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BACKGROUND: Previous retrospective results are evaluated prospectively and blinded. METHODS: A total of 221 eyes previously classified as normal (G1), 279 as moderate risk of glaucoma (G2) and 217 as high risk (G3) according to the Globin Discriminant Function (GDF) Laguna-ONhE index were examined with OCT Spectralis- Results: In G1, the Bruch's Membrane Opening Minimum Rim Width (BMO-MRW) was 332 ± 55 microns; in G2, it was 252 ± 47 (p < 0.0001); and in G3, 231 ± 44 (p < 0.0001). In G1, the 1% and 5% percentiles were 233 and 248, respectively; in G2, they were lower in 28.80% and 42.29% of cases, respectively; and in G3, in 50.23% and 63.59% of cases, respectively. Most of the cases were normal-tension glaucomas. Laguna-ONhE indices showed a curvilinear correlation with BMO-MRW results. The Retinal Nerve Fibre Layer (RNFL) showed a poor relationship with BMO. Assuming G1 to be truly normal, BMO-MRW would have a Receiver operating characteristic (ROC) curve area of 0.901 for G2 and G3 and 0.651 for RNFL. A significant reduction in pixels corresponding to vessels was found in G2 and G3 vs. G1 (p < 0.0001). CONCLUSIONS: In some cases, these defects appear to be mainly glaucomatous, and in others, they are associated with diabetic microangiopathy. In normal tension glaucoma, RNFL defects may be less severe than those inside the nerve.
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OBJECTIVE: To describe a new method to estimate the frequency distribution of optic nerve disc area, using digital retinographic images. METHODS AND ANALYSIS: We analysed 492 023 fundus images obtained with seven fundus cameras, mainly in Caucasian subjects. They were grouped by resolution and zoom. They were automatically segmented by identifying the inner edge of the Elschnig scleral ring. For this purpose, a neural network trained by deep learning previously described was used. The number of pixels contained within the segmentation and their frequency distribution were calculated. The results of each camera, using different number of images, were compared with the global results using the Kolmogorov-Smirnov test to confront frequency distributions. RESULTS: The frequency distribution was non-Gaussian, more limited in small sizes than in large ones. If the median is assigned a theoretical value of 1.95 mm2, the 1th, 5th, 25th, 50th, 75th, 95th and 99th percentiles would correspond to 1.29, 1.46, 1.73, 1.95, 2.20, 2.64 and 3.03 mm2 in all the dataset. The overall differences were significant for the smaller series, but for each percentile their mean value was only 0.01 mm2 and the maximum 0.10 mm2, so they can be considered similar for practical purposes in all cameras. CONCLUSION: By automatically segmenting the edges of the optic nerve and observing the frequency distribution of the number of pixels it delimits, it is possible to estimate the frequency distribution of the disc area in the population as a whole and that of each individual case.
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Glaucoma , Disco Óptico , Técnicas de Diagnóstico Oftalmológico , Fundo de Olho , Humanos , Disco Óptico/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagemRESUMO
Background: Laguna ONhE provides a globin distribution function (GDF), in which a glaucoma discriminator based on deep learning plays an important role, and there is also an optimized globin individual pointer (GIP) for progression analysis. Methods: Signs of optic nerve glaucoma were identified in 1,124,885 fundus images from 203,115 diabetics obtained over 15 years and 117,813 control images. Results: A total of 743,696 images from 313,040 eyes of 173,661 diabetics were analysed. Some exclusions occurred due to excessive illumination, poor quality, or the absence of optic discs. Suspicion of glaucoma was reported in 6.70%, for an intended specificity of 99% (GDF < −15). More signs of glaucoma occur in diabetics as their years of disease increase, and after age 60, compared to controls. The GIP detected progression (p < 0.01) in 2.59% of cases with 4 controls and in 42.6% with 14 controls was higher in cases with lower GDF values. The GDF was corrected for the disc area and proved to be independent of it (r = 0.001925; p = 0.2814). Conclusions: The GDF index suggests a higher and increasing glaucoma probability in diabetics over time. Doubling the number of check-ups from four to eight increases the ability to detect GIP index progression by a factor of 5.
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OBJECTIVE: To identify age-related vascular changes in the optic discs of patients with diabetes with and without signs of glaucoma. METHODS AND ANALYSIS: A total of 2153 eyes of 1797 patients with diabetes without significant retinopathy were monitored with 10 Topcon-NW400 images obtained over 10.27±1.58 years. 571 non-diabetics eyes were selected as controls. Laguna ONhE uses convolutional neural networks to identify optic disc edges, vessels, cup and rim, and provides a glaucoma assessment index-Globin Distribution Function (GDF). RESULTS: In the first image, vessel pixels accounted for 33.88% of the disc area (SD=3.72) in non-glaucoma (DN) and 31.35% (SD=4.05; p<0.0001) in glaucoma cases (DG). This number of pixels was reduced by -0.55% each year (SD=0.77) in the DN and -0.76% (SD=0.86; p=0.0014) in the DG. In the first image, 76.55% of the disc pixels (SD=11.13) belonged to the rim in the DN and 62.05% (SD=11.00; p=0.0014) in the DG, decreasing annually by -0.33% (SD=0.99) in the DN and -0.68% (SD=1.08; p<0.00001) in the DG groups. All rim sectors were reduced over time in the DG group, particularly superotemporal (41°-80°) and inferotemporal (271°-310°). The reduction was smaller in DN, presenting as progressive thickening of the temporal sector (311°-40°). No changes in age were observed in healthy controls. CONCLUSION: Patients with diabetes show progressive reduction of vessels and neuroretinal rim at the optic disc, which is more intense in association with glaucoma. In the absence of glaucoma, the temporal sector of the diabetic rim was not reduced but thickened, displacing the cup nasally.
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Diabetes Mellitus , Glaucoma , Disco Óptico , Doenças Retinianas , Envelhecimento , Glaucoma/diagnóstico , Globinas , Humanos , Disco Óptico/diagnóstico por imagemRESUMO
BACKGROUND: Laguna-ONhE is an application for the colorimetric analysis of optic nerve images, which topographically assesses the cup and the presence of haemoglobin. Its latest version has been fully automated with five deep learning models. In this paper, perimetry in combination with Laguna-ONhE or Cirrus-OCT was evaluated. METHODS: The morphology and perfusion estimated by Laguna ONhE were compiled into a "Globin Distribution Function" (GDF). Visual field irregularity was measured with the usual pattern standard deviation (PSD) and the threshold coefficient of variation (TCV), which analyses its harmony without taking into account age-corrected values. In total, 477 normal eyes, 235 confirmed, and 98 suspected glaucoma cases were examined with Cirrus-OCT and different fundus cameras and perimeters. RESULTS: The best Receiver Operating Characteristic (ROC) analysis results for confirmed and suspected glaucoma were obtained with the combination of GDF and TCV (AUC: 0.995 and 0.935, respectively. Sensitivities: 94.5% and 45.9%, respectively, for 99% specificity). The best combination of OCT and perimetry was obtained with the vertical cup/disc ratio and PSD (AUC: 0.988 and 0.847, respectively. Sensitivities: 84.7% and 18.4%, respectively, for 99% specificity). CONCLUSION: Using Laguna ONhE, morphology, perfusion, and function can be mutually enhanced with the methods described for the purpose of glaucoma assessment, providing early sensitivity.
