Impact of Normal Aging and Progression Definitions on the Specificity of Detecting Retinal Nerve Fiber Layer Thinning

Autor: Luke J. Saunders, Fábio B. Daga, Linda M. Zangwill, Jonathan G Crowston, Felipe A. Medeiros, Zhichao Wu
Rok vydání: 2017
Předmět:
Adult
Male
Retinal Ganglion Cells
0301 basic medicine
Aging
medicine.medical_specialty
genetic structures
Nerve fiber layer
Glaucoma
Sensitivity and Specificity
Cohort Studies
Young Adult
03 medical and health sciences
chemistry.chemical_compound
Nerve Fibers
0302 clinical medicine
Optics
Optical coherence tomography
Predictive Value of Tests
Ophthalmology
Optic Nerve Diseases
medicine
Humans
False Positive Reactions
Prospective Studies
Prospective cohort study
Aged
medicine.diagnostic_test
business.industry
Retinal
Middle Aged
medicine.disease
Healthy Volunteers
eye diseases
030104 developmental biology
medicine.anatomical_structure
chemistry
Predictive value of tests
Disease Progression
030221 ophthalmology & optometry
Female
sense organs
Tomography
business
Tomography
Optical Coherence
Cohort study
Zdroj: American Journal of Ophthalmology. 181:106-113
ISSN: 0002-9394
DOI: 10.1016/j.ajo.2017.06.017
Popis: To evaluate the specificity of current definitions used to identify progressive change of the average peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained on optical coherence tomography (OCT) imaging.Prospective observational cohort study.Setting: University of California, San Diego.Seventy-five eyes from 45 normal participants.Patients were seen at an average of 5.7 visits over 3.2 years, to determine the age-related average RNFL thickness changes and longitudinal measurement variability. Slope and variability estimates were used to reconstruct "real-world" OCT imaging measurements with computer simulations.False-positive rates for progression in normal eyes using different definitions.The estimated normal average RNFL thickness change over time was -0.54 ± 0.23 μm/year (P .001). Even with a recent definition of progression that appeared to guarantee a high level of specificity by accounting for normal aging (requiring a significant negative slope that was more negative than the 5% lower limit of aging), 18% simulated normal eyes were still falsely identified as having progressed after 5 years of annual testing in a clinical practice scenario. However, this was reduced to 8% and 4% when trend-based analysis of progression was performed after adjustments using the mean and 5% lower limit of normal rates of aging, respectively.This study highlights how current definitions for detecting RNFL thinning have an unacceptably poor level of specificity, and that more stringent definitions are required to avoid misleading interpretations of progression on OCT imaging in clinical practice.
Databáze: OpenAIRE
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