0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Evaluation of a Myopic Normative Database for Analysis of Retinal Nerve Fiber Layer Thickness

Sayantan Biswas, MPhil1; Chen Lin, BM1; Christopher K. S. Leung, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
JAMA Ophthalmol. 2016;134(9):1032. doi:10.1001/jamaophthalmol.2016.2343.
Text Size: A A A
Published online

Importance  Analysis of retinal nerve fiber layer (RNFL) abnormalities with optical coherence tomography in eyes with high myopia has been complicated by high rates of false-positive errors. An understanding of whether the application of a myopic normative database can improve the specificity for detection of RNFL abnormalities in eyes with high myopia is relevant.

Objective  To evaluate the diagnostic performance of a myopic normative database for detection of RNFL abnormalities in eyes with high myopia (spherical equivalent, –6.0 diopters [D] or less).

Design, Setting, and Participants  In this cross-sectional study, 180 eyes with high myopia (mean [SD] spherical equivalent, –8.0 [1.8] D) from 180 healthy individuals were included in the myopic normative database. Another 46 eyes with high myopia from healthy individuals (mean [SD] spherical equivalent, –8.1 [1.8] D) and 74 eyes from patients with high myopia and glaucoma (mean [SD] spherical equivalent, –8.3 [1.9] D) were included for evaluation of specificity and sensitivity. The 95th and 99th percentiles of the mean and clock-hour circumpapillary RNFL thicknesses and the individual superpixel thicknesses of the RNFL thickness map measured by spectral-domain optical coherence tomography were calculated from the 180 eyes with high myopia. Participants were recruited from January 2, 2013, to December 30, 2015. The following 6 criteria of RNFL abnormalities were examined: (1) mean circumpapillary RNFL thickness below the lower 95th or (2) the lower 99th percentile; (3) one clock-hour or more for RNFL thickness below the lower 95th or (4) the lower 99th percentile; and (5) twenty contiguous superpixels or more of RNFL thickness in the RNFL thickness map below the lower 95th or (6) the lower 99th percentile.

Main Outcomes and Measures  Specificities and sensitivities for detection of RNFL abnormalities.

Results  Of the 46 healthy eyes and 74 eyes with glaucoma studied (from 39 men and 38 women), the myopic normative database showed a higher specificity (63.0%-100%) than did the built-in normative database of the optical coherence tomography instrument (8.7%-87.0%) for detection of RNFL abnormalities across all the criteria examined (differences in specificities between 13.0% [95% CI, 1.1%-24.9%; P = .01] and 54.3% [95% CI, 37.8%-70.9%; P < .001]) except for the criterion of mean RNFL thickness below the lower 99th percentile, in which both normative databases had the same specificities (100%) but the myopic normative database exhibited a higher sensitivity (71.6% vs 86.5%; difference in sensitivities, 14.9% [95% CI, 4.6%-25.1%; P = .002]).

Conclusions and Relevance  The application of a myopic normative database improved the specificity without compromising the sensitivity compared with the optical coherence tomography instrument’s built-in normative database for detection of RNFL abnormalities in eyes with high myopia. Inclusion of myopic normative databases should be considered in optical coherence tomography instruments.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
Examples of Retinal Nerve Fiber Layer (RNFL) Thickness Analysis

A, Optic disc photographs, RNFL thickness deviation maps, and clock-hour circumpapillary RNFL profiles analyzed by the Cirrus high-definition optical coherence tomography (HD-OCT) and the myopic normative databases of a healthy eye with high myopia (spherical equivalent, –8.75 diopters; axial length, 26.39 mm). B, Optic disc photographs, RNFL thickness deviation maps, and clock-hour circumpapillary RNFL profiles analyzed by the Cirrus HD-OCT and the myopic normative databases of an eye with high myopia and glaucoma (spherical equivalent, –7.00 diopters; axial length, 26.10 mm).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Overlay of Retinal Nerve Fiber Layer (RNFL) Thickness Deviation Maps

A, Frequency distribution map of RNFL abnormalities (with reference to the lower 99th percentiles) constructed by overlaying the RNFL thickness deviation maps analyzed by the Cirrus high-definition optical coherence tomography (HD-OCT) normative database in the control group (n = 46). B, Frequency distribution map of RNFL abnormalities (with reference to the lower 99th percentiles) constructed by overlaying the RNFL thickness deviation maps analyzed by the myopic normative database in the control group (n = 46).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

242 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();