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PURPOSE: To analyze the progression of visual field loss using sector analysis of the cumulative defect curve and other procedures. METHODS: Visual fields of 260 glaucomatous eyes were analyzed over 2.8 years (SD = 1.2) with at least five examinations (mean 6.9; SD = 2.0) using Octopus 311 perimeter and TOP strategy. The authors applied Threshold Noiseless Trend (TNT) program, which performs local filtering of threshold to reduce fluctuation, and analyzed five criteria: 1) a score based on significant progression of eight sectors of the cumulative defect curve (CD); 2) a score based on the presence of points (PO) with significant progression; 3) global progression (GL) of all local deviations; 4) progression of mean defect (MD); 5) progression of the square root of loss variance (sLV). The authors estimated false diagnoses (FD), randomly reordering examinations of each patient. An index of focality of progression (FI) was obtained. RESULTS: sLV presented low sensitivity and GL low specificity. CD and PO presented twice the sensitivity of MD, often proving earlier indicators. The authors observed significant progression of some of the three criteria in 17.5% of the cases when MD <6 dB and in 20.7% when MD >6 dB (FD=5.7%). Agreement between two criteria occurred in 6.8% of cases with MD <6 dB and in 11.6% when MD >6 dB (FD=1.9%). Result reproducibility in successive examinations was observed in 9.9% of cases (FD=1.3%). Focality of progression increased with MD. CONCLUSIONS: PO and CD indicate suspected progression earlier than MD. Reproduction of results in successive examinations or agreement between criteria allows confirmation of progression.
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Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Aberto/fisiopatologia , Transtornos da Visão/fisiopatologia , Campos Visuais , Doença Crônica , Progressão da Doença , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate the specificity of new perimetric indices based on harmony, alone and in combination with structural data, for glaucoma detection. METHODS: In this prospective observational cross-sectional study, one eye of 105 healthy subjects and 97 early and suspect glaucomas were sequentially included and examined with Cirrus optical coherence tomography, twice with OCULUS Smartfield perimeter (SPARK strategy) and twice with Humphrey Analyzer (24-2 SITA-Fast) at the Ophthalmology Department from the University Hospital La Candelaria. Disharmony in the visual field was evaluated including vertical threshold symmetry, threshold rank), and homogeneity (threshold standard deviation from its maximum) using the patient himself/herself as a reference. We also evaluated disharmony in combination with the mean deviation and the pattern standard deviation in a single index (mismatch) and various combinations of morphological and functional indices. Combinations used a new score based on values above certain critical cut-off levels of each index. RESULTS: For 95% specificity, the highest sensitivities were as follows: vertical cup/disc ratio: 28.9%; SPARK threshold rank: 29.9%; and SITA-Fast threshold standard deviation: 28.9%. For the combined indices and 100% specificity, they were 5 SPARK indices mismatch: 10.3%; 5 SITA-Fast indices mismatch: 11.3%; 8 optical coherence tomography indices: 21.9%; 13 SPARK and optical coherence tomography indices: 27.8%; and 13 SITA-Fast and optical coherence tomography indices: 32.0%. CONCLUSION: Disharmony combined with normative value-based indices and/or optical coherence tomography indices is useful for very specific early diagnosis of glaucoma.
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Glaucoma de Ângulo Aberto/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Estudos Transversais , Diagnóstico Precoce , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia de Coerência Óptica , Transtornos da Visão/fisiopatologia , Testes de Campo VisualRESUMO
PURPOSE: To observe the relationship between topographic hemoglobin levels in the optic nerve head (ONH), the rim thickness (BMO-MRW), and retinal nerve fiber layer (RNFL) thickness. METHODS: 96 normal eyes and 82 glaucomas were examined using TOP strategy (Octopus 300 perimeter), SPECTRALIS OCT, and Laguna ONhE program which estimates hemoglobin from conventional color photographs (Horus Scope DEC 200 fundus camera). RESULTS: The correlation between Laguna ONhE glaucoma discriminant function (GDF) and SPECTRALIS BMO-MRW was R = 0.81 (P < 0.0001), similar to that between the BMO-MRW and BMO-RNFL thicknesses (R = 0.85, P < 0.0001) (P = 0.227 between both R values). GDF correlated well with RNFL thicknesses in the 360 degrees around the nerve, similar to mean perimetric sensitivity (MS) and BMO-MRW. The amount of hemoglobin in the nasal and temporal sectors showed low correlation with superior and inferior RNFL thicknesses. The superotemporal and inferotemporal sectors located on the vertical diameter of the disk showed good intercorrelation but without a clear RNFL topographic relationship. CONCLUSION: GDF showed high correlation with RNFL thickness. Except in the nasal and temporal sectors, ONH hemoglobin correlated well with RNFL thickness.
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PURPOSE: To evaluate the effectiveness of quantifying color changes in the optic nerve head in retinal photographs of patients with childhood glaucoma. METHODS: In this observational study, three photographs of the optic nerve head were obtained in 28 patients with childhood glaucoma and 28 age- and sex-matched healthy participants (the childhood glaucoma and control groups, respectively). The Laguna Optic Nerve Head Hemoglobin (ONhE) software (Insoft SL, Tenerife, Spain) was used to determine hemoglobin levels in the optic nerve head. The following parameters were quantified: the hemoglobin levels in the optic nerve head across the whole disc, in 24 sectors (the optic nerve head divided by two concentric rings and eight 45-degree radial sectors), and in the vertical disc diameter (sectors 8 and 20), and the estimated cup-disc ratio and Glaucoma Discriminant Function, which combines the slope of the hemoglobin amount with the mean vertical disc diameter. RESULTS: Patient ages ranged from 9 to 14 years (median: 11 years) in the childhood glaucoma group, and 7 to 13 years (median: 9 years) in the control group (P < .061). Eyes in the childhood glaucoma group showed a significantly higher cup-disc ratio compared to eyes in the control group (0.6 ± 0.2 vs 0.5 ± 0.1, respectively; P < .0001). In the childhood glaucoma group, the Glaucoma Discriminant Function was found to be significantly lower than in the control group (-6.5 ± 31.1 vs 9.4 ± 17.1, respectively; P < .0001). There were no significant differences in the hemoglobin levels in the optic nerve head across the whole disc between eyes in the childhood glaucoma and control groups (58.2% ± 10.9% vs 58.5% ± 6.7%, respectively; P = .847). The Laguna ONhE software showed good reproducibility in measuring percentages of hemoglobin levels in both groups. CONCLUSIONS: The Laguna ONhE software is useful for patients with childhood glaucoma. However, hemoglobin levels in the optic nerve head across the whole disc may have normal values. This method had good reliability and is easy to implement in routine clinical practice. [J Pediatr Ophthalmol Strabismus. 2017;54(6):387-394.].
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Glaucoma/metabolismo , Hemoglobinas/metabolismo , Disco Óptico/metabolismo , Adolescente , Biomarcadores/metabolismo , Criança , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Microscopia Acústica , Disco Óptico/diagnóstico por imagem , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica , Campos VisuaisRESUMO
Neuro-ophthalmologists typically observe a temporal pallor of the optic disc in patients with multiple sclerosis. Here, we describe the emergence of an idea to quantify these optic disc color changes in multiple sclerosis patients. We recruited 12 multiple sclerosis patients with previous optic neuritis attack and obtained photographs of their optic discs. The Laguna ONhE, a new colorimetric software using hemoglobin as the reference pigment in the papilla, was used for the analysis. The papilla of these multiple sclerosis patients showed greater pallor, especially in the temporal sector. The software detected the pallor and assigned hemoglobin percentages below normal reference values. Measurements of optic disc hemoglobin levels obtained with the Laguna ONhE software program had good ability to detect optic atrophy and, consequently, axonal loss in multiple sclerosis patients. This new technology is easy to implement in routine clinical practice.
