Diagnostic Performance of Optical Coherence Tomography Ganglion Cell--Inner Plexiform Layer Thickness Measurements in Early Glaucoma

Ophthalmology. 2014 Apr;121(4):849-54. doi: 10.1016/j.ophtha.2013.10.044. Epub 2014 Jan 3.


Purpose: To evaluate the glaucoma diagnostic performance of ganglion cell inner-plexiform layer (GCIPL) parameters used individually and in combination with retinal nerve fiber layer (RNFL) or optic nerve head (ONH) parameters measured with Cirrus HD-OCT (Carl Zeiss Meditec, Inc, Dublin, CA).

Design: Prospective cross-sectional study.

Participants: Fifty patients with early perimetric glaucoma and 49 age-matched healthy subjects.

Methods: Three peripapillary RNFL and 3 macular GCIPL scans were obtained in 1 eye of each participant. A patient was considered glaucomatous if at least 2 of the 3 RNFL or GCIPL scans had the average or at least 1 sector measurement flagged at 1% to 5% or less than 1%. The diagnostic performance was determined for each GCIPL, RNFL, and ONH parameter as well as for binary or-logic and and-logic combinations of GCIPL with RNFL or ONH parameters.

Main outcome measures: Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

Results: Among GCIPL parameters, the minimum had the best diagnostic performance (sensitivity, 82.0%; specificity, 87.8%; PLR, 6.69; and NLR, 0.21). Inferior quadrant was the best RNFL parameter (sensitivity, 74%; specificity, 95.9%; PLR, 18.13; and NLR, 0.27), as was rim area (sensitivity, 68%; specificity, 98%; PLR, 33.3; and NLR, 0.33) among ONH parameters. The or-logic combination of minimum GCIPL and average RNFL provided the overall best diagnostic performance (sensitivity, 94%; specificity, 85.7%; PRL, 6.58; and NLR, 0.07) as compared with the best RNFL, best ONH, and best and-logic combination (minimum GCIPL and inferior quadrant RNFL; sensitivity, 64%; specificity, 100%; PLR, infinity; and NPR, 0.36).

Conclusions: The binary or-logic combination of minimum GCIPL and average RNFL or rim area provides better diagnostic performances than those of and-logic combinations or best single GCIPL, RNFL, or ONH parameters. This finding may be clinically valuable for the diagnosis of early glaucoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Axons / pathology*
  • Cross-Sectional Studies
  • Diagnostic Techniques, Ophthalmological*
  • Female
  • Glaucoma / diagnosis*
  • Humans
  • Intraocular Pressure
  • Likelihood Functions
  • Male
  • Middle Aged
  • Optic Disk / pathology*
  • Optic Nerve Diseases / diagnosis*
  • Prospective Studies
  • Retinal Ganglion Cells / pathology*
  • Sensitivity and Specificity
  • Tomography, Optical Coherence*
  • Visual Field Tests
  • Visual Fields / physiology