title: Combining information from 3 anatomic regions in the diagnosis of glaucoma with time-domain optical coherence tomography.
abstract: OBJECTIVE
  To improve the diagnosis of glaucoma by combining time-domain optical coherence tomography (TD-OCT) measurements of the optic disc, circumpapillary retinal nerve fiber layer (RNFL), and macular retinal thickness.
  
  
  METHODS
  Ninety-six age-matched normal and 96 perimetric glaucoma participants were included in this observational, cross-sectional study. Or-logic, support vector machine, relevance vector machine, and linear discrimination function were used to analyze the performances of combined TD-OCT diagnostic variables.
  
  
  RESULTS
  The area under the receiver-operating curve (AROC) was used to evaluate the diagnostic accuracy and to compare the diagnostic performance of single and combined anatomic variables. The best RNFL thickness variables were the inferior (AROC=0.900), overall (AROC=0.892), and superior quadrants (AROC=0.850). The best optic disc variables were horizontal integrated rim width (AROC=0.909), vertical integrated rim area (AROC=0.908), and cup/disc vertical ratio (AROC=0.890). All macular retinal thickness variables had AROCs of 0.829 or less. Combining the top 3 RNFL and optic disc variables in optimizing glaucoma diagnosis, support vector machine had the highest AROC, 0.954, followed by or-logic (AROC=0.946), linear discrimination function (AROC=0.946), and relevance vector machine (AROC=0.943). All combination diagnostic variables had significantly larger AROCs than any single diagnostic variable. There are no significant differences among the combination diagnostic indices.
  
  
  CONCLUSIONS
  With TD-OCT, RNFL and optic disc variables had better diagnostic accuracy than macular retinal variables. Combining top RNFL and optic disc variables significantly improved diagnostic performance. Clinically, or-logic classification was the most practical analytical tool with sufficient accuracy to diagnose early glaucoma.
authors: *Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson, AZ †Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA ‡University of Pittsburgh Medical Center, Pittsburgh, PA §Bascom Palmer Eye Institute, University of Miami, Miami, FL ∥Casey Eye Institute, Oregon Health & Science University, Portland, OR.
authors: Mingwu
authors: M
authors: Wang
authors: Ake Tzu-Hui
authors: AT
authors: Lu
authors: Rohit
authors: R
authors: Varma
authors: Joel S
authors: JS
authors: Schuman
authors: David S
authors: DS
authors: Greenfield
authors: David
authors: D
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*