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Diagnostic criteria for detection of retinal nerve fibre layer thickness and neuroretinal rim width abnormalities in glaucoma
  1. Feihui Zheng1,2,
  2. Marco Yu1,2,
  3. Christopher Kai-Shun Leung1
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
  2. 2Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
  1. Correspondence to Dr Christopher Kai-Shun Leung, The Chinese University of Hong Kong, Hong Kong, China; cksleung.cuhk{at}


Background/aims Although measurements of the Bruch’s membrane opening minimum rim width (BMO-MRW) and retinal nerve fibre layer thickness (RNFLT) with optical coherence tomography (OCT) have been widely adopted in the diagnostic evaluation of glaucoma, there is no consensus on the diagnostic criteria to define BMO-MRW and RNFLT abnormalities. This study investigated the sensitivities and specificities of different diagnostic criteria based on the OCT classification reports for detection of glaucoma.

Methods 340 eyes of 137 patients with glaucoma and 87 healthy individuals, all with axial length ≤26mm, had global and sectoral BMO-MRW and RNFLT measured with Spectralis OCT (Heidelberg Engineering). Six diagnostic criteria were examined: global measurement below the fifth or the first percentile; ≥1 sector measurement below the fifth or the first percentile; superotemporal and/or inferotemporal measurement below the fifth or the first percentile. The sensitivities and specificities of BMO-MRW/RNFLT assessment for detection of glaucoma (eyes with visual field (VF) defects) were compared.

Results Among the six criteria examined, superotemporal and/or inferotemporal measurement below the fifth percentile showed the highest sensitivities and specificities for glaucoma detection. Abnormal superotemporal and/or inferotemporal RNFLT attained a higher sensitivity than abnormal superotemporal and/or inferotemporal BMO-MRW to detect mild glaucoma (mean VF MD: −3.32±1.59 dB) (97.9% and 88.4%, respectively, p=0.006), and glaucoma (mean VF MD: −9.36±8.31 dB) (98.4% and 93.6%, respectively, p=0.006), at the same specificity (96.1%).

Conclusions Superotemporal and/or inferotemporal RNFLT/MRW below the fifth percentile yield the best diagnostic performance for glaucoma detection with RNFLT attains higher sensitivities than MRW at the same specificity in eyes without high myopia.

  • glaucoma
  • diagnostic tests/investigation
  • imaging

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  • Contributors Study design: CK-SL. Analysis: CK-SL, MY, FZ. Manuscript drafting: CK-SL, FZ. Data collection: FZ.

  • Funding This study was supported by Hong Kong Research Grants Council General Research Fund 2015/2016 (14101215).

  • Competing interests CK-SL: speaker honorarium—Carl Zeiss Meditec, Heidelberg Engineering; research support—Carl Zeiss Meditec, Heidelberg Engineering.

  • Patient consent for publication Obtained.

  • Ethics approval The study was conducted in accordance with the ethical standards stated in the 1964 Declaration of Helsinki and approved by the Kowloon Central Research Ethics Committee.

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

  • Data availability statement Data are available on request.

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