Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma

Purpose: Detection of early glaucoma remains limited with the conventional analysis of the retinal nerve fiber layer (RNFL). This study assessed whether compensating the RNFL thickness for multiple demographic and anatomic factors improves the detection of glaucoma. Design: Cross-sectional study. Pa...

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Main Authors: Chua, Jacqueline, Schwarzhans, Florian, Wong, Damon, Li, Chi, Husain, Rahat, Crowston, Jonathan G., Perera, Shamira A., Sng, Chelvin C. A., Nongpiur, Monisha E., Majithia, Shivani, Tham, Yih Chung, Thakur, Sahil, Soh, Zhi Da, Cheng, Ching-Yu, Aung, Tin, Fischer, Georg, Vass, Clemens, Schmetterer, Leopold
Other Authors: School of Chemical and Biomedical Engineering
Format: Article
Language:English
Published: 2023
Subjects:
Online Access:https://hdl.handle.net/10356/164205
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Institution: Nanyang Technological University
Language: English
id sg-ntu-dr.10356-164205
record_format dspace
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Engineering::Bioengineering
Glaucoma
Optic Nerve Diseases
spellingShingle Engineering::Bioengineering
Glaucoma
Optic Nerve Diseases
Chua, Jacqueline
Schwarzhans, Florian
Wong, Damon
Li, Chi
Husain, Rahat
Crowston, Jonathan G.
Perera, Shamira A.
Sng, Chelvin C. A.
Nongpiur, Monisha E.
Majithia, Shivani
Tham, Yih Chung
Thakur, Sahil
Soh, Zhi Da
Cheng, Ching-Yu
Aung, Tin
Fischer, Georg
Vass, Clemens
Schmetterer, Leopold
Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
description Purpose: Detection of early glaucoma remains limited with the conventional analysis of the retinal nerve fiber layer (RNFL). This study assessed whether compensating the RNFL thickness for multiple demographic and anatomic factors improves the detection of glaucoma. Design: Cross-sectional study. Participants: Three hundred eighty-seven patients with glaucoma and 2699 healthy participants. Methods: Two thousand six hundred ninety-nine healthy participants were enrolled to construct and test a multivariate compensation model, which then was applied in 387 healthy participants and 387 patients with glaucoma (early glaucoma, n = 219; moderate glaucoma, n = 97; and advanced glaucoma, n = 71). Participants underwent Cirrus spectral-domain OCT (Carl Zeiss Meditec) imaging of the optic disc and macular cubes. Compensated RNFL thickness was generated based on ethnicity, age, refractive error, optic disc (ratio, orientation, and area), fovea (distance and angle), and retinal vessel density. The RNFL thickness measurements and their corresponding areas under the receiver operating characteristic curve (AUCs) were obtained. Main Outcome and Measures: Measured and compensated RNFL thickness measurements. Results: After applying the Asian-specific compensation model, the standard deviation of RNFL thickness reduced, where the effect was greatest for Chinese participants (16.9%), followed by Malay participants (13.9%), and Indian participants (12.1%). Multivariate normative comparison outperformed measured RNFL for discrimination of early glaucoma (AUC, 0.90 vs. 0.85; P < 0.001), moderate glaucoma (AUC, 0.94 vs. 0.91; P < 0.001), and advanced glaucoma (AUC, 0.98 vs. 0.96; P < 0.001). Conclusions: The multivariate normative database of RNFL showed better glaucoma discrimination capability than conventional age-matched comparisons, suggesting that accounting for demographic and anatomic variance in RNFL thickness may have usefulness in improving glaucoma detection.
author2 School of Chemical and Biomedical Engineering
author_facet School of Chemical and Biomedical Engineering
Chua, Jacqueline
Schwarzhans, Florian
Wong, Damon
Li, Chi
Husain, Rahat
Crowston, Jonathan G.
Perera, Shamira A.
Sng, Chelvin C. A.
Nongpiur, Monisha E.
Majithia, Shivani
Tham, Yih Chung
Thakur, Sahil
Soh, Zhi Da
Cheng, Ching-Yu
Aung, Tin
Fischer, Georg
Vass, Clemens
Schmetterer, Leopold
format Article
author Chua, Jacqueline
Schwarzhans, Florian
Wong, Damon
Li, Chi
Husain, Rahat
Crowston, Jonathan G.
Perera, Shamira A.
Sng, Chelvin C. A.
Nongpiur, Monisha E.
