Objective: To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in the diagnosis of glaucoma and to determine the validity of these measurements. Methods: Glaucoma suspects undergoing glaucoma diagnostic tests were recruited consecutively. The numerical results of the Stratus OCT fast optic disc and fast RNFL protocols were analyzed against an independent assessment by glaucoma experts who were blinded as to the results of the OCT. An ROC curve analysis was applied to derive estimates of diagnostic accuracy and multi-level likelihood ratios. Results: A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included. All ONH and RNFL OCT parameters showed statistically significant differences in mean values between the 2 groups. The ROC curve identified the vertical integrated rim area (AUC: 0.822), the cup-disc area ratio (AUC: 0.816), and the horizontal integrated rim width (AUC: 0.794) as the best optic disc parameters; and the RNFL average thickness (AUC: 0.827), the superior quadrant (AUC: 0.807), and the inferior quadrant (AUC: 0.804) as the best RNFL parameters. Multi-level likelihood ratios for ONH and RNFL parameters were calibrated using a projected posttest probability of 70% for a positive test result (therapeutic threshold) and a 10% posttest probability for a negative result (diagnostic threshold). Conclusion The results showed that statistically significant mean differences in ONH and RNFL parameters did not translate into a high predictive ability for each individual parameter. Single cut-off value for each OCT parameter based on the best sensitivity and specificity combination did not result in high predictive values for any single parameter. Multi-level likelihood ratios for the best ONH and RNFL parameters were derived to increase the diagnostic capability of the Stratus OCT.
Tomography, Optical Coherence ; Glaucoma ; Optic Disk

Objective: This study assessed the relationship of two structural tests, optic-disc photography and optical coherence tomography (OCT), and a functional test, standard achromatic perimetry (SAP), in the diagnosis of glaucoma. Methods: A retrospective review of charts from the database of a private glaucoma specialist and the glaucoma clinic of a tertiary hospital was done. The participants were longitudinally evaluated and had comprehensive eye examination, imaging, and functional testing. Optic-disc photographs, OCTs, and SAPs were interpreted and evaluated separately, and then correlated with each other by two glaucoma experts working individually. Sensitivities, specificities, and predictive values were obtained for each diagnostic test and in combination. Kappa statistics were used for interobserver agreement. Results: Three hundred sixty-seven eyes of 188 patients were included in the study. Fifty-eight patients were diagnosed as normal, 130 had glaucoma. OCT had the highest sensitivity and specificity at 70.7% and 76.6%, followed by SAP at 72.4% and 53.5% respectively. Optic-disc photos had the lowest sensitivity and specificity at 55.8% and 54.4% respectively, and the lowest interobserver agreement (kappa = 0.50-0.61). The predictive values of the 3 tests increased to 82% with good interobserver agreement (kappa = 0.68-0.78) when correlated with each other. Conclusion The correlation of structural and functional tests increased the accuracy of diagnosing glaucoma. These examinations offered complementary information and, when used in conjunction with comprehensive clinical evaluation, guided the clinician in the proper management of patients with glaucoma.
Glaucoma Optic Disk Tomography ; Optical Coherence Visual Fields

The development of optical coherence tomography (OCT) has changed the clinical management of ophthalmic diseases by furthering the understanding of pathogenesis, as well as improving the monitoring of their progression and assisting in quantifying the response to treatment modalities in ophthalmic diseases. Initially, the two-dimensional configuration of the optic nerve head (ONH) and the thickness of the retinal nerve fiber layer (RNFL) were the main OCT structural parameters used in clinical management of optic nerve diseases. Now, with higher resolution power and faster acquisition times, the details of ONH and the retina including the macular area can be measured using spectral domain OCT (SD-OCT) with high reproducibility and increased diagnostic ability. OCT can provide structural information to improve the understanding and management of optic nerve diseases. In this review, we will briefly summarize the clinical applications of SD-OCT in glaucoma and nonarteritic anterior ischemic optic neuropathy, which are two representative optic nerve diseases.
Glaucoma ; Nerve Fibers ; Optic Disk ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: Retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) in diabetic patients with normal tension were analyzed using optical coherence tomography (OCT), which revealed that diabetes induce morphologic changes in optic disc and RNFL thickness. METHODS: A total of 192 patients with type 2 diabetes were analyzed with fundus examination and classified as having normal retina, mild - moderate, severe nonproliferative retinopathy (NPDR), or proliferative retinopathy (PDR). These patients were evaluated with OCT and compared with normal control group. RESULTS: The mean average thickness and nasal average thickness of RNFL in mild-moderate, and severe NPDR groups decreased compared with those of the other groups. There was an increase in the temporal average thickness of RNFL in the PDR group. As the duration of diabetes increased, the mean average and nasal average of RNFL thickness also decreased. The severity of diabetic retinopathy didn't show statistically significant differences in a topographic analysis of the optic nerve head. CONCLUSIONS: The mean average thickness and nasal average of RNFL decreased in NPDR groups. Diabetic changes should be considered when diabetes patients are diagnosed with glaucoma or glaucoma progression.
Diabetic Retinopathy ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: To assess the usefulness of two spectral domain optical coherence tomography (SD-OCT) instruments (Cirrus(R), Spectralis(R)) for evaluating optic nerve head and peripapillary structures. METHODS: Images of optic nerve complex were obtained from 136 eyes of 136 patients using enhanced depth imaging technique of 2 SD-OCT instruments. Optic nerve head and peripapillary structures were investigated for their visibility and morphological features in total eyes and glaucomatous eyes. Effect factors for laminar thickness measurement were evaluated and the reproducibility of the lamina cribrosa thickness measured by the 2 OCT instruments was analyzed. RESULTS: Lamina cribrosa thickness was better identified using Spectralis(R) OCT in total and glaucomatous eyes. Short posterior ciliary artery (in total eyes) and peripapillary choroid (in total and glaucomatous eyes) were also better identified using Spectralis(R) OCT (p < 0.001). A cup-disc ratio < or = 0.6 was the significant effect factor for laminar thickness measurement (p < 0.05). Interobserver reproducibility was excellent using both OCT instruments. Intraobserver reproducibility was excellent using Spectralis(R) OCT and moderate using Cirrus(R) OCT. CONCLUSIONS: Spectralis(R) OCT was better for visualizing optic nerve head and peripapillary structures and showed better reproducibility than Cirrus(R) OCT. Thus, the Spectralis(R) may be helpful for detecting and understanding features of the optic nerve complex.
Choroid ; Ciliary Arteries ; Glaucoma ; Humans ; Optic Disk ; Optic Nerve* ; Tomography, Optical Coherence*

