New Glaucoma Insights: PerspectiveRationale and Development of an OCT-Based Method for Detection of Glaucomatous Optic NeuropathyLiebmann, Jeffrey M. MD*; Hood, Donald C. PhD*,†; de Moraes, Carlos Gustavo MD, PhD, MPH*; Blumberg, Dana M. MD, MPH*; Harizman, Noga MD*; Kresch, Yocheved S. OD, MS*; Tsamis, Emmanouil PhD†; Cioffi, George A. MD* Author Information *Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center †Department of Psychology, Columbia University, New York, NY Supported in part by the Jane and David Walentas Glaucoma Research Fund, Columbia University Department of Ophthalmology; an unrestricted grant to the Department of Ophthalmology from Research to Prevent Blindness, Inc., New York, NY; and National Institutes of Health (Bethesda, MD) Grants EY-02115 (D.C.H.) and EY-025253 (C.G.d.M.). Disclosure: J.M.L. received instrument support from Carl Zeiss Meditech Inc. and Heidelberg Engineering GmbH. D.C.H. received equipment and grant funding from Heidelberg Engineering and Topcon Inc.; received grant funding from Novartis. The remaining authors declare no conflict of interest. Reprints: Jeffrey M. Liebmann, MD, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165th Street, Box 29, New York, NY 10032 (e-mail: [email protected]). Journal of Glaucoma: June 2022 - Volume 31 - Issue 6 - p 375-381 doi: 10.1097/IJG.0000000000002005 Buy Metrics Abstract A specific, sensitive, and intersubjectively verifiable definition of disease for clinical care and research remains an important unmet need in the field of glaucoma. Using an iterative, consensus-building approach and employing pilot data, an optical coherence tomography (OCT)-based method to aid in the detection of glaucomatous optic neuropathy was sought to address this challenge. To maximize the chance of success, we utilized all available information from the OCT circle and cube scans, applied both quantitative and semiquantitative data analysis methods, and aimed to limit the use of perimetry to cases where it is absolutely necessary. The outcome of this approach was an OCT-based method for the diagnosis of glaucomatous optic neuropathy that did not require the use of perimetry for initial diagnosis. A decision tree was devised for testing and implementation in clinical practice and research that can be used by reading centers, researchers, and clinicians. While initial pilot data were encouraging, future testing and validation will be needed to establish its utility in clinical practice, as well as for research. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.