Macular ganglion cell/inner plexiform layer measurements by spectral domain optical coherence tomography for detection of early glaucoma and comparison to retinal nerve fiber layer measurements

Am J Ophthalmol. 2013 Dec;156(6):1297-1307.e2. doi: 10.1016/j.ajo.2013.08.001. Epub 2013 Sep 25.


Purpose: To evaluate the performance of ganglion cell layer/inner plexiform layer (GCL/IPL) measurements with spectral-domain optical coherence tomography (Cirrus HD-OCT) for detection of early glaucoma and to compare results to retinal nerve fiber layer (RNFL) measurements.

Design: Cross-sectional prospective diagnostic study.

Methods: We enrolled 99 subjects, including 59 eyes with glaucoma (47 subjects) (mean deviation >-6.0 dB) and 91 normal eyes (52 subjects). Patients underwent biometry and peripapillary and macular OCT imaging. Performance of the GCL/IPL and RNFL algorithms was evaluated with area under receiver operating characteristic curves (AUC), likelihood ratios, and sensitivities/specificities adjusting for covariates. Combination of best parameters was explored.

Results: Average (SD) mean deviation in the glaucoma group was -2.5 (1.9) dB. On multivariate analyses, age (P < 0.001) and axial length (P = 0.03) predicted GC/IPL measurements in normal subjects. No significant correlation was found between average or regional GC/IPL thickness and respective outer retina (OR) thickness measurements (P > 0.05). Average RNFL thickness performed better than average GCL/IPL measurements for detection of glaucoma (AUC = 0.964 vs 0.937; P = 0.04). The best regional measures from each algorithm (inferior quadrant RNFL vs minimum GCL/IPL) had comparable performances (P = 0.78). Entering the GC/IPL to OR ratio into prediction models did not enhance the performance of the GCL/IPL measures. Combining the best parameters from each algorithm improved detection of glaucoma (P = 0.04).

Conclusions: Regional GCL/IPL measures derived from Cirrus HD-OCT performed as well as regional RNFL outcomes for detection of early glaucoma. Using the GC/IPL to OR ratio did not enhance the performance of GCL/IPL parameters. Combining the best measures from the 2 algorithms improved detection of glaucoma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Algorithms
  • Area Under Curve
  • Biometry
  • Cross-Sectional Studies
  • Early Diagnosis
  • Female
  • Glaucoma, Open-Angle / diagnosis*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Nerve Fibers / pathology*
  • Optic Nerve Diseases / diagnosis*
  • Prospective Studies
  • ROC Curve
  • Reproducibility of Results
  • Retinal Ganglion Cells / pathology*
  • Sensitivity and Specificity
  • Tomography, Optical Coherence / methods*
  • Visual Field Tests