title: Spectral-domain Optical Coherence Tomography in Manifest Glaucoma: Its Additive Role in Structural Diagnosis.
abstract: OBJECTIVE
  To investigate the additive role of spectral-domain optical coherence tomography (SDOCT) in the structural diagnosis in glaucoma.
  
  
  METHODS
  Reliability and validity analysis.
  
  
  METHODS
  Structural examinations from 109 eyes of 109 healthy individuals and 151 eyes of 151 glaucoma patients with different severities were included. Four structural-diagnostic examination sets were prepared using stereo-optic disc photography (SDP), red-free retinal nerve fiber layer photography (RNFLP), and SDOCT: (1) SDP (S), (2) SDP and SDOCT (SO), (3) SDP and RNFLP (SR), and (4) SDP, RNFLP, and SDOCT (SRO). Five glaucoma specialists were instructed to classify subjects as normal or glaucoma using each of the 4 diagnostic sets in the order S, SO, SR, and SRO, with a 1-month interval. The interobserver agreement was evaluated using kappa (κ) statistics. The additive effect of SDOCT on the diagnostic performance of the specialists was evaluated using the generalized estimating equation.
  
  
  RESULTS
  Five glaucoma specialists showed an excellent level of interobserver agreement on the diagnostic assessments based on the 4 sets. In the comparison of the collective diagnostic performance of the specialists, addition of SDOCT to SDP showed an approximately 2-fold significant increase in the diagnostic accuracy. Adding SDOCT to SDP significantly enhanced the specialists' structural-diagnostic ability with respect to the moderate glaucoma, though not mild or advanced glaucoma.
  
  
  CONCLUSIONS
  SDOCT significantly enhanced the diagnostic accuracy of the glaucoma specialists' performance, showing its additive diagnostic value in judging glaucomatous structural damage, especially in the moderate stage of glaucoma.
authors: Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea.
authors: Ko Eun
authors: KE
authors: Kim
authors: Department of Biostatistics, Seoul National University Boramae Hospital, Seoul, South Korea.
authors: Sohee
authors: S
authors: Oh
authors: Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
authors: Jin Wook
authors: JW
authors: Jeoung
authors: Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
authors: Min Hee
authors: MH
authors: Suh
authors: Department of Ophthalmology, Pusan National University Yangsan Hospital, Busan, South Korea.
authors: Je Hyun
authors: JH
authors: Seo
authors: Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea.
authors: Martha
authors: M
authors: Kim
authors: Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
authors: Ki Ho
authors: KH
authors: Park
authors: Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
authors: Dong Myung
authors: DM
authors: Kim
authors: Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, South Korea. Electronic address: xcski@hanmail.net.
authors: Seok Hwan
authors: SH
authors: Kim
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009898:Optic Disk / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields