title: Optic disk and nerve fiber layer imaging to detect glaucoma.
abstract: OBJECTIVE
  To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes.
  
  
  METHODS
  Retrospective, cross-sectional study.
  
  
  METHODS
  In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters.
  
  
  RESULTS
  The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs (+/- standard error) were: average RNFL thickness for StratusOCT (0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area with CART produced a sensitivity of 91% and specificity of 96%.
  
  
  CONCLUSIONS
  StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.
authors.affiliation: Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Badalà
authors.forename: Kouros
authors.initials: K
authors.lastname: Nouri-Mahdavi
authors.forename: Duna A
authors.initials: DA
authors.lastname: Raoof
authors.forename: Narakorn
authors.initials: N
authors.lastname: Leeprechanon
authors.forename: Simon K
authors.initials: SK
authors.lastname: Law
authors.forename: Joseph
authors.initials: J
authors.lastname: Caprioli
mesh_terms: D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009887:Ophthalmoscopy / Q000379:methods; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography / Q000379:methods; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods; D014794:Visual Fields