title: Diagnosis of Early-Stage Glaucoma by Grid-Wise Macular Inner Retinal Layer Thickness Measurement and Effect of Compensation of Disc-Fovea Inclination.
abstract: OBJECTIVE
  To evaluate grid-wise analyses of macular inner retinal layer thicknesses and effect of compensation of disc-fovea inclination for diagnosing early-stage glaucoma.
  
  
  METHODS
  Spectral-domain optical coherence tomography measurements over a 6.0 × 6.0-mm macular area were prospectively obtained in 104 eyes of 104 patients with early-stage glaucoma with a mean deviation of -1.8 ± 1.9 dB and 104 eyes of 104 age- and refraction-matched normal subjects. Macular retinal nerve fiber layer (mRNFL), ganglion cell-inner plexiform layer (GCIPL) combined, and ganglion cell complex (GCC) thickness of the entire area and each subdivided macular grid were determined to compare diagnostic capability for glaucoma using receiver operating characteristic curves and various normal cutoff values for each layer thickness and number of grids flagged as abnormal. Diagnostic capability was then compared with that of circumpapillary RNFL (cpRNFL) measurements. Effects of compensation of inclination of disc-fovea line by reconfiguration of the macular grid were also studied.
  
  
  RESULTS
  Macular inner retinal layer analyses using 8 × 8 grids generally yielded higher diagnostic capability. Only the 8 × 8 grid GCC analyses using the various normal cutoff values yielded a sensitivity ≥ 0.90 with specificity ≥ 0.95 under several conditions in discriminating the glaucoma eyes. In glaucoma and normal eyes with both reliable cpRNFL and macular measurements, the best sensitivity/specificity were 0.98/0.95 for the 8 × 8 grid-mRNFL analysis and 0.93/0.96 for the 8 × 8 grid GCC analysis using various normal cutoff values, which were better than that (0.78/0.95) for clock-hour cpRNFL analysis (P = 0.001). Compensation of the disc-fovea inclination did not improve the diagnostic capability.
  
  
  CONCLUSIONS
  Grid-wise analysis of macular GCC--especially using 8 × 8 grids and normative data-based cutoff values--was very useful for diagnosing early-stage glaucoma, though compensation of the disc-fovea inclination had little effect.
authors: Department of Ophthalmology the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors: Chihiro
authors: C
authors: Mayama
authors: Department of Ophthalmology the University of Tokyo Graduate School of Medicine, Tokyo, Japan 2Kanto Central Hospital, Tokyo, Japan.
authors: Hitomi
authors: H
authors: Saito
authors: Department of Ophthalmology the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors: Hiroyo
authors: H
authors: Hirasawa
authors: Department of Ophthalmology the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors: Atsuo
authors: A
authors: Tomidokoro
authors: Department of Ophthalmology the University of Tokyo Graduate School of Medicine, Tokyo, Japan 2Kanto Central Hospital, Tokyo, Japan.
authors: Makoto
authors: M
authors: Araie
authors: Tajimi Iwase Eye Clinic, Tajimi, Japan.
authors: Aiko
authors: A
authors: Iwase
authors: Department of Ophthalmology & Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors: Shinji
authors: S
authors: Ohkubo
authors: Department of Ophthalmology & Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors: Kazuhisa
authors: K
authors: Sugiyama
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Masanori
authors: M
authors: Hangai
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Nagahisa
authors: N
authors: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology*; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D011446:Prospective Studies; D012372:ROC Curve; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields