PURPOSE To develop a new scoring system that uses topographic diagnostic signs of spectral-domain (SD) OCT to enhance glaucoma diagnostic performance for myopic eyes and to validate the system's diagnostic ability. DESIGN Cross-sectional study. PARTICIPANTS A total of 517 patients (517 eyes; spherical equivalent [SE] <-1.0 diopters [D] or axial length >24.0 mm), including 175 highly myopic eyes (SE <-6.0 D or axial length >26.0 mm), were recruited and divided into 2, training (241 eyes) and validation (276 eyes) test sets. METHODS Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) topographic signs were selected based on the morphologic patterns of RNFL (size, shape, location, and agreement between deviation and thickness maps) and GCIPL (size, shape, location, color tone, agreement between maps, and step sign) abnormalities indicative of higher likelihood of myopic glaucoma on deviation and thickness maps. The diagnostic score was compiled according to the sensitivity, specificity, and positive likelihood ratio (PLR) of each diagnostic sign using the training set. The area under the receiver operating characteristic curve (AUC) was plotted and compared between the OCT-provided parameters and the scoring system in the validation set. MAIN OUTCOME MEASURES The diagnostic performance of a new scoring system as validated by AUC. RESULTS Among all of the RNFL and GCIPL parameters, the presence of temporal hemifield asymmetry on the GCIPL thickness map (PLR, 5.98) showed the highest diagnostic ability, followed by location of the RNFL defect (PLR, 5.79) and color tone of the GCIPL defect (PLR, 5.04). The AUC of the topographic scoring system in myopic eyes was 0.979, which was significantly higher than those of the inferior (0.895; P < 0.001) and average (0.894; P < 0.001) RNFL thickness parameters. For highly myopic eyes, the scoring system (AUC, 0.983) also showed a higher diagnostic performance than that of the RNFL and GCIPL thickness parameters (all P < 0.001). CONCLUSIONS Our scoring system including OCT topographic parameters demonstrated to be beneficial for clinicians to differentiate real glaucomatous damage from myopic healthy eyes. Our results support the value of using multitopographic OCT parameters for detecting glaucoma in myopic eyes.

中文翻译：

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识别近视眼青光眼的地形评分系统的开发：光谱域OCT研究。

目的开发一种新的评分系统，该系统使用光谱域（SD）OCT的地形学诊断标志来增强近视眼的青光眼诊断性能，并验证系统的诊断能力。设计横断面研究。参与者共有517例患者（517眼；球形当量[SE] <-1.0屈光度[D]或轴长> 24.0 mm），包括175例高度近视眼（SE <-6.0 D或轴长> 26.0 mm）。募集并分为2组，训练（241眼）和验证（276眼）测试集。方法根据RNFL的形态特征（大小，形状，位置以及偏差与厚度图之间的一致性）和GCIPL（大小，形状），选择视网膜神经纤维层（RNFL）和神经节细胞内丛状层（GCIPL）的地形标志。 ，位置，色调，地图之间的一致性，和阶跃征兆）表明在偏差图和厚度图上近视性青光眼的可能性更高。使用训练集根据每个诊断体征的敏感性，特异性和阳性似然比（PLR）编制诊断分数。绘制接收器工作特性曲线（AUC）下的面积，并在OCT提供的参数和验证集中的评分系统之间进行比较。主要观察指标经AUC验证的新评分系统的诊断性能。结果在所有RNFL和GCIPL参数中，GCIPL厚度图上存在时间半场不对称（PLR，5.98）显示出最高的诊断能力，其次是RNFL缺陷的位置（PLR，5.79）和GCIPL的色调缺陷（PLR，5.04）。近视眼的地形评分系统的AUC为0.979，显着高于下（0.895; P <0.001）和平均（0.894; P <0.001）RNFL厚度参数。对于高度近视的眼睛，评分系统（AUC，0.983）也显示出比RNFL和GCIPL厚度参数更高的诊断性能（所有P <0.001）。结论我们的评分系统包括OCT地形参数，被证明对临床医生区分近视健康眼的真正青光眼损害是有益的。我们的结果支持使用多地形OCT参数检测近视眼中的青光眼的价值。对于高度近视的眼睛，评分系统（AUC，0.983）也显示出比RNFL和GCIPL厚度参数更高的诊断性能（所有P <0.001）。结论我们的评分系统包括OCT地形参数，被证明对临床医生区分近视健康眼的真正青光眼损害是有益的。我们的结果支持使用多地形OCT参数检测近视眼中的青光眼的价值。对于高度近视的眼睛，评分系统（AUC，0.983）也显示出比RNFL和GCIPL厚度参数更高的诊断性能（所有P <0.001）。结论我们的评分系统包括OCT地形参数，被证明对临床医生区分近视健康眼的真正青光眼损害是有益的。我们的结果支持使用多地形OCT参数检测近视眼中的青光眼的价值。