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      Repeatability and Reproducibility of Retinal Nerve Fiber Layer Parameters Measured by Scanning Laser Polarimetry with Enhanced Corneal Compensation in Normal and Glaucomatous Eyes

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          Abstract

          Objective. To assess the intrasession repeatability and intersession reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness parameters measured by scanning laser polarimetry (SLP) with enhanced corneal compensation (ECC) in healthy and glaucomatous eyes. Methods. One randomly selected eye of 82 healthy individuals and 60 glaucoma subjects was evaluated. Three scans were acquired during the first visit to evaluate intravisit repeatability. A different operator obtained two additional scans within 2 months after the first session to determine intervisit reproducibility. The intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) were calculated for all SLP parameters in both groups. Results. ICCs ranged from 0.920 to 0.982 for intravisit measurements and from 0.910 to 0.978 for intervisit measurements. The temporal-superior-nasal-inferior-temporal (TSNIT) average was the highest (0.967 and 0.946) in normal eyes, while nerve fiber indicator (NFI; 0.982) and inferior average (0.978) yielded the best ICC in glaucomatous eyes for intravisit and intervisit measurements, respectively. All COVs were under 10% in both groups, except NFI. TSNIT average had the lowest COV (2.43%) in either type of measurement. Intervisit TRT ranged from 6.48 to 12.84. Conclusions. The reproducibility of peripapillary RNFL measurements obtained with SLP-ECC was excellent, indicating that SLP-ECC is sufficiently accurate for monitoring glaucoma progression.

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          Comparison of the GDx VCC scanning laser polarimeter, HRT II confocal scanning laser ophthalmoscope, and stratus OCT optical coherence tomograph for the detection of glaucoma.

          To compare the abilities of current commercially available versions of 3 optical imaging techniques: scanning laser polarimetry with variable corneal compensation (GDx VCC), confocal scanning laser ophthalmoscopy (HRT II [Heidelberg Retina Tomograph]), and optical coherence tomography (Stratus OCT) to discriminate between healthy eyes and eyes with glaucomatous visual field loss. We included 107 patients with glaucomatous visual field loss and 76 healthy subjects of a similar age. All individuals underwent imaging with a GDx VCC, HRT II, and fast retinal nerve fiber layer scan with the Stratus OCT as well as visual field testing within a 6-month period. Receiver operating characteristic curves and sensitivities at fixed specificities (80% and 95%) were calculated for parameters reported as continuous variables. Diagnostic categorization (outside normal limits, borderline, or within normal limits) provided by each instrument after comparison with its respective normative database was also evaluated, and likelihood ratios were reported. Agreement on categorization between methods (weighted kappa) was assessed. After the exclusion of subjects with unacceptable images, the final study sample included 141 eyes of 141 subjects (75 with glaucoma and 66 healthy control subjects). Mean +/- SD mean deviation of the visual field test result for patients with glaucoma was -4.87 +/- 3.9 dB, and 70% of these patients had early glaucomatous visual field damage. No statistically significant difference was found between the areas under the receiver operating characteristic curves (AUCs) for the best parameters from the GDx VCC (nerve fiber indicator, AUC = 0.91), Stratus OCT (retinal nerve fiber layer inferior thickness, AUC = 0.92), and HRT II (linear discriminant function, AUC = 0.86). Abnormal results for each of the instruments, after comparison with their normative databases, were associated with strong positive likelihood ratios. Chance-corrected agreement (weighted kappa) among the 3 instruments ranged from moderate to substantial (0.50-0.72). The AUCs and the sensitivities at high specificities were similar among the best parameters from each instrument. Abnormal results (as compared with each instrument's normative database) were associated with high likelihood ratios and large effects on posttest probabilities of having glaucomatous visual field loss. Calculation of likelihood ratios may provide additional information to assist the clinician in diagnosing glaucoma with these instruments.
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            Scanning laser polarimetry to measure the nerve fiber layer of normal and glaucomatous eyes.

