Abstract
Background
Optical coherence tomography has become within the last years an established imaging technique with many applications in ophthalmology, and an important tool which contributes to earlier and more accurate diagnosis of glaucoma. As a consequence, detection sensitivity is highly valued. The aim of this study was to assess the reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements by the Stratus Optical Coherence Tomograph (OCT) using the Fast- and Repeat-scan protocols in normal and glaucomatous eyes.
Methods
In the clinical setting, RNFL thickness measurements were obtained from a control group of 40 subjects, consisting of 20 normal volunteers and 20 glaucoma patients. One eye was randomly chosen from each subject, and underwent five RNFL thickness measurements with the Fast- and five with the Repeat-scan protocol, which was also based on the Fast-scan mode. Reproducibility was assessed by the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) for the overall mean RNFL thickness and for each quadrant and clock hour of the peripapillary area.
Results
The Repeat-scan protocol yielded higher ICC and lower CV values in all quadrants and clock hours of the peripapillary area, both in normal and glaucomatous subjects. The difference in CV values between Fast- and Repeat-scan protocol measurements reached statistical significance in the temporal quadrant (P = 0.021) and in clock hour sectors 8, 9 and 12 (P = 0.022, 0.017 and 0.03 respectively). ICC (and CV) for the temporal-, superior-, nasal- and inferior-quadrant RNFL thickness was: for the Fast-scan protocol, 0.913 (7.4%), 0.925 (6.97%), 0.828 (10.31%), 0.964 (4.89%) respectively; and for the Repeat-scan protocol, 0.965 (5.08%), 0.958 (5.26%), 0.906 (8.12%) 0.968 (4.6%) respectively.
Conclusions
Reproducibility of RNFL thickness measurements with the Fast- and Repeat-scan protocols by the Stratus OCT is proved to be very high both in normal and glaucomatous subjects. The Repeat-scan protocol shows higher ICC and lower CV values, statistically significant especially on the temporal side of the peripapillary area, which may indicate a higher reproducibility and greater agreement of measurements. These findings support the fact that the Repeat-scan protocol might be considered as a more precise method for evaluation of RNFL thickness.
Similar content being viewed by others
References
Quigley H, Katz J, Derick R, Gilbert D, Sommer A (1992) An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage. Ophthalmology 99:19–28
Yücel YH, Gupta N, Kalichman M, Mizisin AP, Hare W, de Souza Lima M et al (1998) Relationship of optic disc topography to optic nerve fiber number in glaucoma. Arch Ophthalmol 116:493–497
Mikelberg FS, Yidegiligne HM, Shulzer M (1995) Optic nerve axon count and axon diameter in patients with ocular hypertension and normal visual fields. Ophthalmology 102:342–348
Harwert RS, Carter-Dawson L, Shen F, Smith EL, Crawford ML (1999) Ganglion cell loss underlying visual field defects from experimental glaucoma. Invest Ophthalmol Vis Sci 40:2242–2250
Sommer A, Katz J, Quigley HA et al (1991) Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol 109:77–83
Kerrigan-Baumrind LA, Quigley HA, Pease ME, Kerrigan DF, Mitchell RS (2000) Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons. Invest Ophthalmol Vis Sci 41(3):741–748
Chauhan BC, McCormick TA, Nicolela MT, LeBlanc RP (2001) Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma. Comparison of scanning laser tomography with conventional perimetry and optic disc photography. Arch Ophthalmol 119:1492–1499
Quigley HA, Addicks EM, Green R (1982) Optic nerve damage in human glaucoma III: quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic optic neuropathy, papilledema and toxic optic neuropathy. Arch Ophthalmol 100:135–146
Huang D, Swanson EA, Lin CP et al (1991) Optical coherence tomography. Science 254:1178–1181, doi:10.1126/science.1957169
Schmitt JM (1999) Optical Coherence Tomography (OCT): A Review. IEEE Sel Top Quantum Electron 5(4):1205–1215, doi:10.1109/2944.796348
Schuman JS, Pedult-Kloizman T, Hertzmark E et al (1996) Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology 103:1889–1898