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Diagnóstico por Computador , Técnicas de Diagnóstico Oftalmológico , Esclerose Múltipla/diagnóstico , Atrofia Óptica/diagnóstico , Disco Óptico/patologia , Algoritmos , Colorimetria , Hemoglobinas/análise , Humanos , Processamento de Imagem Assistida por Computador , Fibras Nervosas/patologia , Fotografação , Estudos Prospectivos , Células Ganglionares da Retina/patologia , SoftwareRESUMO
PURPOSE: The computer program laguna onhe determines optic nerve head haemoglobin (ONH Hb) on retinal photographs based on detecting colour differences. This study compares the diagnostic capacity of Laguna ONhE with that of spectral domain optical coherence tomography (OCT) and confocal tomography (HRT III). METHODS: In a prospective, observational, cross-sectional study, glaucomatous (n = 66) and healthy (n = 52) eyes were examined by Spectralis OCT, HRT III and Laguna ONhE. The following Laguna ONhE variables were determined: ONH Hb across the vertical disc diameter (8&20 Hb), estimated cup-disc ratio (C/D) and the glaucoma discriminant function (GDF), which combines the slope of Hb amount with the mean in 8&20 Hb. The three diagnostic methods were compared by calculating areas under ROC curves (AUCs). Correlations between variables were assessed through Spearman's rho coefficient. RESULTS: Areas under ROC curves (AUCs) were 0.785 (95% CI: 0.700-0.863) for GDF, 0.807 (95% CI: 0.730-0.883) for OCT retinal nerve fibre layer thickness (OCT-RNFL) and 0.714 (95% CI: 0.618-0.810) and 0.721 (95% CI: 0.628-0.815) for the HRT III variable GPS (glaucoma probability score) and vertical C/D ratio, respectively. Glaucoma discriminant function (GDF) was correlated with OCT-RNFL (0.587, p 0.001; 0.507, p 0.045; and -0.119, p 0.713 for mild, moderate and advanced glaucoma, respectively), mostly so with inferior OCT-RNFL (0.622; p < 0.001). Glaucoma discriminant function (GDF)-HRT III correlations were lower (rim area 0.471, p < 0.0001; rim/disc area 0.426, p < 0.0001; vertical C/D -0.413, p < 0.0001; GPS -0.408, p < 0.0001; rim volume 0.341, p < 0.0001). CONCLUSION: Similar diagnostic power was observed for Laguna ONhE, Spectralis OCT and HRT III.
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Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Aberto/diagnóstico , Hemoglobinas/metabolismo , Disco Óptico/metabolismo , Doenças do Nervo Óptico/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/metabolismo , Humanos , Pressão Intraocular/fisiologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/metabolismo , Probabilidade , Estudos Prospectivos , Células Ganglionares da Retina/patologia , Tomografia , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: To calculate the amount of hemoglobin (Hb) in the optic nerve head (ONH), using superimposed color fundus images with disc, rim and cup boundaries obtained by OCT-Cirrus. MATERIAL AND METHODS: We examined 100 healthy and 121 glaucomatous eyes using Oculus-Spark perimetry, Cirrus-OCT and Visucam (Zeiss) ONH color images. The Laguna ONhE program was then used to calculate the amount of Hb in the cup and six sectors of the rim. Receiver operating characteristic (ROC) analysis was performed and correlations between parameters were calculated. RESULTS: In suspected and confirmed glaucoma, Hb was significantly lower than controls in all rim sectors, especially the inferior and superonasal (p < 0.0001). Mean deviation (MD) of visual field regions showed greater correlation with the amount of Hb in the superior and inferior sectors of the rim than with rim area (p = 0.02) or nerve fiber layer thickness (p < 0.0001). On ROC analysis, the best diagnostic indicators were OCT rim area, vertical cup/disc ratio (C/D) and Glaucoma Discriminant Function (GDF) of Laguna ONhE, without significant differences. CONCLUSIONS: The amount of Hb in the ONH seems to have an important relationship with glaucomatous visual field sensitivity. The remaining rim has insufficient perfusion in many cases of glaucoma.
