Three-dimensional imaging of the macular retinal nerve fiber layer in glaucoma with spectral-domain optical coherence...

To investigate the three-dimensional (3D), spectral-domain (SD) optical coherence tomography (3D,SD-OCT) imaging of the macular retinal nerve fiber layer (RNFL) in eyes with glaucoma.

The study included 38 eyes of 38 patients with glaucoma and 38 normal eyes of 38 volunteers. With a 3D raster scan SD-OCT protocol, 512 × 128 axial scans were acquired over a 6-mm(2) area of the macula. Findings on 3D,SD-OCT images were compared with those on color and red-free fundus photographs and time-domain (TD) OCT.

Fourteen (30.4%) more RNFL defects were detected on 3D,SD-OCT images than on color fundus photographs. Of these 14, 12 were detected in 10 (90.9%) of 11 eyes with tessellated fundi (P < 0.0001). On 3D,SD-OCT images, complete loss of the RNFL reflectivity was seen in 63.0% of the RNFL defects and thinning of the RNFL in the rest. On TD-OCT cpRNFL analysis, RNFL defects that appeared on 3D,SD-OCT as a complete loss of RNFL reflectivity were detected more often (P = 0.012) than those that appeared as thinning of the RNFL. Inter-rater agreement was better for RNFL defects on 3D,SD-OCT (0.85) than for those on color (0.62-0.64) or red-free (0.68-0.70) fundus photographs. However, 3D,SD-OCT macular RNFL thickness measurements were substantially reproducible but not as reproducible as macular retinal thickness measurements, and neither was as sensitive as TD-OCT cpRNFL thickness measurements for detecting glaucoma.

3D,SD-OCT imaging of the macular RNFL is an effective means of detecting macular RNFL defects and their severity in eyes with glaucoma.