Original Investigation
December 2015

A Region-of-Interest Approach for Detecting Progression of Glaucomatous Damage With Optical Coherence Tomography

Author Affiliations
  • 1Department of Psychology, Columbia University, New York, New York
  • 2Department of Ophthalmology, Columbia University, New York, New York
  • 3Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2015;133(12):1438-1444. doi:10.1001/jamaophthalmol.2015.3871

Importance  Detecting progression of glaucomatous damage is often challenging.

Objective  To test the feasibility of using frequency-domain optical coherence tomography (FD-OCT) and a region-of-interest (ROI) approach to measure progressive changes in glaucomatous damage.

Design, Setting, and Participants  Among a group of patients in an institutional glaucoma practice who were likely to show glaucoma progression, eyes with a history of an optic disc hemorrhage (DH) confirmed by stereophotography were followed up with FD-OCT cube scans of the optic disc. All patients underwent FD-OCT scans on at least 2 occasions separated by at least 1 year (mean, 3.45 years; range, 1.42-6.39 years). Because we were not studying the effects of an optic DH, no constraint was placed on the time between the documentation of an optic DH and the first scan used in the analysis.

Main Outcomes and Measures  After en face images of the FD-OCT scan were aligned based on the blood vessels, circumpapillary images were derived for an annulus 100 µm in width, and the retinal nerve fiber layer (RNFL) thickness profiles were plotted for the first and last visits. The ROI width associated with the optic DH was defined as the region of the RNFL profile below the 1% CI based on healthy norms. The change in the ROI width was compared with the change in the global RNFL thickness, which was obtained by averaging the circumpapillary RNFL thickness.

Results  The change in the ROI width (mean [SD], 8.0° [6.4°]; 95% CI, 4.9° to 11.1°; range, −0.7° to 19.3°) was significant (P < .001, 2-tailed t test) while the change in the global thickness (mean [SD], 2.40 [5.87] μm; 95% CI, −0.48 to 5.28 μm) was not significant (P > .12, 2-tailed t test). Although 15 of the 16 ROIs increased in width between visits, only 11 showed a decrease in the global RNFL thickness.

Conclusions and Relevance  For detecting progression of local RNFL damage in patients with glaucoma, an OCT ROI approach appears superior to the OCT global RNFL thickness measure typically used.