J Korean Ophthalmol Soc.  2013 Jun;54(6):902-912. 10.3341/jkos.2013.54.6.902.

Usefulness of Automated Measurements of Localized Retinal Nerve Fiber Layer Defects Area Using Significance Map

• Seo S
• Shin JW
• Uhm KB

• KMID: 2217266
• DOI: http://doi.org/10.3341/jkos.2013.54.6.902

Abstract

PURPOSE
To evaluate the usefulness of automated measurements of the localized retinal nerve fiber layer (RNFL) defects area in patients with glaucoma.
METHODS
Fifty one patients with localized RNFL defects in RNFL red-free photographs and 53 healthy subjects were included. All participants were imaged with 3D spectral-domain optical coherence tomography (OCT). The area of defects was measured with the RNFL significance map (red = p < 1% and yellow = p < 5%) using Image J manually and Matlab software automatically. The area under the receiver operating characteristic curve (AUC) was calculated for the RNFL defect area of the RNFL photograph and RNFL maps, circumpapillary RNFL thickness, optic disc parameter, and macular inner retina thickness.
RESULTS
High correlation was observed between manually and automatically measured defect areas in the significance map (red area r = 0.904, red and yellow area r = 0.890). The AUC for manually and automatically measured defects area (0.987, 0.966; p < 5%, p = 0.31, respectively) in the significance map was comparable. The latter demonstrated slightly higher but insignificant difference in AUC for inferior quadrant circumpapillary RNFL thickness (0.936; p = 0.22) and was significantly higher than the inferior ganglion cell layer plus inner plexiform layer thickness (0.894) and vertical cup to disc ratio (0.869) (p = 0.018, p = 0.008, respectively).
CONCLUSIONS
The automated measurements of the RNFL defect area in the significance map performed adequately in detecting localized RNFL defects and had a better performance than macular inner retina and optic nerve parameters.

Keyword

Glaucoma; Optic nerve; Retinal nerve fiber layer; Significance map; Spectral-domain optical coherence tomography

MeSH Terms

Area Under Curve
Ganglion Cysts
Glaucoma
Humans
Nerve Fibers
Optic Nerve
Retina
Retinaldehyde
ROC Curve
Tomography, Optical Coherence
Retinaldehyde

Figure

• 

  Figure 1. (A) The cSLO RNFL photographs were overlaid with a color disc photograph (5 × 5 mm2) as a reference image that was obtained by Topcon 3D OCT-2000. (B) The retinal blood vessels (arrow) and RNFL defects (arrow head) were matched between the cSLO RNFL photograph and the reference image. cSLO = confocal scanning laser ophthalmoscope; RNFL = retinal nerve fi-ber layer; OCT = optical coherence tomography; T = temporal; N = nasal.

• 

  Figure 2. (A) Original photograph in the retinal nerve fiber layer (RNFL) significance map, RNFL thickness map, optic disc photo-graph, and cSLO RNFL photograph. The RNFL significance map, RNFL thickness map, and optic disc photograph were obtained by Topcon 3D OCT-2000, and the RNFL photograph was captured by a Nidek F-10 cSLO. (B) Each boundary of the RNFL defects was manually delineated. The areas of the RNFL defects were measured on the 5 × 5 mm2 parapapillary area using Image J software (yellow lines) manually. Superpixels coded in red, red and yellow were automatically calculated by a Matlab computer program ac-cording to the red, green, and blue values in the 5 × 5 mm2 circumpapillary region. Measurement of the area of localized RNFL defect in the significance map (red area = 1.11 mm2, red and yellow area = 2.79 mm2), thickness map (1.40 mm2), cSLO RNFL photograph (1.77 mm2) manually, and automated measurement using significance map (red area = 0.84 mm2, red and yellow area = 3.59 mm2). cSLO = confocal scanning laser ophthalmoscope; RNFL = retinal nerve fiber layer; OCT = optical coherence tomography.

• 

  Figure 3. (A) Scatter plots showing the relationship of manually measured red area (p < 1%) of significance map against automati-cally measured red area (p < 1%) of significance map (r = 0.904, p < 0.001). (B) Relationship of manually measured red and yel-low area (p < 5%) of significance map against automatically measured red and yellow area (p < 5%) of significance map (r = 0.890, p < 0.001).

• 

  Figure 4. Bland-Altman plots of agreement between manually and automatically measured (A) red area (p < 1%) and (B) red and yellow area (p < 5%) in the significance map. Differences between automatically and manually measured areas were plotted against the means. Dash lines represent the 95% confidence intervals.

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  Figure 5. The cut-off point (>0.546 mm2), sensitivity (90.2%), and specificity (94.3%) of automated measurements of sig-nificance map red and yellow area (p < 5%).

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  Figure 6. Receiver operating characteristics curves of the man-ually measured significance map red and yellow area (p < 5%), automatically measured significance map red and yellow area (p < 5%), circumpapillary inferior quadrant retinal nerve fi-ber layer (RNFL) thickness, inferior ganglion cell layer + in-ner plexiform layer thickness (GCL + IPL thickness), and vertical cup to disc ratio (CDR).

Reference

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