Aims To evaluate and compare the accuracy of scanning laser polarimetry with variable corneal compensation (GDx-VCC) and optical coherence tomography (OCT) for detecting glaucomatous damage observed in retinal nerve fibre layer (RNFL) monochromatic photographs from ocular hypertensive (OHT) individuals with normal visual fields.

Methods A total of 181 eyes from 181 patients with intraocular pressure >22 mm Hg were enrolled in a cross-sectional, hospital clinic-based study. All patients underwent full ophthalmological examination, standard automated perimetry, red-free digital RNFL photographs, and RNFL imaging with Stratus OCT and GDx-VCC. Subjects were divided into two groups according to observations from RNFL photographs: 128 OHT subjects without and 53 OHT subjects with RNFL defects. Receiver operating characteristic (ROC) curves plotted for the RNFL parameters were compared between OCT and GDx-VCC.

Results The OCT parameter with the highest diagnostic accuracy for detecting early RNFL defects was average thickness, and for the GDx-VCC was temporal–superior–nasal–inferior–temporal average, with areas under the ROC curve of 0.785 and 0.758, respectively (all AUCs p<0.001).

Conclusion OCT and GDx have similar diagnostic accuracy for identifying early defects detected by RNFL monochromatic photography in OHT patients.