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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Defining glaucomatous optic neuropathy using objective criteria from structural and functional testing.

Jayant Venkatramani Iyer1, Michael V Boland2, Joan Jefferys2

  • 1Glaucoma, Singapore National Eye Centre, Singapore, Singapore.

The British Journal of Ophthalmology
|July 24, 2020
PubMed
Summary

Objective criteria using optical coherence tomography (OCT) and perimetry can define glaucomatous optic neuropathy (GON). This aids consistent comparisons in glaucoma research studies.

Keywords:
Diagnostic tests/InvestigationEpidemiologyField of visionGlaucomaImagingOptic Nerve

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Neurology

Background:

  • Glaucomatous optic neuropathy (GON) diagnosis relies on subjective clinical assessment.
  • Standardized objective criteria are needed for consistent comparisons in glaucoma research.

Purpose of the Study:

  • To establish objective criteria for defining GON using optical coherence tomography (OCT) and perimetry.
  • To facilitate comparisons across glaucoma research studies.

Main Methods:

  • Cross-sectional study of 2580 eyes from 1531 adult glaucoma patients across nine global centers.
  • Evaluated physician diagnosis, OCT, and perimetry data against a global consensus panel of 176 glaucoma specialists.
  • Compared objective measures from OCT and perimetry to physician-graded diagnostic levels (definite, probable, not GON).

Main Results:

  • Neither OCT nor perimetry alone achieved adequate specificity (<90%) for defining GON.
  • The optimal definition combined abnormal OCT nerve fiber layer quadrants with a matching abnormal Glaucoma Hemifield Test.
  • This combined approach yielded 77% sensitivity at 98% specificity.

Conclusions:

  • Objective criteria for defining GON are practical and valuable.
  • These criteria can supplement subjective clinical assessments in glaucoma research.
  • Standardized definitions improve the comparability of glaucoma research studies.