青光眼光学相干断层扫描血管造影术黄斑血管密度诊断准确性的种族差异。

IF 2.8 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2024-03-01 DOI:10.1016/j.ogla.2023.09.003

Gopikasree Gunasegaran MD, Sasan Moghimi MD, Takashi Nishida MD, PhD, Evan Walker MS, Alireza Kamalipour MD, MPH, Jo-Hsuan Wu MD, Golnoush Mahmoudinezhad MD, MPH, Linda M. Zangwill PhD, Robert N. Weinreb MD

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引用次数: 0

摘要

目的：评估和比较光学相干断层扫描血管造影术（OCTA）测量的黄斑血管密度（VD）对非洲裔（AD）和欧洲裔（ED）开角型青光眼患者的诊断准确性。设计：观察、横断面研究。参与者：来自青光眼诊断创新研究的123名青光眼患者共176眼，88名健康参与者共140眼。方法：通过6*6次黄斑扫描获得全图像神经节细胞复合体（wiGCC）厚度和黄斑VD（中央凹旁VD和中央凹周围VD）。在校正了年龄、视野平均偏差（VF-MD）、信号强度指数（SSI）、轴长（AL）、自我报告的高血压和糖尿病等混杂因素后，使用受试者操作特征下面积（AUROC）曲线来评估AD和ED参与者黄斑VD和GCC厚度的诊断准确性。主要结果测量：黄斑VD和wiGCC测量。结果：ED患者的中心凹旁和中心凹周围VD明显低于AD青光眼患者。与ED参与者相比，AD参与者的中心凹旁和中心凹周围VD在青光眼检测方面的表现明显较差（调整后的AUROC分别为0.75[95%CI，0.62，0.87]，0.85[95%CI，0.79，0.90]，P=0.035；和0.82[95%CI分别为0.70，0.92]，0.91[95%CI、0.87，0.94]；P=0.020）。与VD相比，在AD和ED患者中，GCC厚度的诊断准确性相似（调整后的AUROC分别为0.89[95%CI，0.79，0.96]，0.92[95%CI，0.86，0.96]；P=0.313）。黄斑VD和GCC厚度在区分青光眼和健康眼睛方面的诊断准确性随着AD和ED参与者VF-MD的增加而增加。结论：OCTA黄斑VD（而非GCC厚度）对青光眼检测的诊断性能因种族而异。此外，黄斑VD参数在AD患者中检测青光眼的准确性低于ED患者。黄斑VD的诊断性能取决于种族，因此，在解释黄斑OCTA结果时应考虑种族。

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Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma

Purpose

To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma.

Design

Observational, cross sectional study.

Participants

A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study.

Methods

Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes.

Main Outcome Measures

Macular VD and wiGCC measurements.

Results

Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants.

Conclusions

Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results.