title: Diagnostic performance of optical coherence tomography ganglion cell--inner plexiform layer thickness measurements in early glaucoma.
abstract: OBJECTIVE
  To evaluate the glaucoma diagnostic performance of ganglion cell inner-plexiform layer (GCIPL) parameters used individually and in combination with retinal nerve fiber layer (RNFL) or optic nerve head (ONH) parameters measured with Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, CA).
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Fifty patients with early perimetric glaucoma and 49 age-matched healthy subjects.
  
  
  METHODS
  Three peripapillary RNFL and 3 macular GCIPL scans were obtained in 1 eye of each participant. A patient was considered glaucomatous if at least 2 of the 3 RNFL or GCIPL scans had the average or at least 1 sector measurement flagged at 1% to 5% or less than 1%. The diagnostic performance was determined for each GCIPL, RNFL, and ONH parameter as well as for binary or-logic and and-logic combinations of GCIPL with RNFL or ONH parameters.
  
  
  METHODS
  Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR).
  
  
  RESULTS
  Among GCIPL parameters, the minimum had the best diagnostic performance (sensitivity, 82.0%; specificity, 87.8%; PLR, 6.69; and NLR, 0.21). Inferior quadrant was the best RNFL parameter (sensitivity, 74%; specificity, 95.9%; PLR, 18.13; and NLR, 0.27), as was rim area (sensitivity, 68%; specificity, 98%; PLR, 33.3; and NLR, 0.33) among ONH parameters. The or-logic combination of minimum GCIPL and average RNFL provided the overall best diagnostic performance (sensitivity, 94%; specificity, 85.7%; PRL, 6.58; and NLR, 0.07) as compared with the best RNFL, best ONH, and best and-logic combination (minimum GCIPL and inferior quadrant RNFL; sensitivity, 64%; specificity, 100%; PLR, infinity; and NPR, 0.36).
  
  
  CONCLUSIONS
  The binary or-logic combination of minimum GCIPL and average RNFL or rim area provides better diagnostic performances than those of and-logic combinations or best single GCIPL, RNFL, or ONH parameters. This finding may be clinically valuable for the diagnosis of early glaucoma.
authors.affiliation: Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Mwanza
authors.affiliation: Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: donald_budenz@med.unc.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Budenz
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas.
authors.forename: David G
authors.initials: DG
authors.lastname: Godfrey
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas.
authors.forename: Arvind
authors.initials: A
authors.lastname: Neelakantan
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Fouad E
authors.initials: FE
authors.lastname: Sayyad
authors.affiliation: Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Chang
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001369:Axons / Q000473:pathology*; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology