A UNC Ophthalmology faculty-mentored, resident-led study published in the December 2022 Journal of Glaucoma assessed how well glaucomatous changes detected to the optic disc, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) parameters agree among them in pre-perimetric and early perimetric glaucoma, based on optical coherence tomography (Cirrus HD-OCT) normative database classification.
In a retrospective, cross-sectional study over four years (Jan 2017 – Dec 2020), two UNC Ophthalmology residents and two clinical research faculty* reviewed medical charts of 66 patients diagnosed with pre-perimetric and 97 patients diagnosed with early perimetric glaucoma at the UNC Kittner Eye Center. Only Cirrus HD-OCT scans of one eye with less visual field deficit per participant were used for analysis. After comparing parameters from all three anatomic areas using different combination schemes, the authors found diagnostic agreements between optic disc, RNFL, and GCIPL to be “mostly fair” in both groups, suggesting that OCT diagnostic classifications of parameters from the three structures agree rarely.
The findings of this study are clinically relevant and add to existing literature on the use of OCT for glaucoma diagnosis in early stage. From the practical standpoint, the diagnosis of glaucoma in early stages can be considered when abnormal OCT classification is present in one of the three ocular structural atomic areas. The faculty-resident research team concludes that requiring OCT abnormalities to be present in all three anatomic areas can delay the diagnosis of early-stage glaucoma.
Lead study author and Class of 2022 residency graduate Basil Mathews, MD, noted: “Resident-led research is an exciting and important part of continued education in ophthalmology. It taught me a range of research skills, including designing and conducting experiments, how to collect and analyze data, and how to interpret results to clinical ophthalmology and diagnostics. From a resident perspective, it also enabled leadership skills such as communication, problem-solving, and team management that are necessary in seeing a project from inception to completion. The other beauty of peer-reviewed journal article publication is that you become an expert in your research topic of interest, which can ultimately foster future collaborative efforts and professional development.”
UNC Ophthalmology Research Associate Professor and faculty project lead Jean-Claude Mwanza, MD, MPH, PhD, specializes in Glaucoma Diagnostic and Epidemiology Research. He noted: “While it is ideal for all three structures to agree and show abnormalities concomitantly for the diagnosis of early glaucoma to be made with confidence, that is not always the case in the real world. This is something residents see frequently in clinic, but it was academically interesting and important for them to actually conduct a study and show it. I commend Dr. Mathews for taking the lead and drafting the paper and Dr. Le for managing data and all of the statistical analyses.”
* Mathews B, Le P, Budenz D, Mwanza, J-C. Agreement of Diagnostic Classification Between Structural Parameters in Pre-Perimetric and Early Perimetric Glaucoma. Journal of Glaucoma December 1, 2022. DOI: 10.1097/IJG.0000000000002157.
Click here to read this article in the December 2022 Journal of Glaucoma.