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Glaucoma Diagnostic Capability of Global and Regional Measurements of Isolated Ganglion Cell Layer and Inner Plexiform Layer

Chien, Jason L. BS; Ghassibi, Mark P. MD; Patthanathamrongkasem, Thipnapa MD; Abumasmah, Ramiz MD; Rosman, Michael S. MD; Skaat, Alon MD; Tello, Celso MD; Liebmann, Jeffrey M. MD; Ritch, Robert MD; Park, Sung Chul MD

doi: 10.1097/IJG.0000000000000572
Original Studies

Purpose: To compare glaucoma diagnostic capability of global/regional macular layer parameters in different-sized grids.

Materials and Methods: Serial horizontal spectral-domain optical coherence tomography scans of macula were obtained. Automated macular grids with diameters of 3, 3.45, and 6 mm were used. For each grid, 10 parameters (total volume; average thicknesses in 9 regions) were obtained for 5 layers: macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), ganglion cell-inner plexiform layer (GCIPL; GCL+IPL), and ganglion cell complex (GCC; mRNFL+GCL+IPL).

Results: Sixty-nine normal eyes (69 subjects) and 87 glaucomatous eyes (87 patients) were included. For the total volume parameter, the area under the receiver operating characteristic curves (AUCs) in 6-mm grid were larger than the AUCs in 3- and 3.45-mm grids for GCL, GCC, GCIPL, and mRNFL (all P<0.020). For the average thickness parameters, the best AUC in 6-mm grid (T2 region for GCL, IPL, and GCIPL; I2 region for mRNFL and GCC) was greater than the best AUC in 3-mm grid for GCL, GCC, and mRNFL (P<0.045). The AUC of GCL volume (0.920) was similar to those of GCC (0.920) and GCIPL (0.909) volume. The AUC of GCL T2 region thickness (0.942) was similar to those of GCC I2 region (0.942) and GCIPL T2 region (0.934) thickness.

Conclusions: Isolated macular GCL appears to be as good as GCC and GCIPL in glaucoma diagnosis, while IPL does not. Larger macular grids may be better at detecting glaucoma. Each layer has a characteristic region with the best glaucoma diagnostic capability.

*Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai

Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital

Bernard and Shirlee Brown Glaucoma Research Laboratory, Columbia University Medical Center, Harkness Eye Institute, New York

§Department of Ophthalmology, Hofstra Northwell School of Medicine, Hempstead, NY

George Washington University School of Medicine and Health Sciences, Washington, DC

Presented in part at the Association for Research in Vision and Ophthalmology, Denver, CO, May 6, 2015.

Supported by HRH Prince Ahmad bin Abdulaziz Al-Saud Research Fund of the New York Glaucoma Research Institute, Edith C. Blum Foundation Research Grant (A.S.), and Alpha-Omega-Alpha Carolyn L. Kuckein Student Research Fellowship (J.L.C.).

Disclosure: J.M.L.: Instrument support (Heidelberg Engineering, GmbH; Topcon Medical Systems), Consultant (Carl Zeiss Meditec Inc.). R.R.: Consultant (iSonic Medical), Stock options (Diopsys). S.C.P.: Honorarium (Heidelberg Engineering, GmbH). The remaining authors declare no conflict of interest.

Reprints: Sung Chul Park, MD, Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, 210 East 64th Street, New York, NY 10065 (e-mail:

Received March 24, 2016

Accepted September 20, 2016

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