A comparison of optical coherence tomography and retinal nerve fiber layer photography for detection of nerve fiber layer damage in glaucoma

Purpose: To compare optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurements with established methods for assessment of glaucomatous damage using RNFL photography and visual field testing. Design: Cross-sectional study. Participants: Fifty-eight eyes of 58 healthy volunteer ocular hypertensive patients, glaucoma suspect patients, and glaucoma patients were included. Methods: Optical coherence tomography 3.4-mm diameter circular scans were obtained within 3 months of RNFL photography and standard achromatic visual field testing. Three independent observers graded RNFL photographs using two standardized protocols. For each method, superior and inferior arcuate bundles were scored separately, and interobserver and intraobserver variation was measured. Standard achromatic visual field mean deviation in the superior and inferior hemifields was compared with RNFL damage as assessed by photography and OCT RNFL thickness measurements. Main Outcome Measures: Visual field mean deviation and severity of glaucomatous RNFL damage as assessed by photography. Results: Optical coherence tomography RNFL thickness decreased with increasing RNFL damage as assessed by photography using both methods of photographic assessment. Standard achromatic perimetry mean deviation was significantly associated with OCT RNFL thickness (R-2 35%-43%) and RNFL photography severity score (R-2 = 18%-29%). Conclusions: These results suggest that the OCT shows promise for providing quantitative measures of RNFL thickness for diagnosing and monitoring glaucoma. (C) 2000 by the American Academy of Ophthalmology.