title: Population-based evaluation of retinal nerve fiber layer, retinal ganglion cell layer, and inner plexiform layer as a diagnostic tool for glaucoma.
abstract: OBJECTIVE
  We determined the glaucoma screening performance of regional optical coherence tomography (OCT) layer thickness measurements in the peripapillary and macular region, in a population-based setting.
  
  
  METHODS
  Subjects (n = 1224) in the Rotterdam Study underwent visual field testing (Humphrey Field Analyzer) and OCT of the macula and optic nerve head (Topcon 3-D OCT-1000). We determined the mean thicknesses of the retinal nerve fiber layer (RNFL), retinal ganglion cell layer (RGCL), and inner plexiform layer for regions-of-interest; thus, defining a series of OCT parameters, using the Iowa Reference Algorithms. Reference standard was the presence of glaucomatous visual field loss (GVFL); controls were subjects without GVFL, an intraocular pressure (IOP) of 21 mm Hg or less, and no positive family history for glaucoma. We calculated the area under the receiver operating characteristics curve (AUCs) and the sensitivity at 97.5% specificity for each parameter.
  
  
  RESULTS
  After excluding 23 subjects with an IOP > 21 mm Hg and 73 subjects with a positive family history for glaucoma, there were 1087 controls and 41 glaucoma cases. Mean RGCL thickness in the inferior half of the macular region showed the highest AUC (0.85; 95% confidence interval [CI] 0.77-0.92) and sensitivity (53.7%; 95% CI, 38.7-68.0%). The mean thickness of the peripapillary RNFL had an AUC of 0.77 (95% CI, 0.69-0.85) and a sensitivity of 24.4% (95% CI, 13.7-39.5%).
  
  
  CONCLUSIONS
  Macular RGCL loss is at least as common as peripapillary RNFL abnormalities in population-based glaucoma cases. Screening for glaucoma using OCT-derived regional thickness identifies approximately half of those cases of glaucoma as diagnosed by perimetry.
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Henriët
authors.initials: H
authors.lastname: Springelkamp
authors.affiliation: Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States.
authors.forename: Kyungmoo
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Roger C W
authors.initials: RC
authors.lastname: Wolfs
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Gabriëlle H S
authors.initials: GH
authors.lastname: Buitendijk
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Wishal D
authors.initials: WD
authors.lastname: Ramdas
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Netherlands Consortium for Healthy Ageing, Netherlands Genomics Initiative, The Hague, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Vingerling
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Caroline C W
authors.initials: CC
authors.lastname: Klaver
authors.affiliation: Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Abràmoff
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Nomdo M
authors.initials: NM
authors.lastname: Jansonius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016022:Case-Control Studies; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007429:Intraocular Pressure; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology; D012015:Reference Standards; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods / Q000592:standards; D058609:Visual Field Tests
keywords: Iowa Reference Algorithms; OCT; population-based evaluation; retinal thickness measurement