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Defining glaucomatous optic neuropathy using objective criteria from structural and functional testing
  1. Jayant Venkatramani Iyer1,
  2. Michael V Boland2,
  3. Joan Jefferys2,
  4. Harry Quigley3
  1. 1 Glaucoma, Singapore National Eye Centre, Singapore, Singapore
  2. 2 Wilmer Eye Institute, Johns Hopkins University Department of Ophthalmology, Baltimore, Maryland, USA
  3. 3 Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Harry Quigley, Department of Ophthalmology, Johns Hopkins University, Wilmer 122, Johns Hopkins Hospital, Baltimore, MD 21287, USA; hquigley{at}


Background/Aims To identify objective criteria from optical coherence tomography (OCT) and perimetry that denote a useful, specific definition of glaucomatous optic neuropathy (GON) in eyes with open-angle glaucoma for comparisons among glaucoma research studies.

Methods A cross-sectional study of adult patients with glaucoma from nine centres on five continents evaluated de-identified physician diagnosis, OCT and perimetry results for 2580 eyes (1531 patients) in an online database. Each eye was graded by their glaucoma specialist as either definite, probable or not GON. Objective measures from OCT and perimetry, derived from an online consensus panel comprising 176 glaucoma specialists globally, were compared against the three diagnostic levels.

Results Diagnoses were 54% ‘definite’, 22% ‘probable’ and 24% ‘not GON’. Using only OCT data or only field data had inadequate specificity (<90%). The best definitional choice for data from either the most recent or the preceding OCT/field pair had 77% sensitivity at 98% specificity and consisted of abnormal OCT superior or inferior nerve fibre layer quadrant with matching, opposite, abnormal Glaucoma Hemifield Test.

Conclusions Objective criteria to define GON are practical and may be useful for comparisons among clinical studies to supplement subjective clinical assessment.

  • Glaucoma
  • Imaging
  • Optic Nerve
  • Field of vision
  • Diagnostic tests/Investigation
  • Epidemiology

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  • Correction notice This paper has been corrected since it was published online. Table 5 has been updated.

  • Contributors JVI and HQ were involved in the conception, study design, data acquisition and analysis, and manuscript preparation. MVB was involved in study design, data acquisition and manuscript preparation. JJ was involved in data analysis and in manuscript preparation.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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