title: Additive diagnostic role of imaging in glaucoma: optical coherence tomography and retinal nerve fiber layer photography.
abstract: OBJECTIVE
  To investigate the additive diagnostic role of spectral-domain optical coherence tomography (SD-OCT) and red-free retinal nerve fiber layer photography (RNFLP) in making clinical glaucoma diagnosis.
  
  
  METHODS
  Four diagnostic combination sets, including the most recent image from each measurement of 196 glaucoma eyes (including the 44 preperimetric glaucoma eyes) and 101 healthy eyes, were prepared: (1) stereo disc photography and Humphrey visual field (SH), (2) SH and SD-OCT (SHO), (3) SH and RNFLP (SHR), and (4) SHR and SD-OCT (SHRO). Each randomly sorted set was serially presented at 1-month intervals to five glaucoma specialists who were asked to evaluate them in a subjective and independent manner. The specialists' glaucoma-diagnostic performances based on the sets were then compared.
  
  
  RESULTS
  For each specialist, adding SD-OCT to SH or SHR increased the glaucoma-diagnostic sensitivity but not to a level of statistical significance. For one specialist, adding RNFLP to SH significantly increased the sensitivity. Each specialist showed a high level of specificity regardless of the diagnostic set. The overall sensitivity of all specialists' assessments was significantly increased by adding RNFLP or the combination of SD-OCT and RNFLP to SH (P < 0.001); however, adding SD-OCT to SH or SHR did not significantly increase the sensitivity. A similar relationship was noted also for the preperimetric glaucoma subgroup.
  
  
  CONCLUSIONS
  In contrast to RNFLP, SD-OCT did not significantly enhance the diagnostic accuracy of detecting glaucoma or even of preperimetric glaucoma. Our results suggest that, at least for glaucoma specialists, the additive diagnostic role of OCT is limited.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ko Eun
authors.initials: KE
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Seok Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Sohee
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Jeoung
authors.affiliation: Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Min Hee
authors.initials: MH
authors.lastname: Suh
authors.affiliation: Department of Ophthalmology, Pusan National University Yangsan Hospital, Busan, Korea.
authors.forename: Je Hyun
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Martha
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Myung
authors.initials: DM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D010781:Photography / Q000379:methods*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields / Q000502:physiology
keywords: additive diagnostic role; glaucoma diagnosis; glaucoma specialist; retinal nerve fiber layer photography; spectral-domain optical coherence tomography