Early Diagnosis of Glaucoma By Optical Coherence Tomography: A Systematic Review and Network Meta-analysis

This study aimed to investigate normal values and interocular differences in retinal nerve fibre layer (RNFL) thickness, using optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT), in 5-16-year-old children born at full-term with normal birthweights. Fifty-six children with normal visual acuity and refraction were examined with Stratus OCT and HRT. Three examinations were performed in each eye. One eye in each child was randomized for analyses of normal values. Findings in 54 eyes were evaluated. Mean values of RNFL thickness were calculated. Coefficients of variance and intraclass correlations were calculated. The correlation between right and left eyes and the limits of difference were determined for both methods. Mean RNFL thickness was 98.4 μm (standard deviation [SD] 7.88 μm) assessed with OCT and 213.0 μm (SD 54.0 μm) assessed with HRT. No correlations between age or gender and RNFL thickness were found. The coefficients of variance were 2.9% and 5.6% for OCT and HRT, respectively, and intraclass correlations were 0.85 and 0.88, respectively. The limits of difference between the two eyes ranged from -9 μm to 9 μm with OCT and from -109 μm to 87 μm with HRT. Both OCT and HRT can be used in children aged 5-16 years, but OCT provides less variability in determinations of RNFL thickness, both in repeated examinations of the same eye and in comparisons between the two eyes. The present study provides values for normal RNFL thickness in healthy children which can be used to make comparisons with values in children with optic nerve diseases.

To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high-pass resolution perimetry (HRP). Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans-sphenoidal and one trans-cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino-cortical neural channels in HRP. RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression.

Purpose: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured by spectral and time domain optical coherence tomography (OCT).Patients and Methods: One hundred and eighty-eight subjects (normal tension glaucoma, n = 80; primary open angle glaucoma, n = 49; healthy controls, n = 59) were included in this study. Peripapillary RNFL thickness was measured by an Optic Disc Cube 200 × 200 scan of the spectral domain Cirrus HD OCT and by a Fast RNFL scan of the time domain Stratus OCT. They were compared using linear regression (R2), Bland-Altman plots, weighted Kappa (Kw) coefficients, and areas under the receiver operating characteristic curve (AROC).Results: Except for the inferior quadrant, RNFL thickness measurements by Cirrus HD OCT were thinner than Stratus OCT (all p < 0.001); for the inferior quadrant, this tendency was vice versa (p = 0.043). Average RNFL thicknesses of the two OCTs showed a good correlation (R2, 0.852) but not excellent agreement (mean of difference, 4.0 μm; +1.96 SD, 10.7 μm; -1.96 SD, -18.6 μm). Regarding the probability codes, only the average RNFL thickness had almost perfect agreement (Kw, 0.983). In addition, Cirrus HD OCT had the largest AROC for the superior quadrant (0.795), but Stratus OCT had the largest AROC for average RNFL thickness (0.764) (p = 0.281).Conclusions: Except for the inferior quadrant, the average and quadrants RNFL thickness measured by the Cirrus HD OCT were thinner than the Stratus OCT. Regarding discriminating power for glaucoma detection, the Cirrus HD OCT was better than the Stratus OCT for the superior and inferior quadrant RNFL thicknesses but not for the average RNFL thickness.