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Glaucoma/metabolismo , Hemoglobinas/metabolismo , Disco Óptico/metabolismo , Células Ganglionares da Retina/metabolismo , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Biomarcadores/metabolismo , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Disco Óptico/patologia , Estudos Prospectivos , Células Ganglionares da Retina/patologiaRESUMO
PURPOSE: To evaluate intraobserver, interobserver, within-session and between-session reproducibility of the measurement of optic nerve head (ONH) hemoglobin levels by color analysis using Laguna ONhE [optic nerve hemoglobin (ONH Hb)] program. MATERIALS AND METHODS: This was an observational prospective study of 29 eyes (11 glaucomatous; 18 healthy eyes). Two examiners obtained 2 retinal photographs (Canon non-mydriatic retinal camera CD-DGi, Canon Inc.,Tokyo, Japan) in 2 testing sessions 3 weeks apart and analyzed the images using Laguna ONhE. The following parameters were quantified: ONH hemoglobin amounts across the whole disc (ONH Hb) and in the vertical disc diameter (8&20 Hb), cup-disc ratio (C/D), and the Glaucoma Discriminant Function (GDF). Agreement was illustrated using the Bland-Altman plots and reproducibility was assessed comparing the intraclass correlation coefficients (ICC). RESULTS: In session 1, examiner 1 found mean levels of ONH hemoglobin of 67.94±8.70% in healthy eyes and of 57.90±5.36% in glaucomatous eyes. Corresponding values for examiner 2 were 68.27±8.52% and 57.83±4.88%, respectively. ONH Hb and 8&20 Hb measurements were lower in glaucomatous eyes (P=0.002 and P=0.001 respectively). GDF was also more pathologic in glaucomatous group. C/D ratio estimation was greater in the glaucoma group (P=0.003). ONH Hb and 8&20 Hb showed the highest ICCs (all above 0.9). Variability was greater for GDF (ICC>0.8) and C/D ratio estimation (ICC>0.71). CONCLUSIONS: Measurement of ONH Hb levels using the Laguna ONhE program shows high reproducibility both in glaucomatous and nonglaucomatous ONHs.
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Glaucoma de Ângulo Aberto/fisiopatologia , Hemoglobinas/metabolismo , Disco Óptico/irrigação sanguínea , Doenças do Nervo Óptico/fisiopatologia , Oxiemoglobinas/metabolismo , Artéria Retiniana/fisiologia , Veia Retiniana/fisiologia , Idoso , Idoso de 80 Anos ou mais , Colorimetria , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Oxigênio/sangue , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos , Tonometria OcularRESUMO
PURPOSE: To calculate the relative amount of hemoglobin (Hb) in sectors of the optic nerve head (ONH) from stereoscopic color fundus images using the Laguna ONhE method and compare the results with the visual field evaluation and optical coherence tomography (OCT). METHODS: Healthy eyes (n = 87) and glaucoma eyes (n = 71) underwent reliable Oculus Spark perimetry and Cirrus OCT. Optical nerve head color images were acquired with a nonmydriatic stereoscopic Wx Kowa fundus camera. Laguna ONhE program was applied to these images to calculate the relative Hb amount in the cup and six sectors of the rim. Receiver operating characteristic (ROC) analysis and correlations between parameters were calculated. RESULTS: We did not observe any variations in the relative amount of Hb in relation to age in healthy subjects (R(2) = 0.033, P > 0.05). Maximum ROC area confidence intervals were observed for a combination between perimetric indices and the Laguna ONhE Glaucoma discriminant function (0.970-0.899) followed by rim area (0.960-0.883), and mean deviation (MD; 0.944-0.857). In glaucoma cases, relative Hb amount presented significant reduction in all rim sectors, especially 231° to 270° and 81° to 120° (P < 0.001), except in the temporal 311° to 40° (P = 0.11). Perimetry mean sensitivity by sectors was better correlated with respective Hb levels than with rim areas or the corresponding nerve fiber thickness, especially the superior and inferior sectors (P < 0.05). CONCLUSIONS: Visual field sensitivity was better correlated with Hb levels than with rim sector areas or the corresponding nerve fiber thickness. In many cases the remaining rim show low perfusion, especially in the superior and inferior sectors.
