PMID- 34230023
OWN - NLM
STAT- MEDLINE
DCOM- 20221129
LR  - 20221203
IS  - 1468-2079 (Electronic)
IS  - 0007-1161 (Linking)
VI  - 106
IP  - 12
DP  - 2022 Dec
TI  - Combined structure-function analysis in glaucoma screening.
PG  - 1689-1695
LID - 10.1136/bjophthalmol-2021-319178 [doi]
AB  - AIM: To assess the applicability of a structure-function (S-F) analysis combining 
      spectral-domain optical coherence tomography (SD-OCT) and standard automated 
      perimetry (SAP) in glaucoma screening in a middle-aged population. METHODS: A 
      randomised sample of 3001 Caucasian participants aged 45-49 years of the Northern 
      Finland Birth Cohort Eye Study was examined. We performed an eye examination, 
      including 24-2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) 
      photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by 
      Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated 
      against clinical glaucoma diagnosis, that is, the positive '2 out of 3' rule 
      based on the clinician's evaluation of ONH and RNFL photographs and visual fields 
      (VFs). RESULTS: At a specificity of 97.5%, the sensitivity for glaucomatous 
      damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated 
      areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive 
      predictive values were 8 %, 10% and 12%, respectively. By applying a 
      classification tree approach combining OCT, SAP and defect localisation data, a 
      sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of 
      glaucomatous structural and functional defects, the correlation with glaucoma 
      increased significantly if the abnormal VF test points were located on borderline 
      or abnormal OCT zones. CONCLUSION: SAP performs slightly better than OCT in 
      glaucoma screening of middle-aged population. However, the diagnostic capability 
      can be improved by S-F analysis.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Karvonen, Elina
AU  - Karvonen E
AUID- ORCID: 0000-0001-6521-6695
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland 
      elina.karvonen@fimnet.fi.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
AD  - Department of Ophthalmology, Helsinki University Hospital and University of 
      Helsinki, Helsinki, Finland.
FAU - Stoor, Katri
AU  - Stoor K
AUID- ORCID: 0000-0003-3589-0923
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
FAU - Luodonpaa, Marja
AU  - Luodonpaa M
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
FAU - Hagg, Pasi
AU  - Hagg P
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
FAU - Leiviska, Ilmari
AU  - Leiviska I
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
FAU - Liinamaa, Johanna
AU  - Liinamaa J
AUID- ORCID: 0000-0003-3424-7207
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
FAU - Tuulonen, Anja
AU  - Tuulonen A
AUID- ORCID: 0000-0003-1077-3691
AD  - Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
FAU - Saarela, Ville
AU  - Saarela V
AUID- ORCID: 0000-0003-3189-7626
AD  - Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
AD  - PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu 
      University, Oulu, Finland.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210706
PL  - England
TA  - Br J Ophthalmol
JT  - The British journal of ophthalmology
JID - 0421041
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - *Glaucoma/diagnosis
MH  - Intraocular Pressure
MH  - Nerve Fibers
MH  - *Optic Disk/diagnostic imaging
MH  - Tomography, Optical Coherence/methods
MH  - Visual Field Tests/methods
MH  - Visual Fields
OTO - NOTNLM
OT  - diagnostic tests/investigation
OT  - epidemiology
OT  - glaucoma
OT  - imaging
COIS- Competing interests: None declared.
EDAT- 2021/07/08 06:00
MHDA- 2022/11/25 06:00
CRDT- 2021/07/07 06:14
PHST- 2021/03/02 00:00 [received]
PHST- 2021/06/11 00:00 [accepted]
PHST- 2021/07/08 06:00 [pubmed]
PHST- 2022/11/25 06:00 [medline]
PHST- 2021/07/07 06:14 [entrez]
AID - bjophthalmol-2021-319178 [pii]
AID - 10.1136/bjophthalmol-2021-319178 [doi]
PST - ppublish
SO  - Br J Ophthalmol. 2022 Dec;106(12):1689-1695. doi: 
      10.1136/bjophthalmol-2021-319178. Epub 2021 Jul 6.