Majithia, Shivani
Tham, Yih Chung
Thakur, Sahil
Soh, Zhi Da
Cheng, Ching-Yu
Aung, Tin
Fischer, Georg
Vass, Clemens
Schmetterer, Leopold
author_sort Chua, Jacqueline
title Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
title_short Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
title_full Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
title_fullStr Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
title_full_unstemmed Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
title_sort multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma
publishDate 2023
url https://hdl.handle.net/10356/164205
_version_ 1787136781853917184
spelling sg-ntu-dr.10356-1642052023-12-29T06:53:35Z Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma Chua, Jacqueline Schwarzhans, Florian Wong, Damon Li, Chi Husain, Rahat Crowston, Jonathan G. Perera, Shamira A. Sng, Chelvin C. A. Nongpiur, Monisha E. Majithia, Shivani Tham, Yih Chung Thakur, Sahil Soh, Zhi Da Cheng, Ching-Yu Aung, Tin Fischer, Georg Vass, Clemens Schmetterer, Leopold School of Chemical and Biomedical Engineering Singapore National Eye Centre Duke- NUS Medical School SERI-NTU Advanced Ocular Engineering (STANCE) Engineering::Bioengineering Glaucoma Optic Nerve Diseases Purpose: Detection of early glaucoma remains limited with the conventional analysis of the retinal nerve fiber layer (RNFL). This study assessed whether compensating the RNFL thickness for multiple demographic and anatomic factors improves the detection of glaucoma. Design: Cross-sectional study. Participants: Three hundred eighty-seven patients with glaucoma and 2699 healthy participants. Methods: Two thousand six hundred ninety-nine healthy participants were enrolled to construct and test a multivariate compensation model, which then was applied in 387 healthy participants and 387 patients with glaucoma (early glaucoma, n = 219; moderate glaucoma, n = 97; and advanced glaucoma, n = 71). Participants underwent Cirrus spectral-domain OCT (Carl Zeiss Meditec) imaging of the optic disc and macular cubes. Compensated RNFL thickness was generated based on ethnicity, age, refractive error, optic disc (ratio, orientation, and area), fovea (distance and angle), and retinal vessel density. The RNFL thickness measurements and their corresponding areas under the receiver operating characteristic curve (AUCs) were obtained. Main Outcome and Measures: Measured and compensated RNFL thickness measurements. Results: After applying the Asian-specific compensation model, the standard deviation of RNFL thickness reduced, where the effect was greatest for Chinese participants (16.9%), followed by Malay participants (13.9%), and Indian participants (12.1%). Multivariate normative comparison outperformed measured RNFL for discrimination of early glaucoma (AUC, 0.90 vs. 0.85; P < 0.001), moderate glaucoma (AUC, 0.94 vs. 0.91; P < 0.001), and advanced glaucoma (AUC, 0.98 vs. 0.96; P < 0.001). Conclusions: The multivariate normative database of RNFL showed better glaucoma discrimination capability than conventional age-matched comparisons, suggesting that accounting for demographic and anatomic variance in RNFL thickness may have usefulness in improving glaucoma detection. Agency for Science, Technology and Research (A*STAR) National Medical Research Council (NMRC) National Research Foundation (NRF) Published version Supported by the National Medical Research Council, Singapore, Republic of Singapore (grant nos.: CG/C010A/2017, OFIRG/0048/2017, OFLCG/004c/2018, TA/MOH-000249-00/2018, and MOH-OFIRG20nov-0014); the National Research Foundation, Singapore, Republic of Singapore (grant nos.: NRF-CRP24-2020-0001 and NRF2019-THE002-0006); A*STAR (grant no.: A20H4b0141); the Singapore Eye Research Institute & Nanyang Technological University (SERI-NTU Advanced Ocular Engineering [STANCE] Program); the Duke-NUS Medical School (grant no. Duke-NUS-KP(Coll)/2018/0009A); and the SERI-Lee Foundation, Singapore, Republic of Singapore (grant no.: LF1019-1). 2023-01-09T07:29:18Z 2023-01-09T07:29:18Z 2022 Journal Article Chua, J., Schwarzhans, F., Wong, D., Li, C., Husain, R., Crowston, J. G., Perera, S. A., Sng, C. C. A., Nongpiur, M. E., Majithia, S., Tham, Y. C., Thakur, S., Soh, Z. D., Cheng, C., Aung, T., Fischer, G., Vass, C. & Schmetterer, L. (2022). Multivariate normative comparison, a novel method for improved use of retinal nerve fiber layer thickness to detect early glaucoma. Ophthalmology Glaucoma, 5(3), 359-368. https://dx.doi.org/10.1016/j.ogla.2021.10.013 2589-4234 https://hdl.handle.net/10356/164205 10.1016/j.ogla.2021.10.013 34718222 2-s2.0-85120863525 3 5 359 368 en CG/C010A/2017 OFIRG/0048/2017 OFLCG/004c/2018 TA/MOH-000249-00/2018 MOH-OFIRG20nov-0014 NRF-CRP24-2020-0001 NRF2019-THE002-0006 A20H4b0141 Duke-NUS-KP(Coll)/2018/0009A LF1019-1 Ophthalmology Glaucoma © 2021 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Published by Elsevier Inc. application/pdf