title: Comparing spectral-domain optical coherence tomography and standard automated perimetry to diagnose glaucomatous optic neuropathy.
abstract: OBJECTIVE
  To compare the abilities of standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SDOCT) in diagnosing eyes with glaucomatous optic neuropathy (GON).
  
  
  METHODS
  In a cross-sectional study, 280 eyes of 175 subjects referred to tertiary eye care center by general ophthalmologists for a glaucoma evaluation underwent retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) imaging with SDOCT. All subjects had at least 2 reliable and repeatable SAP. Two glaucoma experts masked to clinical and SAP results classified the optic nerves into GON and nonglaucomatous groups based on digital optic disc photographs. Ability of SDOCT parameters and SAP to discriminate GON eyes from nonglaucomatous eyes was evaluated using sensitivity, specificity, and likelihood ratios (LR).
  
  
  RESULTS
  Experts classified 179 eyes into GON and 101 eyes into nonglaucomatous group. Sensitivity of SAP (69.8%) was significantly lower (P<0.05) than that of inferior quadrant RNFL thickness (83.8%), average RNFL thickness (77.2%), GCC focal loss volume (FLV, 81.5%), and global loss volume (GLV, 82.6%). Specificity and positive LR of SAP (95% and14.1, respectively) were significantly greater than those of all RNFL parameters, FLV (84.2% and 5.1) and GLV (82.2% and 4.6). Negative LR of SAP (0.32) was significantly inferior to that of inferior quadrant RNFL thickness (0.22), FLV (0.22), and GLV (0.21).
  
  
  CONCLUSIONS
  Most of the RNFL and GCC parameters of SDOCT had better sensitivities and negative LRs to diagnose GON compared with SAP. The specificities and positive LRs of most SDOCT parameters were inferior to that of SAP.
authors.affiliation: *VST Glaucoma Center †Center for Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.
authors.forename: Harsha L
authors.initials: HL
authors.lastname: Rao
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Yadav
authors.forename: Uday K
authors.initials: UK
authors.lastname: Addepalli
authors.forename: Viquar U
authors.initials: VU
authors.lastname: Begum
authors.forename: Sirisha
authors.initials: S
authors.lastname: Senthil
authors.forename: Nikhil S
authors.initials: NS
authors.lastname: Choudhari
authors.forename: Chandra S
authors.initials: CS
authors.lastname: Garudadri
mesh_terms: D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields / Q000502:physiology