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Ophthalmology. 2014 Apr;121(4):849-54. doi: 10.1016/j.ophtha.2013.10.044. Epub 2014 Jan 3.

Diagnostic performance of optical coherence tomography ganglion cell--inner plexiform layer thickness measurements in early glaucoma.

Author information

1
Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
2
Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: donald_budenz@med.unc.edu.
3
Glaucoma Associates of Texas, Dallas, Texas.
4
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
5
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.

Abstract

PURPOSE:

To evaluate the glaucoma diagnostic performance of ganglion cell inner-plexiform layer (GCIPL) parameters used individually and in combination with retinal nerve fiber layer (RNFL) or optic nerve head (ONH) parameters measured with Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, CA).

DESIGN:

Prospective cross-sectional study.

PARTICIPANTS:

Fifty patients with early perimetric glaucoma and 49 age-matched healthy subjects.

METHODS:

Three peripapillary RNFL and 3 macular GCIPL scans were obtained in 1 eye of each participant. A patient was considered glaucomatous if at least 2 of the 3 RNFL or GCIPL scans had the average or at least 1 sector measurement flagged at 1% to 5% or less than 1%. The diagnostic performance was determined for each GCIPL, RNFL, and ONH parameter as well as for binary or-logic and and-logic combinations of GCIPL with RNFL or ONH parameters.

MAIN OUTCOME MEASURES:

Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

RESULTS:

Among GCIPL parameters, the minimum had the best diagnostic performance (sensitivity, 82.0%; specificity, 87.8%; PLR, 6.69; and NLR, 0.21). Inferior quadrant was the best RNFL parameter (sensitivity, 74%; specificity, 95.9%; PLR, 18.13; and NLR, 0.27), as was rim area (sensitivity, 68%; specificity, 98%; PLR, 33.3; and NLR, 0.33) among ONH parameters. The or-logic combination of minimum GCIPL and average RNFL provided the overall best diagnostic performance (sensitivity, 94%; specificity, 85.7%; PRL, 6.58; and NLR, 0.07) as compared with the best RNFL, best ONH, and best and-logic combination (minimum GCIPL and inferior quadrant RNFL; sensitivity, 64%; specificity, 100%; PLR, infinity; and NPR, 0.36).

CONCLUSIONS:

The binary or-logic combination of minimum GCIPL and average RNFL or rim area provides better diagnostic performances than those of and-logic combinations or best single GCIPL, RNFL, or ONH parameters. This finding may be clinically valuable for the diagnosis of early glaucoma.

PMID:
24393348
DOI:
10.1016/j.ophtha.2013.10.044
[Indexed for MEDLINE]

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