title: Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: pattern of RNFL defects in glaucoma.
abstract: OBJECTIVE
  To characterize the distribution pattern, angular width, and area of retinal nerve fiber layer (RNFL) defects in glaucoma using spectral-domain optical coherence tomography (OCT).
  
  
  METHODS
  Prospective, cross-sectional study.
  
  
  METHODS
  We included 113 normal subjects and 116 glaucoma patients.
  
  
  METHODS
  One eye from each individual was randomly selected for Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA) RNFL imaging of the 6 × 6-mm² parapapillary region. The RNFL defects were identified in the RNFL thickness deviation map as superpixels coded in red. The angular location and the angular width of RNFL defects were measured. The proportion of area with RNFL measurements within the normal ranges in the RNFL thickness deviation map was expressed as the RNFL area index (RAI): 1 - [area of superpixels coded in red/(6 × 6 - optic disc and parapapillary atrophic area)]. The diagnostic performance between RAI and average RNFL thickness was compared with the area under the receiver operating characteristic curve after adjusting refraction, signal strength, optic disc, and parapapillary atrophic areas.
  
  
  METHODS
  Frequency distribution profiles and distribution patterns of RNFL defects, diagnostic sensitivity and specificity of RAI, and average RNFL thickness.
  
  
  RESULTS
  The RNFL defects in glaucoma were most frequently found at the inferotemporal meridian at 284° (80.4%), followed by the superotemporal meridians at 73° (54.2%). The respective proportions of localized (angular width ≤ 30°) and diffuse (angular width > 30°) RNFL defects were 11.4% and 70.5% in mild glaucoma (MD ≥ 6 dB), and 4.2% and 94.5% in moderate to advanced glaucoma (MD < -6 dB). The RAI was 90.2 ± 6.4% and 83.6 ± 7.4% in the mild and moderate to advanced glaucoma groups, respectively. At a specificity of 90.0%, the respective diagnostic sensitivity of RAI and average RNFL thickness was 95.7% (95% confidence interval, 92.2-99.1%) and 94.0% (90.1-99.1%).
  
  
  CONCLUSIONS
  Analysis of the pattern of RNFL defects with spectral domain OCT imaging offers important insights in understanding the characteristics of RNFL damage. As RNFL defects expand in size as the disease progresses, measurement of the angular width and area of RNFL defects can provide an additional dimension for evaluation of glaucoma.
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Peoples Republic of China.
authors.forename: Christopher K S
authors.initials: CK
authors.lastname: Leung
authors.forename: Nathan
authors.initials: N
authors.lastname: Choi
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
authors.forename: Shu
authors.initials: S
authors.lastname: Liu
authors.forename: Cong
authors.initials: C
authors.lastname: Ye
authors.forename: Lan
authors.initials: L
authors.lastname: Liu
authors.forename: Gilda W
authors.initials: GW
authors.lastname: Lai
authors.forename: Johnson
authors.initials: J
authors.lastname: Lau
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D003430:Cross-Sectional Studies; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields