The Effects of Race, Optic Disc Area, Age, and Disease Severity on the Diagnostic Performance of Spectral-Domain Optical Coherence Tomography

PURPOSE. To evaluate the effect of race (African or European descent), age, disc area, and severity of disease on the diagnostic ability of spectral-domain optical coherence tomography (SDOCT) imaging of the optic nerve, macula, and retinal nerve fiber layer (RNFL) in the detection of glaucomatous injury. METHODS. In this cross-sectional observational study, data from SDOCT images of 312 eyes of 167 subjects without ocular disease and 233 eyes of 163 patients with open-angle glaucoma. A receiver operating characteristic (ROC) regression modeling technique was used to evaluate the influence of race on the diagnostic accuracy of the ONH, RNFL, and macular parameters in SDOCT in glaucoma, while adjusting and evaluating the possible confounding effects of age, disease severity, and size of the optic disc. RESULTS. The optimal performing measurements of the RNFL and macula were more effective than optic nerve (aROC(RNFL) = 0.87, aROC(inner macula) = 0.88, and aROC(rim area) = 0.81) for the overall group. No variation was noted in the diagnostic performance of SDOCT between racial groups nor was there any association of race with differences in disc area for structural parameters of the optic nerve, RNFL, and macula. Advanced disease severity was associated with increased diagnostic accuracy, with improved performance in eyes with more severe visual field loss. CONCLUSIONS. The diagnostic ability of ONH, RNFL, and macular measurements in the detection of glaucoma was similar across racial groups, and disc area had a minimal effect on the overall diagnostic efficacy of SDOCT. No significant differences were seen in the diagnostic performance of the SDOCT between these groups when generalized or race-specific normative data were used. (Invest Ophthalmol Vis Sci. 2011; 52: 6148-6153) DOI:10.1167/iovs.10-6698