Diagnostic Power of Optic Disc Morphology, Peripapillary Retinal Nerve Fiber Layer Thickness, and Macular Inner Retinal Layer Thickness in Glaucoma Diagnosis With Fourier-domain Optical Coherence Tomography

Purpose: To evaluate the capability of the optic disc, peripapillary retinal nerve fiber layer (P-RNFL), macular inner retinal layer (M-IRL) parameters, and their combination obtained by Fourier-domain optical coherent tomography (OCT) in differentiating a glaucoma suspect from perimetric glaucoma. Methods: Two hundred and twenty eyes from 220 patients were enrolled in this study. The optic disc morphology, P-RNFL, and M-IRL were assessed by the Fourier-domain OCT (RTVue OCT, Model RT100, Optovue, Fremont, CA). A linear discriminant function was generated by stepwise linear discriminant analysis on the basis of OCT parameters and demographic factors. The diagnostic power of these parameters was evaluated with receiver operating characteristic (ROC) curve analysis. The diagnostic power in the clinically relevant range (specificity >= 80%) was presented as the partial area under the ROC curve (partial AROC). Results: The individual OCT parameter with the largest AROC and partial AROC in the high specificity (>= 80%) range were cup/disc vertical ratio (AROC = 0.854 and partial AROC = 0.142) for the optic disc parameters, average thickness (AROC = 0.919 and partial AROC = 0.147) for P-RNFL parameters, inferior hemisphere thickness (AROC = 0.871 and partial AROC = 0.138) for M-IRL parameters, respectively. The linear discriminant function further enhanced the ability in detecting perimetric glaucoma (AROC = 0.970 and partial AROC = 0.172). Conclusions: Average P-RNFL thickness is the optimal individual OCT parameter to detect perimetric glaucoma. Simultaneous evaluation on disc morphology, P-RNFL, and M-IRL thickness can improve the diagnostic accuracy in diagnosing glaucoma.