PURPOSE: Optic nerve head surface depression in patients with glaucoma has been previously reported. We quantitatively compared the mean optic disc cup surface depth between glaucoma-like disc (GLD) patients with large cup-to-disc ratios and primary open-angle glaucoma (POAG) patients. METHODS: A total of 40 eyes of 40 patients with GLD and 40 eyes of 40 patients with POAG were included in this study. All patients had an average cup-to-disc ratio of 0.7–0.8. The optic disc area, mean cup-to-disc ratio, and mean optic disc cup volume were measured using spectral domain optical coherence tomography (Cirrus™ HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA, USA). The mean optic disc cup surface depth was calculated using the formula: (mean optic disc cup volume/[optic disc area × mean cup-to-disc ratio2]) − 200 µm. RESULTS: The mean ages of patients were 61.18 ± 11.83 and 59.65 ± 11.69 years for the GLD and POAG groups, respectively. The average cup-to-disc ratios were 0.74 ± 0.03 and 0.75 ± 0.03 for the GLD and POAG groups, respectively, but no significant difference was observed between the two groups. The mean optic disc cup surface depths were 144.74 ± 82.78 µm and 199.53 ± 90.26 µm for the GLD and POAG groups, respectively, and the difference between the two groups was statistically significant (p = 0.006, t-test). CONCLUSIONS: POAG patients showed a significantly greater mean optic disc cup surface depth compared to GLD patients with a similar mean cup-to-disc ratio. Based on the results of spectral domain optical coherence tomography, confirming the mean optic disc cup surface depth is expected to provide additional information to distinguish GLD from POAG patients.
Depression ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Optic Disk ; Tomography, Optical Coherence

PURPOSE: Optical coherence tomography (OCT) is a new imaging technique that can provide cross-sectional images of the retina. This study was designed to evaluate the thickness of the retinal nerve fiber layer (RNFL) and optic nerve head shape in normal eyes using OCT. METHODS: A total of 134 normal Korean volunteers in different age groups (age range, 10-50 years) were recruited for this study. Fifty-nine males and 75 females were enrolled. The mean age of the subjects was 24.0+/-12.91 years. RESULTS: At optic disc scan, the horizontal and vertical C/D ratios were 0.55 and 0.48, respectively, which were statistically significant (p<0.05). A significant positive correlation with increasing age was identified in the C/D area ratio and horizontal C/D ratio. According to the RNFL scan, the inferior and superior areas were significantly thicker than the nasal and superior areas. These areas were thinner with age. In addition, RNFL thickness in the superonasal, inferotemporal and superotemporal areas differed between subjects under 20 years old and those over 21 years old. CONCLUSIONS: We determined that RNFL thickness and optic nerve head shape in normal Koreans had age-related differences. These results could provide correctness with OCT scan in glaucoma patients.
Female ; Glaucoma ; Humans ; Male ; Nerve Fibers ; Optic Disk ; Retina ; Retinaldehyde ; Tomography, Optical Coherence* ; Volunteers ; Young Adult