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Fundo de Olho , Glaucoma/fisiopatologia , Hemoglobinas/análise , Aumento da Imagem/instrumentação , Interpretação de Imagem Assistida por Computador/instrumentação , Oftalmoscópios , Disco Óptico/química , Retina/química , Software , Tomografia de Coerência Óptica , Fatores Etários , Idoso , Feminino , Glaucoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
PURPOSE: The authors sought to quantify neighboring and distant interpoint correlations of threshold values within the visual field in patients with glaucoma. METHODS: Visual fields of patients with confirmed or suspected glaucoma were analyzed (n = 255). One eye per patient was included. Patients were examined using the 32 program of the Octopus 1-2-3. Linear regression analysis among each of the locations and the rest of the points of the visual field was performed, and the correlation coefficient was calculated. The degree of correlation was categorized as high (r(2) > 0.66), moderate (0.66 > or = r(2) > 0.33), or low (r(2) < or = 0.33). The standard error of threshold estimation was calculated. RESULTS: Most locations of the visual field had high and moderate correlations with neighboring points and with distant locations corresponding to the same nerve fiber bundle. Locations of the visual field had low correlations with those of the opposite hemifield, with the exception of locations temporal to the blind spot. The standard error of threshold estimation increased from 0.6 to 0.9 dB with an r(2) reduction of 0.1. CONCLUSION: Locations of the visual field have highest interpoint correlation with neighboring points and with distant points in areas corresponding to the distribution of the retinal nerve fiber layer. The quantification of interpoint correlations may be useful in the design and interpretation of visual field tests in patients with glaucoma.
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Glaucoma/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Limiar Sensorial , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodosRESUMO
Objective. To evaluate a new method of measuring hemoglobin (Hb) levels and quantifying the color changes in the optic nerve head of Parkinson's disease (PD) patients. We also compared differences in retinal nerve fiber layer (RNFL) thicknesses obtained using spectral domain optical coherence tomography (OCT) device between PD group and healthy group. Methods. One hundred and fifty-five PD patients and 91 sex- and age-matched healthy subjects were included in this cross-sectional study. OCT examinations and one photograph of the optic disc were performed. The Laguna ONhE ("optic nerve hemoglobin"; Insoft SL, Tenerife, Spain) software was used to analyze the Hb level on the acquired optic disc photographs. Results. PD patients exhibited significantly reduced mean optic disc Hb percentages (57.56% in PD, 67.63% in healthy subjects; P = 0.001) as well as reduced Hb in almost all analyzed sectors, with the largest differences detected in the inferior and nasal sectors. RNFL parameters were significantly reduced in PD patients compared with healthy subjects, especially in the inferior quadrant. Conclusions. Measurements of optic disc Hb levels obtained with the Laguna ONhE software had good ability to detect optic nerve color changes (more papillary paleness and consequently this could suggest optic atrophy and axonal loss) in PD patients.
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AIMS: To evaluate a new method for measuring haemoglobin (Hb) levels and quantifying the colour changes in the optic nerve head of multiple sclerosis (MS) patients to detect axonal loss and consequently optic disc atrophy. MATERIAL AND METHODS: 40 MS patients and 40 age and sex-matched healthy subjects were included in this prospective cross-sectional study and underwent a full ophthalmological examination, including three photographs of the optic disc. The Laguna ONhE ('optic nerve hemoglobin'; Insoft SL, Tenerife, Spain) software was used to obtain the Hb analysis in each of the 24 sectors and average Hb of optic disc photographs acquired. Reproducibility of measurements provided by Laguna ONhE program was analysed. RESULTS: MS patients showed significant reduction of optic disc Hb percentages in average Hb (58.99% in MS, 65.39% in healthy subjects; p<0.001) and in almost all analysed sectors with the largest differences in temporal sectors. Laguna ONhE program showed good reproducibility measuring Hb percentages in MS patients and healthy subjects. CONCLUSIONS: Measurements of optic disc Hb levels obtained with Laguna ONhE software had good ability detecting optic atrophy and axonal loss in MS patients. This method had good reliability and is easy to implement in routine clinical practice.