Schuman JS, Hee MR, Puliafito CA et al (1995) Quantification of nerve fibre layer thickness in normal and glaucomatous eyes using optical coherence tomography: a pilot study. Arch Ophthalmol 113:586–596
Carpineto P, Ciancaglini M, Zuppardi E et al (2003) Reliability of nerve fibre layer thickness measurements using optical coherence tomography in normal and glaucomatous eyes. Ophthalmology 110:190–195, doi:10.1016/S0161–6420(02)01296–4
Klemm M, Rumberger E, Walter A, Richard G (2002) Reproduzierbarkeit von Messungen der retinalen Nervenfaserschichtdicke. Ophthalmologe 99:345–351, doi:10.1007/s00347–001–0556-y
Blumenthal EZ, Williams JM, Weinreb RN et al (2000) Reproducibility of nerve fibre layer thickness measurements by use of optical coherence tomography. Ophthalmology 107:2278–2282, doi:10.1016/S0161–6420(00)00341–9
Jones AL, Sheen NJL, North RV et al (2001) The Humphrey Optical Coherence Tomography Scanner: quantitative analysis and reproducibility study of the normal human retinal nerve fibre layer. Br J Ophthalmol 85:673–677, doi:10.1136/bjo.85.6.673
British Standards Institution (1994) Accuracy (trueness and precision) of measurement methods and results: General principles and definitions. HMO, London. BS ISO 5725 (part1)
British Standards Institution (1994) Accuracy (trueness and precision) of measurement methods and results: Basic methods for the determination of repeatability and reproducibility of a standard measurement method. HMO, London. BS ISO 5725 (part 2)
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 2:307–310
Medeiros FA, Zangwill LM, Bowd C, Vessani RM, Susanna R Jr, Weinreb RN (2005) Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. Am J Ophthalmol 139(1):44–55, doi:10.1016/j.ajo.2004.08.069
Sihota R, Sony P, Gupta V, Dada T, Singh R (2006) Diagnostic capability of optical coherence tomography in evaluating the degree of glaucomatous retinal nerve fiber damage. Invest Ophthalmol Vis Sci 47(5):2006–2010, doi:10.1167/iovs.05–1102
Hoffmann EM, Medeiros FA, Sample PA, Boden C, Bowd C, Bourne RR et al (2006) Relationship between patterns of visual field loss and retinal nerve fiber layer thickness measurements. Am J Ophthalmol 141(3):463–471, doi:10.1016/j.ajo.2005.10.017
Fercher AF, Hitzenberger CK, Drexler W, Kamp G, Sattmann H (1993) In vivo optical coherence tomography. Am J Ophthalmol 116:113–114
Wu Z, Vazeen M, Varma R, Chopra V, Walsh AC, LaBree LD et al (2007) Factors associated with variability in retinal nerve fiber layer thickness measurements obtained by optical coherence tomography. Ophthalmology 114(8):1505–1512, doi:10.1016/j.ophtha.2006.10.061
Smith M, Frost A, Graham CM, Shaw S (2007) Effect of pupillary dilation on glaucoma assessments using Optical Coherence Tomography. Br J Ophthalmol 91:1686–1690, doi:10.1136/bjo.2006.113134
Paunescu LA, Schuman JS, Price LL et al (2004) Reproducibility of nerve fiber layer thickness, macular thickness, and optic nerve head measurements using Stratus OCT. Invest Ophthalmol Vis Sci 45:1716–1724, doi:10.1167/iovs.03–0514
Budenz DL, Chang RT, Xiangrum H, Knighton RW, Tielsch JM (2005) Reproducibility of retinal nerve fiber thickness measurements using the Stratus OCT in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 46:2440–2443, doi:10.1167/iovs.04–1174
Budenz DL, Fredette MJ, Feuer WJ, Anderson DR (2008) Reproducibility of peripapillary retinal nerve fiber thickness measurements with Stratus OCT in glaucomatous eyes. Ophthalmology 115(4):661-666, doi:10.1016/j.ophtha.2007.05.035
Acknowledgments
We thankfully acknowledge the valuable contribution of Prof. Allan Chang, director of “Centre for Clinical Studies, Mater Health Services, Brisbane, Queensland, Australia”, to the statistical analysis of our data.
Author information
Authors and Affiliations
Corresponding author
Additional information
No financial interests in any of the products mentioned in the study.
Rights and permissions
About this article
Cite this article
Tzamalis, A., Kynigopoulos, M., Schlote, T. et al. Improved reproducibility of retinal nerve fiber layer thickness measurements with the repeat-scan protocol using the Stratus OCT in normal and glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 247, 245–252 (2009). https://doi.org/10.1007/s00417-008-0946-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-008-0946-9