PURPOSE: To investigate the retinal nerve fiber layer (RNFL) thickness concordance when measured by spectral domain (SD) and swept source (SS) optical coherence tomography (OCT), and to compare glaucoma-discriminating capability. METHODS: RNFL thicknesses were measured with the scan circle, centered on the optic nerve head, in 55 healthy, 41 glaucoma suspected, and 87 glaucomatous eyes. The RNFL thickness measured by the SD-OCT (sdRNFL thickness) and SS-OCT (ssRNFL thickness) were compared using the t-test. Bland-Altman analysis was performed to examine their agreement. We compared areas under the receiver operating characteristics curve and examined sdRNFL and ssRNFL thickness for discriminating glaucomatous eyes from healthy eyes, and from glaucoma suspect eyes. RESULTS: The average ssRNFL thickness was significantly greater than sdRNFL thickness in healthy (110.0 ± 7.9 vs. 100.1 ± 6.8 µm, p < 0.001), glaucoma suspect (96.8 ± 9.3 vs. 89.6 ± 7.9 µm, p < 0.001), and glaucomatous eyes (74.3 ± 14.2 vs. 69.1 ± 12.4 µm, p = 0.011). Bland-Altman analysis showed that there was a tendency for the difference between ssRNFL and sdRNFL to increase in eyes with thicker RNFL. The area under the curves of the average sdRNFL and ssRNFL thickness for discriminating glaucomatous eyes from healthy eyes (0.984 vs. 0.986, p = 0.491) and glaucoma suspect eyes (0.936 vs. 0.918, p = 0.132) were comparable. CONCLUSIONS: There was a tendency for ssRNFL thickness to increase, compared with sdRNFL thickness, in eyes with thicker RNFL. The ssRNFL thickness had comparable diagnostic capability compared with sdRNFL thickness for discriminating glaucomatous eyes from healthy eyes and glaucoma suspect eyes.
Glaucoma ; Nerve Fibers* ; Optic Disk ; Retinaldehyde* ; ROC Curve ; Tomography, Optical Coherence*

PURPOSE: The objective of this study is to compare optic nerve head (ONH) analysis parameters and retinal nerve fiber layer (RNFL) thickness parameters as measured by optical coherence tomography (OCT) among age-matched normal eyes, glaucoma-suspect eyes, and early glaucomatous eyes; and to determine the discriminating parameter best suited to distinguish early glaucoma in age-matched normal eyes and glaucoma- suspect eyes. METHODS: One hundred two normal eyes, 72 glaucoma-suspect eyes, and 85 eyes with early glaucoma that had been submitted to OCT and Humphrey field analysis were enrolled in this study. Optic nerve head analysis values and RNFL thickness values with OCT scans were compared among all groups. Sensitivity and specificity for the detection of early glaucoma were determined with a receiver operating characteristic (ROC) curve. RESULTS: The best-suited parameters were determined to be from 0.637 to 0.753 in optic nerve head parameters and from 0.506 to 0.759 in RNFL thickness parameters calculated with the area under the ROC curve (AUROC). The average thickness for early glaucomatous eye (0.818) had the widest AUROC among all parameters. The sensitivity and specificity of RNFL thickness parameter were determined to be 49.4% and 93.1%, respectively, at the cut-off value 92.17 micrometer. CONCLUSIONS: Optic nerve head and RNFL thickness parameters measured with OCT have relatively high sensitivity and specificity for detecting early glaucomatous eyes. Furthermore, they may provide clinically relevant information for the detection of early glaucomatous damage and for monitoring glaucomatous changes.
Glaucoma* ; Humans ; Nerve Fibers ; Optic Disk ; Retinaldehyde ; ROC Curve ; Sensitivity and Specificity ; Tomography, Optical Coherence*

PURPOSE: To determine if korean normative database improve diagnostic ability of Stratus OCT for detection of glaucoma. METHODS: Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were measured using a Stratus OCT. The normative data were collected from 129 normal individuals. We obtained values at the 5% and 1% levels according to the disc area stratified into equal thirds to minimize the error by the individual variation of optic disc size and these levels were considered abnormal. One eye of each 94 normal-tension glaucoma patients with early visual field defects (mean deviaton = -3.84+/-1.40dB) and 87 another normal subjects were enrolled. Glaucoma was defined by visual field defects. RESULTS: The use of Korean normative database had higher sensitivity and no significant difference of specificity than that of a Stratus OCT except for a few parameters. The criteria that show the highest diagnostic ability were 1 > or = quadrants RNFL thickness abnormal at the < 5% when using a Korean normative database (sensitivity = 81.9%, specificity = 81.6%) and 1 > or = clock hours abnormal at the < 5% when using a Stratus OCT normative database (sensitivity = 71.3%, specificity = 87.4%) (p=0.004, p=0.180, respectively, McNemar test). CONCLUSIONS: The criterion using a Korean normative database had higher sensitivity and no difference of specificity compared with criterion using a Stratus OCT normative database. The best criterion using a Korean normative database may be helpful for early detection of normal-tension glaucoma.
Eye ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; Sensitivity and Specificity ; Tomography, Optical Coherence ; Visual Fields