TY - JOUR
T1 - Differentiating glaucoma from chiasmal compression using optical coherence tomography
T2 - The macular naso-temporal ratio
AU - Kleerekooper, Iris
AU - Wagner, Siegfried K.
AU - Trip, S. Anand
AU - Plant, Gordon T.
AU - Petzold, Axel
AU - Keane, Pearse A.
AU - Khawaja, Anthony P.
N1 - Funding Information: IK has been funded through the postdoctoral research fund of the ECTRIMS. SKW is funded through a Medical Research Council Clinical Research Training Fellowship (MR/TR000953/1). PK is supported by a Moorfields Eye Charity Career Development Award (R190028A) and a UK Research & Innovation Future Leaders Fellowship (MR/T019050/1). SAT receives support from the UCLH Biomedical Research Centre. APK is supported by a UKRI Future Leaders Fellowship (MR/T040912/1), an Alcon Research Institute Young Investigator Award and a Lister Institute Fellowship. Funding Information: SAT reported receiving nonfinancial support and/or personal fees from Biogen Inc, Merck Serono, Novartis International AG, F. Hoffmann–La Roche AG, and Teva Pharmaceuticals, and involvement with clinical trials run by Biogen Inc and Sanofi Genzyme. AP reported being a member of the steering committee for the Optical Coherence Tomography in MS study (Novartis International AG) and the SC Zeiss OCTA Angio-Network; receiving consulting fees for performing ocular coherence tomography quality control for the PASSOS study (Novartis International AG); receiving grant support for the RECOVER trial from University College San Francisco, the RESTORE trial from a Dutch private foundation, and the nimodipine trial from Fight for Sight; receiving nonfinancial support from Moorfields Eye Hospital; institutional research funding from the NIHR; speaker fees from Heidelberg Spectralis Lecture at Heidelberg Academy; and research funding from UK Biobank Eye and Vision Consortium outside the submitted work. PK has acted as a consultant for DeepMind, Roche, Novartis, Apellis, and BitFount and is an equity owner in Big Picture Medical. He has received speaker fees from Heidelberg Engineering, Topcon, Allergan, and Bayer. APK has consulted for Abbvie, Aerie, Google Health, Novartis, Reichert, Santen, Thea. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023
Y1 - 2023
N2 - Background/aims: The analysis of visual field loss patterns is clinically useful to guide differential diagnosis of visual pathway pathology. This study investigates whether a novel index of macular atrophy patterns can discriminate between chiasmal compression and glaucoma. Methods: A retrospective series of patients with preoperative chiasmal compression, primary open-angle glaucoma (POAG) and healthy controls. Macular optical coherence tomography (OCT) images were analysed for the macular ganglion cell and inner plexiform layer (mGCIPL) thickness. The nasal hemi-macula was compared with the temporal hemi-macula to derive the macular naso-temporal ratio (mNTR). Differences between groups and diagnostic accuracy were explored with multivariable linear regression and the area under the receiver operating characteristic curve (AUC). Results: We included 111 individuals (31 with chiasmal compression, 30 with POAG and 50 healthy controls). Compared with healthy controls, the mNTR was significantly greater in POAG cases (β=0.07, 95% CI 0.03 to 0.11, p=0.001) and lower in chiasmal compression cases (β=-0.12, 95% CI-0.16 to-0.09, p<0.001), even though overall mGCIPL thickness did not discriminate between these pathologies (p=0.36). The mNTR distinguished POAG from chiasmal compression with an AUC of 95.3% (95% CI 90% to 100%). The AUCs when comparing healthy controls to POAG and chiasmal compression were 79.0% (95% CI 68% to 90%) and 89.0% (95% CI 80% to 98%), respectively. Conclusions: The mNTR can distinguish between chiasmal compression and POAG with high discrimination. This ratio may provide utility over-and-above previously reported sectoral thinning metrics. Incorporation of mNTR into the output of OCT instruments may aid earlier diagnosis of chiasmal compression.
AB - Background/aims: The analysis of visual field loss patterns is clinically useful to guide differential diagnosis of visual pathway pathology. This study investigates whether a novel index of macular atrophy patterns can discriminate between chiasmal compression and glaucoma. Methods: A retrospective series of patients with preoperative chiasmal compression, primary open-angle glaucoma (POAG) and healthy controls. Macular optical coherence tomography (OCT) images were analysed for the macular ganglion cell and inner plexiform layer (mGCIPL) thickness. The nasal hemi-macula was compared with the temporal hemi-macula to derive the macular naso-temporal ratio (mNTR). Differences between groups and diagnostic accuracy were explored with multivariable linear regression and the area under the receiver operating characteristic curve (AUC). Results: We included 111 individuals (31 with chiasmal compression, 30 with POAG and 50 healthy controls). Compared with healthy controls, the mNTR was significantly greater in POAG cases (β=0.07, 95% CI 0.03 to 0.11, p=0.001) and lower in chiasmal compression cases (β=-0.12, 95% CI-0.16 to-0.09, p<0.001), even though overall mGCIPL thickness did not discriminate between these pathologies (p=0.36). The mNTR distinguished POAG from chiasmal compression with an AUC of 95.3% (95% CI 90% to 100%). The AUCs when comparing healthy controls to POAG and chiasmal compression were 79.0% (95% CI 68% to 90%) and 89.0% (95% CI 80% to 98%), respectively. Conclusions: The mNTR can distinguish between chiasmal compression and POAG with high discrimination. This ratio may provide utility over-and-above previously reported sectoral thinning metrics. Incorporation of mNTR into the output of OCT instruments may aid earlier diagnosis of chiasmal compression.
KW - Glaucoma
KW - Retina
UR - http://www.scopus.com/inward/record.url?scp=85164524216&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bjo-2023-323529
DO - https://doi.org/10.1136/bjo-2023-323529
M3 - Article
C2 - 37385651
SN - 0007-1161
JO - British journal of ophthalmology
JF - British journal of ophthalmology
M1 - bjo-2023-323529
ER -