Editors Selection IGR 19-4

Clinical Examination Methods: Fiber layer measurements at various sites

Gábor Holló

Comment by Gábor Holló on:

79196 Macular versus nerve fibre layer versus optic nerve head imaging for diagnosing glaucoma at different stages of the disease: Multicenter Italian Glaucoma Imaging Study, Michelessi M; Riva I; Martini E et al., Acta Ophthalmologica, 2019; 97: e207-e215

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In addition to the peripapillary retinal nerve fiber layer thickness (RNFLT), various parameters including macular retinal thickness and minimum rim width (MRW) have become available on the Spectralis OCT system for glaucoma assessment. In the Multicenter Italian Glaucoma Imaging Study, Michelessi et al. address an important issue for Spectralis OCT users: which parameter perform the best to separate healthy eyes from open-angle glaucomatous eyes. The study population comprised 197 glaucoma eyes and 83 normal eyes (one eye per participant) which were classified according to the result of reliable Humphrey 24-2 visual field tests. Glaucoma suspects and preperimetric glaucoma eyes were not included. The average MRW showed the best diagnostic performance (AUC 0.968; sensitivity at > 90% specificity 92.4%), followed by the average RNFLT (AUC 0.939; sensitivity at > 90% specificity 84.77%), and then central macular thickness (AUC ≤ 0.918; sensitivity at > 90% specificity ≤ 81.73). For the separation of early glaucoma eyes from the normal eyes average MRW (AUC 0.956) and average RNFLT (AUC 0.929) performed similarly and significantly better than central macular thickness parameters (AUC ≤ 0.874). It is also interesting that AUCs of the MRW sectors were not statistically inferior to that of average MRW. These results suggest that average and sector MRW are particularly useful new diagnostic parameters of the Spectralis OCT. They perform similarly to average RNFLT and considerably better than any macular thickness parameter of the same OCT system.

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