Structural and functional assessment of macula to diagnose glaucoma

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Diagnostics

Background:

• Glaucoma diagnosis relies on both structural and functional assessments.
• Macular assessments are crucial for early glaucoma detection.
• Comparing spectral domain optical coherence tomography (SDOCT) with standard automated perimetry (SAP) and microperimetry (MP) is essential for optimizing diagnostic strategies.

Purpose of the Study:

• To compare the diagnostic performance of structural (ganglion cell-inner plexiform layer (GCIPL) thickness via SDOCT) and functional (visual sensitivities via SAP and MP) macular assessments in glaucoma detection.
• To evaluate the effectiveness of different macular sectors in diagnosing glaucoma using these methods.

Main Methods:

• A prospective study involving 61 glaucoma eyes and 46 control eyes.
• Measurements included GCIPL thickness (SDOCT) and visual sensitivities (SAP, MP) in the central 10° macula.
• Diagnostic ability was assessed using area under the receiver-operating characteristic (AUC) curves and sensitivity at 95% specificity.

Main Results:

• GCIPL parameters showed higher AUCs (0.58–0.79) compared to SAP (0.59–0.71) and MP (0.59–0.72), though not statistically significant for all sectors.
• Sensitivities at 95% specificity were significantly better for GCIPL (31–59%) than SAP (16–34%) and MP (8–38%).
• Inferotemporal, inferior, and superotemporal sectors demonstrated the best diagnostic capabilities for both GCIPL and visual sensitivity.

Conclusions:

• Ganglion cell-inner plexiform layer (GCIPL) thickness measurement using SDOCT is a more effective structural biomarker for glaucoma diagnosis at the macula than functional tests like SAP and MP.
• SDOCT-based GCIPL assessment offers superior sensitivity for detecting glaucoma compared to visual field testing.
• Macular structural assessment holds significant promise for improving glaucoma diagnosis.