscheiden. Für die Verlaufskontrolle können neben der Änderung der stereometrischen Parameter die Topographic Change Analysis (TCA) und die Trendanalyse verwendet werden. Außerdem bietet der Flickervergleich wertvolle Möglichkeiten, um topographische Änderungen im Vergleich zur Basisuntersuchung zu evaluieren. Die wichtige klinische Untersuchung wird bei richtiger Anwendung des Verfahrens und entsprechender Erfahrung mit der Interpretation sinnvoll ergänzt.AbstractThe Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observer’s experience.

New options of high resolution optical coherence tomography in glaucoma diagnostic

At present time domain optical coherence tomography (TD-OCT) plays a less important role in glaucoma diagnostics and is used mainly for macula diagnostics. The Fourier domain optical coherence tomography (FD-OCT) with enhanced resolution has new options to detect glaucoma changes. This new technology is referred as frequency domain or spectral domain OCT. This paper will present current and new options of OCT in glaucoma diagnostics. Measurements of the optic nerve head and the retinal nerve fiber layer thickness using this new technology have been shown to be reproducible. Devices which use TD-OCT (e.g. Stratus-OCT) have a lower resolution than devices that use FD-OCT (e.g. RTVue-100; 10 microm versus 5 microm axial resolution). A new option is the evaluation of the retinal ganglion cell complex. The measurement of the optic nerve head and the retinal nerve fiber layer using FD-OCT are promising for glaucoma diagnostics. How this new technology, especially the ganglion cell complex analysis is comparable to other technologies and whether it is helpful for glaucoma diagnostics and monitoring of management will be evaluated in future studies.

Neue Möglichkeiten der hochauflösenden optischen Kohärenztomographie in der Glaukomdiagnostik

At present time domain optical coherence tomography (TD-OCT) plays a less important role in glaucoma diagnostics and is used mainly for macula diagnostics. The Fourier domain optical coherence tomography (FD-OCT) with enhanced resolution has new options to detect glaucoma changes. This new technology is referred as frequency domain or spectral domain OCT. This paper will present current and new options of OCT in glaucoma diagnostics. Measurements of the optic nerve head and the retinal nerve fiber layer thickness using this new technology have been shown to be reproducible. Devices which use TD-OCT (e.g. Stratus-OCT) have a lower resolution than devices that use FD-OCT (e.g. RTVue-100; 10 microm versus 5 microm axial resolution). A new option is the evaluation of the retinal ganglion cell complex. The measurement of the optic nerve head and the retinal nerve fiber layer using FD-OCT are promising for glaucoma diagnostics. How this new technology, especially the ganglion cell complex analysis is comparable to other technologies and whether it is helpful for glaucoma diagnostics and monitoring of management will be evaluated in future studies.

Glaukomdiagnostik und Verlaufskontrolle mit dem Heidelberg Retina Tomograph

The Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observers experience.ZusammenfassungDie konfokale Scanning-Laser-Ophthalmoskopie mittels der Heidelberg Retina Tomographie (HRT) bietet ein Diagnoseverfahren, welches schnelle, nichtinvasive topographische Informationen über den Sehnervenkopf, den neuroretinalen Randsaum und über die retinale Nervenfaserschichtdicke liefert. Der HRT ist aktuell eines der führenden Systeme für die Diagnose und Verlaufskontrolle eines Glaukoms. Die Implementation von diversen Auswertestrategien wie der Moorfields Regressionsanalyse (MRA) und des Glaucoma Probability Scores (GPS) sowie Diskriminanzanalysen helfen dem Kliniker, ein Glaukomauge von einem gesunden Auge zu unterscheiden. Für die Verlaufskontrolle können neben der Änderung der stereometrischen Parameter die Topographic Change Analysis (TCA) und die Trendanalyse verwendet werden. Außerdem bietet der Flickervergleich wertvolle Möglichkeiten, um topographische Änderungen im Vergleich zur Basisuntersuchung zu evaluieren. Die wichtige klinische Untersuchung wird bei richtiger Anwendung des Verfahrens und entsprechender Erfahrung mit der Interpretation sinnvoll ergänzt.AbstractThe Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observer’s experience.

Glaukomdiagnostik und Verlaufskontrolle mit dem Heidelberg Retina Tomograph@@@Glaucoma diagnosis and follow-up using the Heidelberg Retina Tomograph

The Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observers experience.ZusammenfassungDie konfokale Scanning-Laser-Ophthalmoskopie mittels der Heidelberg Retina Tomographie (HRT) bietet ein Diagnoseverfahren, welches schnelle, nichtinvasive topographische Informationen über den Sehnervenkopf, den neuroretinalen Randsaum und über die retinale Nervenfaserschichtdicke liefert. Der HRT ist aktuell eines der führenden Systeme für die Diagnose und Verlaufskontrolle eines Glaukoms. Die Implementation von diversen Auswertestrategien wie der Moorfields Regressionsanalyse (MRA) und des Glaucoma Probability Scores (GPS) sowie Diskriminanzanalysen helfen dem Kliniker, ein Glaukomauge von einem gesunden Auge zu unterscheiden. Für die Verlaufskontrolle können neben der Änderung der stereometrischen Parameter die Topographic Change Analysis (TCA) und die Trendanalyse verwendet werden. Außerdem bietet der Flickervergleich wertvolle Möglichkeiten, um topographische Änderungen im Vergleich zur Basisuntersuchung zu evaluieren. Die wichtige klinische Untersuchung wird bei richtiger Anwendung des Verfahrens und entsprechender Erfahrung mit der Interpretation sinnvoll ergänzt.AbstractThe Heidelberg Retina Tomograph (HRT) is a glaucoma diagnosis system that provides fast, noninvasive topographic information about the optic nerve head, the neuroretinal rim, and the thickness of the nerve fiber layer. With these capabilities, it is one of the leading laser systems for detecting glaucoma. Statistical methods such as the Moorfields regression analysis and the glaucoma probability score, as well as discriminant functions implemented in the instrument, support the clinician in discriminating between glaucoma and healthy eyes. The primary method for assessing glaucomatous change using the HRT is topographic change analysis, a technique that compares the variability within a baseline examination to that between baseline and follow-up examinations. The stereometric trend analysis reports changes in normalized topographic parameters over time. Furthermore, the flicker comparison enables the detection of small topographic changes over time. The use of HRT does not replace clinical examination but facilitates the assessment and management of glaucoma according to the observer’s experience.