Glaucoma Diagnostic Ability of Quadrant and Clock-Hour Neuroretinal Rim Assessment Using Cirrus HD Optical Coherence Tomography

Abstract

PURPOSE. The aim of this study was to investigate the glaucoma diagnostic ability of quadrant and clock-hour neuroretinal rim assessment by Cirrus HD spectral-domain optical coherence tomography (OCT). METHODS. Eighty eyes of 80 glaucoma patients and 80 eyes of 80 healthy subjects were enrolled. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Cirrus HD-OCT. Quadrant and clock-hour rim areas and thicknesses were obtained from optic nerve head images and 360 degrees circumferential rim thickness curve of Cirrus HD-OCT, respectively. Area under receiver operating characteristic curves (AUCs) and sensitivities of RNFL thicknesses, rim areas, and rim thicknesses at a 90% specificity level were calculated. RESULTS. Quadrant and clock-hour rim area and thickness showed good diagnostic ability for glaucoma in all areas (AUCs, 0.877-0.969; sensitivities, 67.5%-96.3%). When the AUCs of RNFL thicknesses, rim areas, and rim thicknesses were compared, no significant difference was found in global area and superior and inferior quadrants (P > 0.05). However, in nasal and temporal quadrants, rim area and thickness had greater AUCs (AUCs, 0.919-0.945; sensitivities, 82.5%-86.3%) than RNFL thickness (AUCs, 0.749-0.776; sensitivities, 12.5%-33.8%; P < 0.001). Eyes with moderate to advanced glaucoma (mean deviation < -6 dB) had thinner RNFL than mild glaucoma (mean deviation >= -6 dB) in global area, superior, inferior, and temporal quadrants (P < 0.003); rim area and thickness showed no significant difference in all areas (P > 0.003). CONCLUSIONS. Neuroretinal rim assessment in nasal and temporal areas by Cirrus HD-OCT may enhance glaucoma diagnostic ability. RNFL and rim changes measured by Cirrus HD-OCT may be different according to the stages of glaucomatous damage. (Invest Ophthalmol Vis Sci. 2012; 53: 2226-2234) DOI:10.1167/iovs.11-8689