PurposeTo describe a new method, the Optical Coherence Tomography (OCT) Glaucoma Staging System, for classifying retinal nerve fiber layer (RNFL) damage assessed with OCT.Patients and methodsThe OCT Glaucoma Staging System was created based on data obtained from Nidek RS 3000 spectral-domain (sd)-OCT. This system uses the superior and inferior quadrant RNFL thickness values, plotted on an x-y diagram for staging structural damage severity in glaucoma. A non-linear equation and two regression lines describe the boundary lines which separate the different sectors of the diagram. These mathematical formulas have been used to create a software, which provides a quick classification of the RNFL damage. Sensitivity and specificity of the system were assessed in a different cohort including 64 patients with early OAG, and 62 normal subjects.ResultsThree hundred and two OCT tests from 98 healthy controls and 284 patients affected by either ocular hypertension or chronic open-angle glaucoma were considered in order to design the new classification system. The OCT Glaucoma Staging System classifies RNFL defects into 6 stages of increasing severity ranging from borderline to stage 5, and 3 groups according to defect localization (superior, inferior, or diffuse). Sensitivity and specificity in discriminating between healthy and glaucomatous eyes were 95.2 and 91.9%, respectively, considering borderline results as abnormal.ConclusionsThe OCT Glaucoma Staging System appears to provide a standardized and objective classification of glaucomatous RNFL damage. It can be used in day-to-day clinical practice for an easy and fast interpretation of RNFL measurements obtained with OCT.