Detection of Glaucoma Progression by Assessment of Segmented Macular Thickness Data Obtained Using Spectral Domain Optical Coherence Tomography

PURPOSE. We evaluated the clinical use of segmented macular layer thickness measurement in terms of glaucoma diagnosis and the ability to detect progression, and to compare such outcomes to those by circumpapillary retinal nerve fiber layer (cRNFLT) and total macular thickness (TMT) measurements. METHODS. The study included 141 glaucomatous and 61 healthy eyes. All glaucomatous eyes were subjected to at least four spectral domain optical coherence tomography (SD-OCT) examinations (mean follow-up, 2.13 years). Segmented macular layers were the macular nerve fiber layer (NFL), ganglion cell and inner plexiform layer (GCA), and outer retinal layer (ORL; from outer plexiform layer to retinal pigment epithelium). Areas under receiver operating characteristic curves (AUCs) discriminating healthy from glaucomatous eyes were determined in baseline measurements. The sensitivity and specificity of these parameters in terms of glaucoma progression detection were determined, with reference to assessment of optic disc/retinal nerve fiber layer (RNFL) photographs/visual field (VF) deterioration as standard(s). RESULTS. GCA afforded the best diagnostic performance among three macular layers. The AUC of the GCA thickness (GCAT) was less than that of cRNFLT (0.869 vs. 0.953, P = 0.018), but superior to that of TMT (0.790, P = 0.05). Of the eyes, 38 showed progression during follow-up by standard methods. The sensitivities of TMT, GCAT, and cRNFLT values in terms of detection of progression were 14%, 8%, and 5%, respectively. CONCLUSIONS. Although baseline cRNFL measurement was optimal in terms of glaucoma diagnosis, the GCAT and TMT showed similar levels of sensitivity in progression detection. (Invest Ophthalmol Vis Sci. 2012;53:3817-3826) DOI:10.1167/iovs.11-9369