Elsevier

Ophthalmology

Volume 112, Issue 3, March 2005, Pages 391-400
Ophthalmology

Original article
Comparison of macular and peripapillary measurements for the detection of glaucoma: An Optical Coherence Tomography study

Poster presented at: American Academy of Ophthalmology meeting, October, 2004; New Orleans, Louisiana.
https://doi.org/10.1016/j.ophtha.2004.10.020Get rights and content

Objective

To evaluate macular nerve fiber layer (NFL) thickness in glaucomatous damage by optical coherence tomography (OCT) and to compare its discriminating power for glaucoma and glaucoma suspects with that of total macular thickness and peripapillary NFL thickness.

Design

Cross-sectional, case–control, comparative study.

Participants

A total of 133 eyes from 133 subjects including 46 normal eyes, 48 glaucoma-suspect eyes, and 39 glaucoma eyes were enrolled.

Methods

Macular NFL thickness, total macular thickness, and peripapillary NFL thickness were measured by Stratus OCT in each diagnostic group.

Main outcome measures

The patterns and measurements of macular NFL, total macular, and peripapillary NFL thickness in total mean, 4 quadrants, and 12 clock hours. The discriminating power of each parameter for detection of glaucoma suspects and glaucoma was evaluated by areas under the receiver operating characteristic curve (AROC). Correspondence with visual field function was studied by linear regression analysis.

Results

The macular NFL profile exhibited a double-hump pattern with peaks over superonasal and inferonasal sectors. A significant difference in macular NFL thickness between normal and glaucoma-suspect groups was found at the 6-o'clock position, whereas a difference was found in all except the temporal clock hours between normal and glaucoma subjects. No significant difference in AROCs for detection of glaucoma suspects or glaucoma was found when macular NFL thickness and total macular thickness measurements were compared. However, mean macular NFL thickness demonstrated a stronger correlation with visual function than mean macular thickness (r = 0.39/R2 = 0.15 vs. r = 0.23/R2 = 0.05, P =0.042). Among all the findings, inferior peripapillary NFL thickness had the best performance in discriminating glaucoma (AROC, 0.91) and glaucoma suspects (AROC, 0.67). It also had the strongest correlation with visual function (r = 0.60/R2 = 0.36, P<0.001).

Conclusions

Macular NFL thickness was significantly reduced in glaucoma. It had a similar discriminating power for glaucoma detection but a stronger correlation with visual function than total macular thickness. Peripapillary NFL thickness, however, outperformed both total macular and macular NFL thickness in terms of glaucoma detection and visual function correlation. Peripapillary NFL thickness, as a total measurement of both macular and peripheral NFL, is still the best surrogate marker in glaucoma assessment.

Section snippets

Subjects

One hundred thirty-three Hong Kong Chinese including 46 normal subjects, 48 glaucoma suspects, and 39 glaucoma patients examined during the period from October 2003 to February 2004 in the Department of Ophthalmology, Caritas Medical Center, who met the inclusion criteria of the study, were included. Caritas Medical Centre is the ophthalmic referral center in the Hong Kong Hospital Authority Kowloon West Cluster, serving a population size of approximately 1.2 million. The study was conducted in

Results

A total of 133 eyes from 133 subjects was included in the study. Only 1 eye was chosen in random in each subject, and each individual was assigned to 1 of the 3 diagnostic groups. Table 1 shows the demographics of the subjects. With regard to age, gender, and refractive error, there were no significant differences among the groups. For the mean deviation and the pattern standard deviation in the visual field results, significant differences were found between glaucoma and normal groups (P

Discussion

Numerous experimental and clinical studies have demonstrated that the retinal NFL becomes atrophic in glaucoma.13, 14, 15 Damages to the retinal NFL and the optic disc frequently precede visual field loss. Most modern imaging devices, including confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography (OCT), are noninvasive techniques designed to target on the optic nerve head for scanning. The advantages of OCT have been recognized as being unaffected

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    Manuscript no. 240318.

    The authors have no proprietary interest in the development or marketing of any product mentioned in the article.

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