The purpose of this study was to model the influence of cataract on Spectral Domain Optical Coherence Tomography (SDOCT) image quality and Retinal Nerve Fibre Layer (RNFL) thickness measurements. SDOCT images, made with two different devices (3DOCT-1000, Topcon and Cirrus HD-OCT), before and after cataract surgery were compared and judged against measurements from normal subjects using artificial filters simulating the effects of cataract. Optical density of the images was calculated based on a mathematical model described previously. In total, forty-eight eyes were included for pre- and postoperative cataract extraction measurements. OCT image quality significantly (p < 0.001) improved postoperative and postoperative RNFL thickness was significantly (p < 0.001) thicker in both groups of patients. The measurements using artificial filters showed a rather precise linear relation between change in filter induced optical density and change in RNFL thickness (R = 0.941, p < 0.001 for 3DOCT-1000 and R = 0.785, p < 0.001 for Cirrus HD-OCT). For the patient groups, the relation was less marked, 3DOCT-1000 Rs = 0.697, p < 0.03 and Cirrus HD-OCT Rs = 0.444, p < 0.03. The predictive potential based on the found linear relationship between OCT-effective optical density of cataract and the cataract-induced underestimation was however limited, and mean difference ± SD between predicted and measured RNFL thickness were 1.68 ± 7.55 (3DOCT-1000) and 3.71 ± 2.97 (Cirrus HD-OCT) micron. A linear relationship exists between OCT-effective optical density of cataract and underestimation of RNFL thickness measured with OCT. This finding holds promise to correct for cataract-induced changes in RNFL measurements, but will differ for each type of OCT device.

Objective: To discuss the correlation between the peripapillary retinal nerve fiber layer (RNFL) thickness and the visual field mean defect in different periods of pseudoexfoliation glaucoma (PXG). Methods: This was a clinical case control study. In the study, samples were selected consecutively from patients who were hospitalized in the Glaucoma Department of the First Hospital of Shijiazhuang from January 2013 to January 2018. The PXG group included 97 eyes of 97 patients who were divided into an early PXG group (28 eyes), a medium PXG group (27 eyes), and a late PXG group (42 eyes). The normal control group consisted of 32 eyes of 32 people who were matched for age, gender and refractive error. All subjects underwent spectral domain optical coherence tomography (SD-OCT) scans to measure peripapillary RNFL thickness in every quadrant. The SD-OCT and the visual field measurements among the different groups were compared using analysis of variance, and the correlation between the average RNFL thickness and visual field defects were analyzed with a Pearson correlation. Results: The average RNFL thickness in the normal control group, and the early, medium and late PXG groups was 104±11 μm, 92±14 μm, 82±12 μm, and 54±18 μm, respectively. The difference between the 4 groups in nasal, nasal superior, temporal superior, temporal, temporal inferior, nasal inferior quadrants and the average RNFL thickness were all statistically significant (F=24.38, 36.40, 47.84, 8.70, 95.46, 54.75, 82.28, all P<0.001). The differences between the normal control group and the early PXG group in the temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences between the normal control group and the medium PXG group in the nasal, nasal superior, temporal superior, temporal inferior, and nasal inferior quadrants and the average RNFL thickness were statistically significant (all P<0.05). The differences in RNFL thickness between the normal control group and the late PXG group in every quadrant were statistically significant (P<0.001). The average RNFL thickness was positively correlated with visual field mean differences in the medium PXG group and the late PXG group (r=0.404, P=0.037; r=0.582, P<0.001). Conclusions: The average peripapillary RNFL thickness is positively correlated with visual field mean differences in the medium and late PXG eyes. The changes of peripapillary RNFL thickness can be monitered by SD-OCT, which can be used as an important reference index for the status and follow-up of PXG. Key words: optical coherence tomography; pseudoexfoliation glaucoma; peripapillary retinal nerve fiber layer thickness; visual field mean defect; correlation

