Diagnostic Ability of Individual Macular Layers by Spectral-Domain OCT in Different Stages of Glaucoma.
Jacqueline Chua, Bingyao Tan, Mengyuan Ke, Florian Schwarzhans, Clemens Vass, Damon Wong, Monisha E Nongpiur, Chua Mae Chui Wei, Xinwen Yao, Ching-Yu Cheng, Tin Aung, Leopold Schmetterer
Summary
Single-layer mGCL thickness is comparable to the traditional cpRNFL thickness for the diagnosis of early/moderate glaucoma, whereas cpRNFL thickness remains the most efficient for advanced glaucoma.
Abstract
PURPOSE
To compare the diagnostic ability of macular intraretinal layer thickness with circumpapillary retinal nerve fiber layer (cpRNFL) thickness, either when used individually or in combination with cpRNFL for detecting early, moderate, and advanced glaucoma.
DESIGN
Cross-sectional study.
PARTICIPANTS
A total of 423 glaucoma participants and 423 age- and gender-matched normal participants.
METHODS
Participants underwent Cirrus spectral-domain OCT (SD-OCT) imaging (Carl Zeiss Meditec, Dublin, CA) using the optic disc and macular scanning protocols. Iowa Reference Algorithms (version 3.8.0) were used for intraretinal layer segmentation, and mean thickness of intraretinal layers was rescaled with magnification correction using axial length value. Thickness measurements of each layer/sector and their corresponding areas under the receiver operating characteristic curve (AUCs) were obtained. Glaucoma eyes were subdivided based on of their visual field severity (early, n = 234; moderate, n = 107; advanced, n = 82).
MAIN OUTCOME MEASURES
Intraretinal layers.
RESULTS
Some 67% of participants were male, their average ± standard deviation age was 65±9 years. Circumpapillary retinal nerve fiber layer, macular ganglion cell layer (mGCL), and macular inner plexiform layer (mIPL) were significantly thinner in the glaucoma groups (P 0.05). Combining macular and cpRNFL parameters improved the diagnostic performance for early glaucoma (AUC = 0.908; P = 0.002) and moderate glaucoma (AUC = 0.944; P = 0.031) but not for advanced glaucoma (AUC = 0.991; P > 0.05).
CONCLUSIONS
Single-layer mGCL thickness is comparable to the traditional cpRNFL thickness for the diagnosis of early/moderate glaucoma, whereas cpRNFL thickness remains the most efficient for advanced glaucoma. Combining macular measurements (GCL and GCL-IPL) and cpRNFL improved the discrimination of early/moderate glaucoma but not of advanced glaucoma. For the diagnosis of early glaucoma, both macular and optic disc scans should be used.
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Discussion
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