            To determine whether retardation (change in polarization) measurements of healthy subjects and glaucoma patients obtained by using a confocal scanning laser polarimeter correspond to known properties of the nerve fiber layer. A polarimeter, an optical device used to measure the change in linear polarization of light (retardation), was interfaced with a scanning laser ophthalmoscope to obtain retardation data at 65,536 locations (256 x 256 pixels) in a study of normal subjects and patients with primary open-angle glaucoma. To validate the instrument, we compared our measurements with known properties of the human retinal nerve fiber layer in 105 normal subjects. Additionally, we compared retardation measurements in eyes of 64 normal subjects and 64 age-matched glaucoma patients treated in a referral practice. In normal eyes, mean (+/- S.D.) peripapillary retardation was highest in the superior and inferior arcuate regions and lowest in the temporal and nasal regions, 12.0 +/- 1.9, 13.1 +/- 2.0, 7.0 +/- 1.8, and 7.0 +/- 1.6 degrees, respectively. Retardation decreased toward the periphery and was lower over blood vessels. In normal eyes, retardation decreased with increasing age in the superior and inferior regions. Mean retardation was statistically significantly higher among normal eyes than glaucoma eyes in the inferior and superior regions but not in the temporal or nasal areas. Scanning laser polarimetry provides quantitative measurements that correspond to known properties of the retinal nerve fiber layer in normal and glaucomatous eyes.
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              Imaging of the retinal nerve fibre layer for glaucoma.

              Glaucoma is a group of diseases characterised by retinal ganglion cell dysfunction and death. Detection of glaucoma and its progression are based on identification of abnormalities or changes in the optic nerve head (ONH) or the retinal nerve fibre layer (RNFL), either functional or structural. This review will focus on the identification of structural abnormalities in the RNFL associated with glaucoma. A variety of new techniques have been created and developed to move beyond photography, which generally requires subjective interpretation, to quantitative retinal imaging to measure RNFL loss. Scanning laser polarimetry uses polarised light to measure the RNFL birefringence to estimate tissue thickness. Optical coherence tomography (OCT) uses low-coherence light to create high-resolution tomographic images of the retina from backscattered light in order to measure the tissue thickness of the retinal layers and intraretinal structures. Segmentation algorithms are used to measure the thickness of the retinal nerve fibre layer directly from the OCT images. In addition to these clinically available technologies, new techniques are in the research stages. Polarisation-sensitive OCT has been developed that combines the strengths of scanning laser polarimetry with those of OCT. Ultra-fast techniques for OCT have been created for research devices. The continued utilisation of imaging devices into the clinic is refining glaucoma assessment. In the past 20 years glaucoma has gone from a disease diagnosed and followed using highly subjective techniques to one measured quantitatively and increasingly objectively.
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                Author and article information

                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi Publishing Corporation
                2314-6133
                2314-6141
                2015
                22 June 2015
                : 2015
                : 729392
                Affiliations
                1Department of Ophthalmology, Miguel Servet University Hospital, Aragon Health Sciences Institute, 50009 Zaragoza, Spain
                2Department of Surgery, Gynecology and Obstetrics, University of Zaragoza, 50009 Zaragoza, Spain
                3Department of Family Medicine, Seminario Primary Health Care Center, 50009 Zaragoza, Spain
                4Department of Neurosciences, University of Pisa, 56100 Pisa, Italy
                5Department of Ophthalmology, University of Siena, 53100 Siena, Italy
                Author notes
                *Antonio Ferreras: aferreras@ 123456msn.com

                Academic Editor: Alfredo García-Layana

                Article
                10.1155/2015/729392
                4491554
                dcec138d-ba5f-4f06-9ee7-53820c9a77a3
                Copyright © 2015 Mirian Ara et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 September 2014
                : 4 March 2015
                Categories
                Clinical Study

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