Purpose
To compare the diagnostic accuracy and reproducibility of the Laguna ONhE program (with automatic segmentation of the optic nerve head cupping and neuro-retinal rim using new algorithms), with morphological (OCT) and functional (visual field) information.
Methods
96 healthy subjects and 82 glaucomas were examined twice with photographic images obtained with a fundus camera Horus Scope DEC-200 (MiiS) and analyzed with the modified Laguna ONhE (Insoft) software, twice with Cirrus OCT (Zeiss), once with Spectralis OCT (Heidelberg) and once with Octopus 300 TOP-32 (Haag-Streit). Statistics used: Receiver operator characteristic (ROC) curve analysis, Pearson correlations, intra-class correlation coefficients (ICC) and respective confidence intervals (CI), and kappa concordance index.
Results
Laguna ONhE glaucoma discriminant function (GDF) was among the indices of greatest area under the ROC curve (AUROC) (Confidence interval CI=0.87-0.95 in the first examination and 0.86-0.94 in the second), similar to that obtained with Bruch’s membrane opening-minimum rim width (BMO-MRW) of Spectralis (CI=0.91-0.97). Diagnostic concordance between the two was good (kappa =0.639) and similar to that observed, for example, between the set of Spectralis and Cirrus indices (kappa=0.592). Based on hemoglobin information, Laguna ONhE estimation of rim and cup shape and size showed AUROC equivalent to those of Cirrus (Cirrus vertical C/D ratio CI=0.86-0.94, Estimated Laguna ONhE vertical C/D ratio CI=0.83-0.92). For a specificity of 95%, the cut of diagnostic value of the (estimated) Laguna ONhE vertical C/D ratio was 0.59-0.62 and for the (average) Cirrus 0.68-0.75. The reproducibility of Laguna ONhE indices measured with ICC was: GDF (CI=0.88-0.93) and estimated Hb C/D vertical ratio (CI=0.90-0.94). This proved similar to the C/D vertical ratio Cirrus reproducibility (CI=0.95-0.97). Cirrus RNFT reproducibility was slightly better (CI=0.98-0.99). Perimetric indices showed slightly lower diagnostic capacity, but this was not statistically significant with most of others: Mean defect AUROC (CI=0.82-0.91) and square root of loss variance AUROC (CI=0.79-0.89).
Conclusions
Laguna ONhE showed high diagnostic capacity and reproducibility, equivalent to other methods such as OCT. This procedure provides information different from functional or morphological data, related with optic nerve head perfusion. Morphological estimation using Laguna ONhE showed a similar range of diagnostic capacity in the sample analyzed to that measured by OCT.