Background Glaucoma is an optic neuropathy caused by structural damage of the optic nerve,and its early diagnosis is critical for arresting the irreversible damage of visual function. Optical coherence tomography (OCT) allows an early diagnosis of glaucoma by the measurements of the optic disc and retinal nerve fiber parameters. Objective This study was carried out to evaluate the effects of optic disc tomography and the measurement of the retinal nerve fiber layer (RNFL) thickness by spectral-domain OCT on the diagnosis of glaucomatous eye. Methods It was a noninterventional, cross-sectional study. The optic disc topographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 62 normal eyes and 67 glaucomatous eyes. The area under the receiver operating characteristic curve( ROC ) was used to assess the ability to differentiate glaucoma eyes from normal eyes of each testing parameter. This trial complied with the Helsinki Declaration and was approved by the Clinical Trial Ethic Committee of Beijing Tongren Hospital. All of the participants signed the written informed consent before any medical examination. Results In the comparison of demography ,the ages of patients, the mean deficiency( MD ) and pattern standard difference( PSD ) of perimetry were obviously larger in the glaucoma group, primary open angle glaucoma ( POAG ) group and primary closure-angle glaucoma(PACG) group than those of normal controls( P＜0. 01 ). No significant differences were found in the disc area between a total glaucoma group, POAG group or PACG group and normal group ( P =0. 101,0. 741 and 0. 652, respectively) ;however, the average RNFL thickness between normal eyes and glaucomatous eyes were significantly different( 109. 758 μm versus 79. 539 μm, P＜0. 01 ). Among the eight regions around the optic disc, the thickest RNFL located at the inferotemporal( 150. 109 μm) and superotemporal( 146. 105 μm) regions in normal eyes,and at the superotemporal( 104. 354 μm) and inferotemporal( 102. 436 μm) regions in glaucomatous eyes. Both in normal and glaucomatous eyes,the thinnest RNFL located at the nasal(NU+NL) and temporal(TU + TL) regions. For optic disc topographic parameters,the highest ROC were observed in rim volume( ROC--0. 850,0. 841 and 0. 862 in total glaucoma,POAG and PACG, respectively) and vertical cup/disc ratio( ROC =0. 840,0. 849 and 0. 830 in total glaucoma,POAG and PACG,respectively), and the sensitivities for specificity cutoff set at 80％ were 73.1％ and 76. 1％ in total glaucoma,73.0％ and 81.1％ in POAG and 73.3％ and 70.0％ in PACG, respectively. For RNFL thickness ,the highest ROC was observed in average RNFL( ROC =0. 925,0. 910 and 0. 942 in total glaucoma, POAG and PACG,respectively) ,and the sensitivities for specificity cutoff set at 80％ were 89. 6％ ,89.2％ and 90. 0％ in total glaucoma,POAG and PACG, respectively. Among the eight regions around the optic disc, RNFL thickness of region IT achieved the highest ROC, RNFL thickness of region TU and TL had the lowest ROC. Conclusions RTVue OCT appears to be of fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT shows promise for the diagnosis of glaucoma. Key words: Optical coherence tomography; Glaucoma; Optic disc; Retinal nerve fiber layer

BackgroundTo determine the influences of myopia and optic disc size on ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) thickness profiles obtained by spectral domain optical coherence tomography (OCT).MethodsOne hundred and sixty-eight eyes of 168 young myopic subjects were recruited and assigned to one of three groups according to their spherical equivalent (SE) values and optic disc area. All underwent Cirrus HD-OCT imaging. The influences of myopia and optic disc size on the GCIPL and RNFL thickness profiles were evaluated by multiple comparisons and linear regression analysis. Three-dimensional surface plots of GCIPL and RNFL thickness corresponding to different combinations of myopia and optic disc size were constructed.ResultsEach of the quadrant RNFL thicknesses and their overall average were significantly thinner in high myopia compared to low myopia, except for the temporal quadrant (all Ps ≤0.003). The average and all-sectors GCIPL were significantly thinner in high myopia than in moderate- and/or low-myopia (all Ps ≤0.002). The average OCT RNFL thickness was correlated significantly with SE (0.81 μm/diopter, P < 0.001), axial length (-1.44 μm/mm, P < 0.001), and optic disc area (5.35 μm/mm2, P < 0.001) by linear regression analysis. As for the OCT GCIPL parameters, average GCIPL thickness showed a significant correlation with SE (0.84 μm/diopter, P < 0.001) and axial length (-1.65 μm/mm, P < 0.001). There was no significant correlation of average GCIPL thickness with optic disc area. Three-dimensional curves showed that larger optic discs were associated with increased average RNFL thickness and that more-myopic eyes were associated with decreased average GCIPL and RNFL thickness.ConclusionMyopia can significantly affect GCIPL and RNFL thickness profiles, and optic disc size has a significant influence on RNFL thickness. The current OCT maps employed in the evaluation of glaucoma should be analyzed in consideration of refractive status and optic disc size.

