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Glaucoma Dia nosis

Taiwan Academy of OphthalmologyTaipei, Taiwan, April 1-2, 2012

with OCT

David Huang, MD, PhD

Weeks Professor of Ophthalmic Research

Professor of Ophthalmology & Biomedical Engineering

Casey Eye Institute, Oregon Health & Science University

Portland, Oregon

Financial Interests:Dr. D. Huang has a significiant financial interest in Optovue, a company that may have a commercial interest in the results ofthis research and technology. This potential individual conflict of interest has been reviewed and managed by OHSU.Optovue, Inc.: stock options, patent royalty, grants, speaker honorarium & travel supportCarl Zeiss Meditec, Inc.: patent royalty

Time-domain (TD) OCT issusceptible to eye movements

768pixels(Ascans)captured

in1.92secondsis

slowerthaneye

movements

Koozekanani,BoyerandRoberts.TrackingtheOpticNervehead inOCTVideoUsingDualEigenspaces and

anAdaptiveVascularDistribution Model;IEEETransactionsonMedicalImaging,Vol.22,No.12,2003

Stratus OCT scan paths with (black)

and without (white) tracking

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Scan location and eye movementsaffect results

Properly centered Poorly centered: too inferior Poorly centered: too superior

T S N I T T S N I T T S N I T

Normal Double Hump Inferior RNFL Loss Superior RNFL Loss

SD-OCT is much faster than TD-OCT2006

26,000S ectral-domain

Zeiss400

Speed(A-scans

/sec)

Time-domain

SD-OCT has >50x speed & 2x resolution of TD-OCT

OCT1/21996

Zeiss Stratus

2002100

16 10 5Resolution (m)

David Huang, MD, PhD www.COOLLab.net

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-diagnosis and tracking ofGlaucoma over TD-OCT?

SD-OCT and TD-OCT NFL profiles havesimilar glaucoma diagnostic accuracy

Cirrus SD-OCT equivalent to Stratus TD-OCT Leun CK et al. O hthalmolo 2009 116:1257 .

Park SB et al. Arch Ophthalmol2009; 127:1603

Chang RT et al. Ophthalmology2009; 115:2294

Moreno-Montanes J et al. IOVS2010; 51:335

Jeoung JW, Park KH. IOVS2010; 51: 938.

RTVue SD-OCT equivalent to Stratus TD-OCT Sehi M et al. Am J Ophthalmol2009; 148:597

OTI SD-OCT equivalent to Stratus TD-OCT Cho et al. J Glaucoma2011;20:15

Spectralis SD-OCT better than HRT cSLO Leung CK et al. Ophthalmology2010; 117:267

Sung, et al, Br J Ophthalmol, 2011, 95:909-914

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SDOCTNFLmappingmaybebetterat

detectingfocalRNFLbundledefect

Jeoung,etal,

IOVS 2010;

51:938

SD-OCT NFL reproducibility is better

than TD-OCT: glaucoma tracking may bebetter with SD-OCT

Cirrus SD-OCT better than Stratus TD-OCT Leung CK et al. Ophthalmology2009;116:1257

Schuman JS. Trans Am Ophthalmol Soc 2008; 106:426

RTVue SD-OCT better than Stratus TD-OCT Schuman JS. Trans Am Ophthalmol Soc 2008; 106:426

Intersession Coefficient of Variation

. or - 3.6% for TD-OCT Leung CK et al. Ophthalmology2009;116:1257

Sung, et al, Br J Ophthalmol, 2011, 95:909-914

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Can FD-OCT mapping of the macular ganglioncell complex improve diagnostic accuracy?

NormalGCC

Glaucoma with thinner GCC GCC

NFLGCL

IPL}GCC

Ishikawa H et al. IOVS2005; 46:2012.Tan O et al. Ophthalmology, 2008;115:949.

Tan O et al. Ophthalmology2009; 116:2305.David Huang, MD, PhD www.AIGStudy.net

Macular GCC and peripapillary NFL are equaland complementary in diagnostic power

Venn Diagram of % Eyes Below 5 percentile

AROC

GCC-AVG (m) 0.90

GCC-FLV (%) 0.92

GCC-GLV (%) 0.92

Tan O, et al., Ophthalmology2009; 116:2305-2314. www.AIGStudy.net

NFL-AVG (m) 0.92 GCC improves diagnostic sensitivity by9% in PG group and 11% in PPG group

GCC & NFL have similardiagnostic accuracy

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GCC and NFL thicknesses havesimilar diagnostic accuracy

GCC and NFL AROC are equivalent eong , e a , ; : .

Kim NR, et al, IOVS 2010; 51:46414651.

Cho JW, et al, IOVS 2010; 51:64016407.

Mori S, et al IOVS 2010; 19:528534.

Rao, et al, Opthalomology 2010;117:1692-1699e1

Garas, et al, Eye (Lond) 2011;25:57-65

Kim, et al, BJO 2011; 95:1115-1121

GCC may have higher diagnostic accuracy inhigh myopes Kita, et al, Jpn J Galucoma 2011;55:228-234

Shoji, et al, IOVS 2011; 52:1098-1102

Combining GCC, NFL, and disc data

improves sensitivity

RTVue SD-OCT

Huang JY, J Glaucoma2011;20:87

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Combining measurements from all 3 anatomicregions with machine learning classifiersboosted diagnostic accuracy

Diagnostic AROC Sensitivity

RTVue SD-OCT

Parameter (at 5 percentile cutoff)

Support VectorMachine (SVM)

0.963

P < 0.02

86%

P < 0.01

Best NFL 0.924 67%

Best GCC 0.920 68%

Best Disc 0.886 56%

85 normal eyes, 72 perimetric glaucoma eyesDavid Huang, MD, PhD www.AIGStudy.net

SD-OCT provides more repeatable

measurements that may be useful forglaucoma tracking

NFL GCC

TD-OCT (Stratus) -9.9%

SD-OCT (RTVue) -5.6% -5.1%

95 Percentile Cutoff for Intervisit Change inOverall Average Thickness in Normal Subjects

David Huang, MD, PhD www.AIGStudy.net

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Subject 108 Perimetric Glaucoma OS

Hemorrha e Rim thinning

Baseline 1 year 2 year 3 year


Humphrey VF Glaucoma Progression Analysis


No Change

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TD-OCT (Stratus) Serial Analysis


No Change

SD-OCT (RTVue) NFL GlaucomaProgression Report

4.7% lossNon-Significant Progression


Time Baseline 1 year 2 year 3 year

NFL avg 91.6 90.3 91.8 87.3

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SD-OCT (RTVue) GCC GlaucomaProgression Report

11.4% lossSignificant Progression


Time Baseline 1 year 2 year 3 year

GCC avg 83.1 79.5 82.2 73.6

Summary SD-OCT & TD-OCT NFL thickness profiles

have similar diagnostic accuracy

SD-OCT NFL thickness maps may provideearlier detection of focal loss

SD-OCT NFL thickness measurement ismore reproducible and may be better at

SD-OCT GCC thickness analysis maycomplement NFL thickness for both diagnosisand tracking


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R01 EY013516 www.AIGStudy.net

Consortium PI:David Huang

MD, PhD

SitePI: David

Yimin Wang,

PhD

Ou Tan,

PhD

Xinbo Zhang,

PhD

Carolyn Quinn, Krisha S. Kishor,Mitra Sehi, Robert DiLaura Sharon Bi, MCIS

Site PI: Rohit

Varma, MD, MPH

Vikas Chopra,

MDBrian Francis,

MD

Site PI: James G.

Fujimoto, PhD

Site PI: Joel S.

Schuman, MD

Greenfield, MDMD MDPhD

RobertNoecker, MD

Gadi Wollstein,

MD

Hiroshi Ishikawa,MD

Larry Kagemann,MS

Narrow An le Detection

Taiwan Academy of Ophthalmology

Taipei, Taiwan, April 1-2, 2012

with Fourier-Domain OCT

David Huang, MD, PhD

Weeks Professor of Ophthalmic Research

Professor of Ophthalmology & Biomedical Engineering

Casey Eye Institute, Oregon Health & Science UniversityPortland, Oregon

Financial Interests:Dr. D. Huang has a significiant financial interest in Optovue, a company that may have a commercial interest in the results ofthis research and technology. This potential individual conflict of interest has been reviewed and managed by OHSU.Optovue, Inc.: stock options, patent royalty, grants, speaker honorarium & travel supportCarl Zeiss Meditec, Inc.: patent royalty

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Coauthors

Yan Li, PhD MaolongTang, PhD

XinboZhang, PhD

BrianFrancis, MD

Bing Qin, MDChunhiuiJiang MD

Long v. Short Wavelength Infrared

Shorter wavelength and widerbandwidth give finer resolution

Longer wavelength gives deeperpenetration for angle and scleralimaging

Technology Visante RTVue

Axial resolution(FWHM cornea)

17 m 5 m

Wavelength 1310 nm 830 nm


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Better penetration at 1310 nmGreater resolution at 830 nm

Angle recess

1310 nm

830 nm


Schwalbes line

Measuring of angle opening distance isbetter at Schwalbes line for 830nm OCT

limbus

Schwalbesline

AOD-SL

Scleralspur

AOD-SL = angle opening distance at Schwalbes line


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Clinical study

Subjects 24 primary angle open glaucoma (PAOG); .

Gonioscopy Dark room gonioscopy; Modified Shaffer grade on all quadrants; Performed by a glaucoma specialist.

Fourier-domain OCT RTVue (Optovue Inc., Fremont, CA, USA) with CAM; Line scans on temporal and nasal quadrants; Low photopic condition (6.6 fcd); Graded by two ophthalmologists.


Visibility of angle landmarks in830nm OCT

% VisibleSchwalbe's

line

An erior

limbus (P)

Angle

recess (P)

Scleral

spur(P)

Observer 1 Nasal 100.0 98.5 (0.50) 87.7 (

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AOD-SL and SL-SS measurements

AOD-SL= angle openingdistance at Schwalbes line

- =AOD-SL

Occludable angle Open angle

P-value

m (range) m (range)

Schwalbes line (SL) and the

sclera spur (SS)


AOD-SL194100 446196

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www.COOLLab.net

David Huang,MD, PhD

Maolong Tang,PhD

Ou Tan,PhD

Yimin Wang,PhD

Yan Li,PhD

Xinbo Zhang,PhD

Jason Tokayer,MS

Janice VanNorman, COT

Matthew Bald

MichelleMontalto

Yali Jia,PhD

Kathleen S.Torok, MA

taiwan oct 2012

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