Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

Purpose: To test the hypothesis that macular ganglion cell layer (GCL) measurements detect early glaucoma with higher accuracy than ganglion cell/inner plexiform layer (GCIPL) thickness measurements. Design: Cross-sectional study.Participants: The first cohort included 58 glaucomatous eyes with visual field mean deviation (MD) & GE; -6 dB and 125 normal eyes. The second cohort included 72 glaucomatous and 73 normal/glaucoma suspect (GS) eyes with scans able to create GCL/GCIPL deviation maps.Methods: In the first cohort, 8 x 8 GCL and GCIPL grids were exported and 5 superior and inferior sectors were defined. Global and sectoral GCL and GCIPL measures were used to predict glaucoma. In the second cohort, proportions of scan areas with abnormal (< 5% and < 1% cutoffs) and supernormal (> 95% and > 99% cutoffs) thicknesses on deviation maps were calculated. The extents of GCL and GCIPL abnormal areas were used to predict glaucoma. Main Outcome Measures: Extents of abnormal GCL/GCIPL regions and areas under receiver operating characteristic curves (AUROC) for prediction of glaucoma were compared between GCL or GCIPL measures.Results: The average & PLUSMN; standard deviation MDs were -3.7 & PLUSMN; 1.6 dB and -2.7 & PLUSMN; 1.8 dB in glaucomatous eyes in the first and second cohorts, respectively. Global GCIPL thickness measures (central 18 & DEG; x 18 & DEG; macular region) performed better than GCL for early detection of glaucoma (AUROC, 0.928 vs. 0.884, respectively; P = 0.004). Superior and inferior sector 3 thickness measures provided the best discrimination with both GCL and GCIPL (inferior GCL AUROC, 0.860 vs. GCIPL AUROC, 0.916 [P = 0.001]; superior GCL AUROC, 0.916 vs. GCIPL AUROC, 0.900 [P = 0.24]). The extents of abnormal GCL regions at a 1% cutoff in the central elliptical area were 17.5 & PLUSMN; 22.2% and 6.4 & PLUSMN; 10.8% in glaucomatous and normal/GS eyes, respectively, versus 17.0 & PLUSMN; 22.2% and 5.7 & PLUSMN; 10.5%, respectively, for GCIPL (P = 0.06 for GCL and 0.002 for GCIPL). The extents of GCL and GCIPL supernormal regions were mostly similar in glaucomatous and normal eyes. The best performance for prediction of glaucoma in the second cohort was detected at a P value of < 1% within the entire scan for both GCL and GCIPL (AUC, 0.681 vs. 0.668, respectively; P = 0.29).Conclusions: Macular GCL and GCIPL thicknesses are equivalent for identifying early glaucoma with current OCT technology. This is likely explained by limitations of inner macular layer segmentation and concurrent changes within the inner plexiform layer in early glaucoma. Ophthalmology Glaucoma 2023;6:58-67 & COPY; 2022 by the American Academy of Ophthalmology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

The purpose of this study was to compare the accuracy of macular ganglion cell layer (GCL) measurements with ganglion cell/inner plexiform layer (GCIPL) thickness measurements in detecting early glaucoma. The results showed that GCL and GCIPL thicknesses were equivalent in identifying early glaucoma with current OCT technology. This may be due to limitations in inner macular layer segmentation and concurrent changes within the inner plexiform layer in early glaucoma.