The aim of this study was to assess parameters of retinal morphology by using high-definition optical coherence tomography (OCT) in patients with Wolfram syndrome (WFS) and their relation to optic tract atrophy in magnetic resonance imaging (MRI). High-definition OCT and MRI parameters were evaluated in 12 patients with WFS (three males, nine females; median age at examination 12y 8mo, range 10y 2mo-15y 11mo) and referred to 30 individuals with type 1 diabetes (T1D) (12 males, 18 females; median age at examination 20y 5mo, range 16y 8mo-21y 4mo) and 33 typically developing comparison participants (10 males, 23 females; median age at examination 20y 7mo, range 13y-22y 4mo). Total thickness and quadrant thickness of the retinal nerve fibre layer (RNFL), macular full-thickness parameters and macular ganglion cell layer/inner plexiform layer, intraorbital and intracranial thickness of the optical nerve, as well as the optic chiasm and visual tracts were significantly reduced in patients with WFS compared with those having T1D and the typically developing comparison participants. Optic chiasm thickness correlated negatively in patients with WFS with both age (r=-0.79; p=0.002) and duration of diabetes (r=-0.62; p=0.032). Thickness of the intraorbital parts of the optic nerves in patients with WFS correlated positively with thickness of the superior RNFL (r=0.73; p=0.006). High-definition OCT in combination with MRI could become an important tool for evaluating the effectiveness of therapeutic trials in patients with WFS. Provides evidence of significant reduction of retinal parameters and optic nerves in patients with Wolfram syndrome (WFS). Shows correlations between magnetic resonance imaging parameters and retinal morphology parameters in patients with WFS.

Peripapillary Retinal Nerve Fiber Layer Thickness in a Population of 6-Year-Old Children: Findings by Optical Coherence Tomography

To evaluate the role and ability of optical coherence tomography (OCT) to detect differences in peripapillary retinal nerve fiber layer (RNFL) thickness between normal and glaucomatous eyes and also between different severities of glaucoma. This cross-sectional observational study included 160 eyes of 160 healthy subjects and 134 eyes of 134 patients with primary open-angle glaucoma (POAG). Peripapillary RNFL thickness was measured on OCT using the fast RNFL thickness protocol. The RNFL thickness parameters used for evaluation included average RNFL thickness and inferior, superior, nasal, and temporal RNFL thickness. The glaucomatous eyes were subdivided into three subgroups on the basis of visual field defects and a fourth subgroup of eyes blinded by glaucoma. RNFL thickness parameters were compared among the normal eyes and the glaucoma subgroups. Correlation of global visual field indices with RNFL thickness parameters was also performed. The average RNFL in control subjects, early glaucoma, moderate glaucoma, severe glaucoma, and blind glaucoma were 102.30 +/- 10.34, 77.68 +/- 15.7, 66.07 +/- 15.5, 53.65 +/- 14.2, and 44.93 +/- 4.95 microm, respectively. There was a significant difference in all RNFL thickness parameters between normal and all glaucoma subgroups (P < 0.001). Average and inferior RNFL thicknesses showed the highest area under the receiver operating characteristic curve, with 0.905 and 0.862 for normal versus early glaucoma, 0.705 and 0.722 for early versus moderate glaucoma, 0.737 and 0.717 for moderate versus severe glaucoma, and 0.635 and 0.584 for severe versus blind glaucoma. Both mean deviation (MD) and corrected pattern standard deviation (CPSD) showed a significant correlation with all the RNFL thickness parameters in eyes with glaucoma (P < 0.001). RNFL thickness measured on OCT may serve as useful adjuncts in accurately and more objectively distinguishing normal from glaucomatous eyes, even in the early stages of glaucoma and may help to differentiate various severities of glaucoma. Average and inferior RNFL thicknesses are among the most efficient parameters for distinguishing such a differentiation. RNFL thicknesses in eyes blinded by glaucoma provide an estimate of the component of the RNFL thickness, which is not related to visual function.

