Diagnostic Capabilities Of Optical Coherence Tomography, Frequency-Doubling Technology, And Short-Wavelength Automated Perimetry To Distinguish Chronic Glaucoma

Objective and Significance: To investigate the ability of the three diagnostic tests: Optical Coherence Tomography(OCT), Frequency-Doubling Technology(FDT), and Short-Wavelength Automated Perimetry(SWAP) to distinguish normal, ocular hypertensives and from chronic glaucomatous eyes and to propose some highly efficient indices to diagnose glaucoma earlier.Materials and Methods: (1) Prospective, non-randomized, cross-sectional study;(2)148 eyes of consecutive normal(n=40), chronic glaucoma(CG, n=30), glaucoma suspects(GS, n=59)and ocular-hypertensives(OHT, n=19)were enrolled and completed routine ophthalmic examination, OCT RNFL3.4, FDT 24-2 threshold, SWAP 24-2 threshold, Humphrey 24-2 threshold, fundus examination, IOP measurement and gonioscope examination within 1 week; (3)To define the positive diagnostic standards and grading levels of OCT, FDT and SWAP;(4)Studied indices: sensitivity, specificity, accuracy, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and the initial 30 indices including Smax/Navg, Smax, FDT PSD, SWAPMD, OCT1, Smax/Imax, FDTMD, SWAP PSD, OCT7; (5)All data were evaluated with SPSS 11.0 for Windows.Results:(1) Diagnostic capability indices of OCT, FDT and SWAPTablel Diagnostic capability indices of OCT, FDT and SWAP(2) Parallel test of OCT and FDT could increase the sensitivity to 96.7%(CG), 86.8%(GS)and 83.4%(OHT) while decrease the specificity to 67.8%, and serial test of them two could increase the specificity to 97.2% while decrease the sensitivity to 66.6%(CG), 40.3%(GS)and 32.4%(OHT); Parallel test of OCT, FDT and SWAP could increase the sensitivity to 99.4%(CG), 94.6%(GS)and 87.7%(OHT) while decrease the specificity to 64.4%, and serial test of them three could increase the specificity to 99.9% while decrease the sensitivity to 55.5%(CG), 23.9%(GS)and 8.5%(OHT);(3)OCT3, OCT4, OCT5, OCT6, OCT10, OCTN, OCTT and Smax/Tavg were eliminated by ANOVA (P>0.05) and Smax/Navg, Smax, FDT PSD, SWAP MD, OCT1, Smax/Imax, FDT MD, SWAP PSD were screened out by Dunnett-t test (P<0.05) and brought into Receiver Operating Characteristic(ROC) analysis afterwards, together with the recommended OCT7[20];(4)The highly efficient indices evaluated by areas under ROC curve of non-parametric method were: Group CO: SWAP MD(0.974+0.015), FDT MD(0.968+ 0.029), SWAP PSD(0.963+ 0.023), FDT PSD(0.953+0.034), Smax/Navg(0.929+ 0.031), Smax(0.893+0.040), OCT 1(0.889+0.045), OCT7(0.872+0.053); Group GS: FDT PSD(0.931+ 0.026), SWAP PSD(0.913+0.029), Smax/Navg(0.813 +0.046), Smax(0.781+0.046), OCT1 (0.764+0.051); Group OHT: Smax/Navg(0.899+0.040), SWAP PSD(0.839 + 0.063), FDT PSD(0.821 + 0.071), Smax(0.791 + 0.074), Smax/Imax(0.774+ 0.080), SWAP MD(0.753+ 0.070).Conclusions:(1) Sensitivity, accuracy and positive likelihood ratio of OCT, FDT and SWAP are highest in Group CG, and then in Group GS and lowest in Group OHT;(2) Sensitivity of FDT is higher than SWAP and OCT in all study groups, especially in Group OHT and GS, so FDT can be a useful screening tool;(3)Specificity of finding glaucomatous injury: SWAP>FDT>OCT; For all study groups, abnormal SWAP results may indicate more possibilities of illness than FDT and OCT, while normal ones may predict less possibilities of CG; For Group GS and OHT, normal FDT results may indicate less possibilities of illness;(4)Parallel tests of OCT, FDT (and SWAP) can increase sensitivity significantly to avoid missed diagnosis and serial tests can increase specificity significantly to excludemisdiagnosis;(S)Diagnostic capabilities of the index-PSD are better than MD and all the OCX's indices in Group GS, and it can be the principal reference index for early diagnosis of CG;(6)Smax/Navg's diagnostic capabilities are the most prominent in Group OHX, and among all OCX's 26 indices, OCX1, Smax, Smax/Imax, Smax/Navg can be the important reference indices f...