Assuntos
Colorimetria/instrumentação , Hemoglobinas/metabolismo , Esclerose Múltipla Recidivante-Remitente/patologia , Oftalmoscopia/métodos , Disco Óptico/patologia , Doenças do Nervo Óptico/patologia , Adulto , Atrofia/patologia , Colorimetria/métodos , Colorimetria/normas , Diagnóstico por Computador/métodos , Diagnóstico por Computador/normas , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Oftalmoscopia/normas , Disco Óptico/irrigação sanguínea , Doenças do Nervo Óptico/epidemiologia , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
PURPOSE: To compare diagnostic capabilities and agreement between Oculus-Spark perimetry and 3 procedures of glaucoma morphologic analysis. METHODS: A total of 102 normal eyes and 104 consecutive eyes with suspected or confirmed glaucoma (1 eye per subject) were analyzed in a prospective observational case-control study, using Spark strategy (Oculus Easyfield Perimeter), Heidelberg retinal tomograph (HRT), Zeiss laser polarimetry (GDx), and Cirrus optical coherence tomography (OCT). RESULTS: Spark first phase lasted 37 seconds and all 4 phases 2:34 minutes. Specificities and sensitivities were as follows: Spark mean deviation (MD) first phase (95.1%, 85.6%), MD second and final phases (95.1%, 86.5%), GDx-nerve fiber indicator (95.1%, 57.4%), HRT-Reinhard Burk discriminant function (95.1%, 52.9%), HRT glaucoma probability score (95.1%, 71.2%), Cirrus OCT vertical cup/disc ratio (96.1%, 85.6%), and Cirrus OCT retinal nerve fiber layer thickness (95.1%, 68.0%). Diagnostic agreement between second and final Spark MD phases was kappa=0.92; between phase 1 Spark/MD and Cirrus OCT/vertical C/D ratio was kappa=0.78. Agreements between the 2 Cirrus OCT indices was kappa=0.69 and between the 2 HRT indices was kappa=0.559. The correlation coefficient between second and final MD and PSD was 0.99, and 0.98 between the number of scotomatous points. There was high concordance in scotoma position in both phases (kappa=0.86). The linear correlation coefficients between the morphologic indices were 0.48-0.78, and between morphologic and functional indices 0.51-0.76. Correlation coefficients comparing morphologic and functional indices were similar in the first and the last phase (p>0.05 in all cases). CONCLUSIONS: Spark perimetry appears to show useful sensitivity and specificity, even in the first phase, and good agreement with the morphology.
Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Glaucoma/diagnóstico , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Estudos de Casos e Controles , Humanos , Pressão Intraocular , Estudos Prospectivos , Curva ROC , Polarimetria de Varredura a Laser , Sensibilidade e Especificidade , Tomografia , Tomografia de Coerência Óptica , Testes de Campo VisualRESUMO
PURPOSE: We evaluated and compared the ability of a new method for measuring hemoglobin (Hb) levels at the optic nerve head (ONH) to that of visual field evaluation, scanning laser ophthalmoscopy (HRT), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) for diagnosing glaucoma. METHODS: Healthy eyes (n = 102) and glaucomatous eyes (n = 101) underwent reliable Oculus Spark perimetry, and imaging with the HRT, GDx, and Cirrus OCT. In addition, ONH color images were acquired with a non-mydriatic fundus camera. The Laguna ON(h)E program then was used to calculate the Hb amount in each of 24 sectors of the ONH. Sensitivities at 95% fixed specificity, diagnostic agreement, and linear correlations between parameters with the best diagnostic ability were calculated. RESULTS: The glaucoma discriminant function (GDF) of the Laguna program, evaluating Hb in the vertical intermediate sectors and center/periphery Hb amount slope, yielded an 89.1% sensitivity and 95.1% specificity, which was superior or similar to the other tests. The best GDF diagnostic agreement was for the OCT-vertical cup-to-disc (C/D) ratio (kappa = 0.772) and the final phase Spark pattern SD (kappa = 0.672). Hb levels correlated strongly with the Spark mean sensitivity (first phase 0.70, final phase 0.71). Hb also correlated well with the Reinhard OW Burk discriminant function of the HRT (0.56), nerve fiber indicator of GDx (-0.64), and vertical C/D ratio of OCT (0.71). CONCLUSIONS: Hb levels evaluated by color analysis of ONH photographs had high reproducibility, a high sensitivity-specificity balance, and moderate to strong agreement with other structural and functional tests.