To evaluate and compare the utility of ganglion cell complex with peripapillary retinal nerve fibre layer and optic nerve head measurements for detection of localized defects in patients with preperimetric glaucoma using spectral-domain optical coherence tomography. Prospective study. Preperimetric glaucoma patients. A total of 105 eyes with preperimetric glaucoma and 68 age- and refractive error-matched control eyes were enrolled. The ability to detect localized retinal nerve fibre layer defects by RTVue-100 spectral-domain optical coherence tomography (Optovue, Inc., Fremont, CA, USA) was assessed calculating the areas under receiver operating characteristic curves. The ability to detect localized retinal nerve fibre layer defects by spectral-domain optical coherence tomography. Global volume loss and superior ganglion cell complex thickness showed the largest area under receiver operating characteristic curve values (both areas under receiver operating characteristic curves 0.84, P < 0.001) among ganglion cell complex parameters. Average peripapillary retinal nerve fibre layer thickness afforded the best diagnostic capability (area under receiver operating characteristic curve 0.89, P < 0.001), whereas among optic nerve head parameters, the horizontal cup:disc ratio yielded the highest area under receiver operating characteristic curve (0.85, P < 0.001). No statistical difference was evident between the areas under receiver operating characteristic curves of the most informative parameters when the data were gathered from the three different sites (ganglion cell complex, peripapillary retinal nerve fibre layer, and optic nerve head) (P > 0.02). Ganglion cell complex thickness was significantly reduced in eyes with preperimetric glaucoma. Ganglion cell complex imaging using spectral-domain optical coherence tomography may be a useful ancillary modality for detection of early macular changes in glaucomatous eyes with localized retinal nerve fibre layer defects.

Purpose: To analyze peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters with regard to age in children by using optical coherence tomography (OCT). Methods: We analyzed RNFL thickness and ONH parameters by using Stratus OCT Model 3000 (Zeiss-Humphrey) in two-hundred eyes of 100 children ranging in age from 5 to 14 years, with 5 males and 5 females for each age. Results: The RNFL thicknesses for 100 children (200 eyes) in total were as follows: Mean 104.67±9.07 µm, superior 131.84±18.71 µm, temporal 78.49±12.91 µm, nasal 73.85±14.26 µm, and Inferior 133.87±18.58 µm. The parameters of ONH for 100 children (200 eyes) in total were as follows: optic disc area 2.80±0.21 mm2, rim area 1.85±0.28 mm2, cup to disc area ratio 0.34±0.08, horizontal cup to disc diameter ratio 0.47±0.11, and vertical cup to disc diameter ratio 0.49±0.11. In analyzed RNFL thickness and ONH according to age, there was a significant negative correlation among mean RNFL, inferior RNFL, and age (r=-0.258, p=0.000, r=-0.464, p=0.000). There was a significant positive correlation between nasal RNFL and age (r=0.135, p=0.028). There was a significant positive correlation between disc area and age (r=0.528, p=0.000). There was a significant negative correlation among the cup to disc area ratio, the horizontal cup to disc diameter ratio, the vertical cup to disc diameter ratio, and age (r=-0.170, p=0.008, r=-0.266, p=0.000, r=-0.155, p=0.014). Conclusions: OCT can be used to measure RNFL thickness and ONH parameters in children. Age had an effect on RNFL thickness and ONH parameters in children.

