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Sol La Bruna, Anvit Rai, Grace Mao, Jennifer Kerr, Heer Amin, Zane Z. Zemborain, Ari Leshno, Emmanouil Tsamis, Carlos Gustavo De Moraes, Donald C. Hood; The OCT RNFL Probability Map and Artifacts Resembling Glaucomatous Damage. Trans. Vis. Sci. Tech. 2022;11(3):18. https://doi.org/10.1167/tvst.11.3.18.
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The purpose of this study was to improve the diagnostic ability of the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) probability (p-) map by understanding the frequency and pattern of artifacts seen on the p-maps of healthy control (HC) eyes resembling glaucomatous damage.
RNFL p-maps were generated from wide-field OCT cube scans of 2 groups of HC eyes, 200 from a commercial normative group (HC-norm) and 54 from a prospective study group, as well as from 62 patient eyes, which included 32 with early glaucoma (EG). These 32 EG eyes had 24-2 mean deviation (MD) better than −6 dB and perimetric glaucoma as defined by 24-2 and 10-2 criteria. For the HC groups, “glaucoma-like” arcuates were defined as any red region near the temporal half of the disc.
Seven percent of the 200 HC-norm and 11% of the 54 HC RNFL p-maps satisfied the definition of “glaucoma-like,” as did all the patients’ p-maps. The HC p-maps showed two general patterns of abnormal regions, “arcuate” and “temporal quadrant,” and these patterns resembled those seen on some of the RNFL p-maps of the EG eyes. A “vertical midline” rule, which required the abnormal region to cross the vertical midline through the fovea, had a specificity of >99%, and a sensitivity of 75% for EG and 93% for moderate to advanced eyes.
Glaucoma-like artifacts on RNFL p-maps are relatively common and can masquerade as arcuate and/or widespread/temporal damage.
A vertical midline rule had excellent specificity. However, other OCT information is necessary to obtain high sensitivity, especially in eyes with early glaucoma.
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