Article Text

Download PDFPDF
Qualitative evaluation of neuroretinal rim and retinal nerve fibre layer on optical coherence tomography to detect glaucomatous damage
  1. Zhichao Wu1,2,3,
  2. Jayme R Vianna4,
  3. Alexandre S C Reis5,
  4. Zane Z Zemborain1,
  5. Seung H Lee1,
  6. Abinaya Thenappan1,
  7. Denis S D Weng1,
  8. Emmanouil Tsamis1,
  9. Devon B Joiner1,
  10. Robert Ritch6,
  11. Carlos Gustavo V De Moraes7,
  12. Donald C Hood1,7
  1. 1 Department of Psychology, Columbia University, New York City, New York, USA
  2. 2 Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
  3. 3 Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
  4. 4 Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
  5. 5 Ophthalmology, Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil
  6. 6 Ophthalmology, New York Eye and Ear Infirmary, New York City, New York, USA
  7. 7 Department of Ophthalmology, Columbia University Medical Center, New York City, New York, USA
  1. Correspondence to Dr Zhichao Wu, Centre for Eye Research Australia, East Melbourne, Victoria, Australia; wu.z{at}


Purpose To understand the added value of Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements to conventional circumpapillary retinal nerve fibre layer (cpRNFL) thickness measurements on optical coherence tomography (OCT) imaging for discriminating between perimetric glaucoma and healthy eyes, evaluated through a qualitative evaluation.

Methods 384 healthy eyes and 188 glaucoma eyes were evaluated, and glaucoma eyes were categorised as perimetric (n=107) based on a history of ≥3 consecutive abnormal 24–2 visual field tests or suspected glaucoma if they did not (n=81). OCT-derived BMO-MRW and cpRNFL reports were qualitatively evaluated by two experienced graders in isolation at first, and then by using both reports combined. The diagnostic performance (sensitivity at 95% specificity, total and partial area under the receiver operating characteristic curve) of detecting perimetric glaucoma with each method were compared.

Results All diagnostic performance measures for detecting perimetric glaucoma eyes were not significantly different when using either the cpRNFL or BMO-MRW reports alone compared with using both reports combined (p≥0.190), nor when comparing the use of each report in isolation (p≥0.500).

Conclusions Experienced graders exhibited no difference in discriminating between perimetric glaucoma and healthy eyes when using a cpRNFL report alone, the BMO-MRW report alone or the two reports combined. Therefore, either OCT imaging report of the neuroretinal tissue could be used effectively for detecting perimetric glaucoma, but further studies are needed to determine whether there are specific advantages of each method, or the combination of both, when evaluating eyes that have a greater degree of diagnostic uncertainty.

  • Glaucoma
  • Imaging
  • Diagnostic tests/Investigation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ZW, JRV, ASCR, ZZZ, SHL, AT, DSDW, RR and DCH were responsible for the design of the study. All authors were responsible for the interpretation of the data, as well as preparation, review and approval of the article.

  • Funding This study was supported by a National Institutes of Health Grant R01-EY-02115 (DCH), and R01-EY-025253 (CGVDM), Lary Stromfeld Research Fund of NYEEI (RR), Joseph and Marilyn Rosen Research Fund of the New York Glaucoma Research Institute, New York, NY (RR) and a National Health & Medical Research Council Early Career Fellowship (#1104985, ZW).

  • Competing interests DCH: financial support—Topcon (F, C), Heidelberg Engineering (F, C).

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board approvals were obtained from both sites for this study, and it adhered to the Declaration of Helsinki and the Health Insurance Portability and Accountability Act.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas