University of Oulu

Karvonen E, Stoor K, Luodonpää M, et al. Combined structure–function analysis in glaucoma screening. British Journal of Ophthalmology 2022;106:1689-1695.

Combined structure–function analysis in glaucoma screening

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Author: Karvonen, Elina1,2,3; Stoor, Katri1,2; Luodonpää, Marja1,2;
Organizations: 1Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
2PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
3Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
4Tays Eye Centre, Tampere University Hospital, Tampere, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
Persistent link:
Language: English
Published: BMJ, 2022
Publish Date: 2023-03-15


Aim: To assess the applicability of a structure–function (S-F) analysis combining spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in glaucoma screening in a middle-aged population.

Methods: A randomised sample of 3001 Caucasian participants aged 45–49 years of the Northern Finland Birth Cohort Eye Study was examined. We performed an eye examination, including 24–2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive ‘2 out of 3’ rule based on the clinician’s evaluation of ONH and RNFL photographs and visual fields (VFs).

Results: At a specificity of 97.5%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones.

Conclusions: SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.

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Series: British journal of ophthalmology
ISSN: 0007-1161
ISSN-E: 1468-2079
ISSN-L: 0007-1161
Volume: 106
Issue: 12
Pages: 1689 - 1695
DOI: 10.1136/bjophthalmol-2021-319178
Type of Publication: A1 Journal article – refereed
Field of Science: 3125 Otorhinolaryngology, ophthalmology
Funding: The Oulu University Hospital grant number 24301140, Oulu, Finland; The University of Oulu grant number 24000692, Oulu, Finland; ERDF European Regional Development Fund grant number 539/2010 A31592, Brussels, Belgium; Competitive State Research Funding of Tampere University Hospital, Tampere, Finland (no grant number available); Glaukooma Tukisäätiö (Glaucoma Support) Lux Foundation, Helsinki, Finland (no grant number available); Sokeain Ystävät (Friends of Blind Persons) Foundation, Helsinki, Finland (no grant number available); Silmäsäätiö (Eye) Foundation, Helsinki, Finland (no grant number available); Association of the Finnish Ophthalmologists, Helsinki, Finland (no grant number available); The sponsor or funding organisation had no role in the design or conduct of this research. No conflicting relationship exists for any author.
Dataset Reference: All data relevant to the study are included in the article or uploaded as supplementary information.
Copyright information: © Authors (or their employer(s)) 2022. This article has been accepted for publication in British Journal of Ophthalmology 2022 following peer review, and the Version of Record can be accessed online at