title: Green disease in optical coherence tomography diagnosis of glaucoma.
abstract: OBJECTIVE
  Optical coherence tomography (OCT) has become an integral component of modern glaucoma practice. Utilizing color codes, OCT analysis has rendered glaucoma diagnosis and follow-up simpler and faster for the busy clinician. However, green labeling of OCT parameters suggesting normal values may confer a false sense of security, potentially leading to missed diagnoses of glaucoma and/or glaucoma progression.
  
  
  RESULTS
  Conditions in which OCT color coding may be falsely negative (i.e., green disease) are identified. Early glaucoma in which retinal nerve fiber layer (RNFL) thickness and optic disc parameters, albeit labeled green, are asymmetric in both eyes may result in glaucoma being undetected. Progressively decreasing RNFL thickness may reveal the presence of progressive glaucoma that, because of green labeling, can be missed by the clinician. Other ocular conditions that can increase RNFL thickness can make the diagnosis of coexisting glaucoma difficult. Recently introduced progression analysis features of OCT may help detect green disease.
  
  
  CONCLUSIONS
  Recognition of green disease is of paramount importance in diagnosing and treating glaucoma. Understanding the limitations of imaging technologies coupled with evaluation of serial OCT analyses, prompt clinical examination, and structure-function correlation is important to avoid missing real glaucoma requiring treatment.
authors.affiliation: aBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida bCurrent Address: Fillmore Eye Clinic, Alamogordo, New Mexico, USA.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Sayed
authors.forename: Michael
authors.initials: M
authors.lastname: Margolis
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D005188:False Negative Reactions; D005901:Glaucoma / Q000000981:diagnostic imaging*; D006801:Humans; D007429:Intraocular Pressure; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000592:standards*