Objective To investigate the damage of retinal ganglion cell (RGC) axons in retinitis pigmentosa (RP) quantitatively by using reduced-filed-of-view DTI (rfov-DTI) together with optical coherence tomography (OCT). Methods Thirty four patients(68 eyes,Patient group)and 33 healthy controls(66 eyes, Control group) were enrolled in this study. Measures of rfov-DTI and OCT of both eyes in all subjects were performed by 3.0 MRI. The difference of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ//) and radial diffusivity (λ⊥) were compared by two independent sample t test. The peripapillary retinal nerve fiber layer (RNFL) thickness in temporal and lateral nose, which data don't conform to normal distribution, were calculated by average and four quadrants and compared by Mann-Whitney U test, the average RNFL thickness and RNFL thickness in low quadrant and upper quadrant were compared by two independent sample t test.Spearman rank were performed to determine the correlation between DTI parameters of optic nerves (ONs) and RNFL thickness. Results The value of FA, MD, λ//, λ⊥, average, temporalside, nasal side, low quadrant and upper quadrant RNFL thickness in patient group were 0.445±0.078, (1.330±0.236)×10-3mm2/s, (5.502±0.263)×10-3mm2/s, (4.494±0.238)×10-3mm2/s, (104.7±25.4)μm, (104.0±31.0)μm, (65.0±25.0)μm, (122.0±33.3)μm, and (117.4±37.7)μm respectively and the data in control group were 0.581±0.043, (1.079±0.146)×10-3mm2/s, (5.349±0.214)×10-3mm2/s, (4.195±0.126)×10-3mm2/s, (101.2±10.6)μm, (70.0±10.8)μm, (81.3±13.4)μm, (127.3±12.5)μm, (126.3±11.5)μm respectively. Compared with the control group, the value of MD, λ//, λ⊥ were significantly higher but FA was significantly lower (t=-12.388, 7.394, 3.695, 9.062;all P<0.01). The temporal RNFL was significantly thicker while the nasal RNFL was much thinner than that in control group respectively(Z=-8.384, -4.518;all P<0.01);the average, low quadrant and upper quadrant RNFL thickness showed no significant differences compared with the control group(t=-1.217, -1.843, 1.049;P=0.227, 0.069, 0.297).Especially, there was a weak correlation between the temporal RNFL thickness and FA (r=0.268,P=0.029), however, no correlation of nasal RNFL thickness with mean FA was found (r=0.164,P=0.186). Conclusions rFOV-DTI together with OCT can provide information about the pathology of RGC axon disease in patients with RP. there is a weak correlation between the retinal nerve fiber layer and the pathological changes of optic nerve in the retinal ganglion cells,but the performance were not coincident. Key words: Retinal degeneration; Retinal ganglion cells; Diffusion tensor imaging; Optic nerve; Optical coherence tomography

Purpose: The aim of the study was to compare the optical coherence tomography (OCT) parameters of the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) and to identify which measurements are best able to differentiate between normal and glaucoma suspect eyes.Methods: The study included 27 eyes with ocular hypertension (OHT), 33 eyes with pre‐perimetric glaucoma (PG), 30 perimetrically unaffected eyes of patients with glaucoma in the fellow eye (FE) and 58 eyes of age‐matched normal volunteers. All subjects underwent a complete eye examination with standard automated perimetry, optic disc photography and OCT imaging. Peripapillary ‘fast RNFL thickness scans’ and ‘fast optic disc scans’ were performed with time‐domain OCT. The ONH and RNFL parameters were compared among the four study groups. The ONH and RNFL parameters were examined alone and then combined via four linear discriminant functions (LDF): LDF 1, the optimal combination of ONH parameters; LDF 2, the optimal combination of RNFL parameters; LDF 3, the optimal combination of both ONH and RNFL parameters; and LDF 4, the optimal combination of the best 11 parameters. The areas under the receiver operating curves (AUC) and the sensitivity at fixed specificity of at least 80 and 95 per cent were calculated for single parameters and LDF combinations and then compared. The best 11 parameters were selected based on their AUC values.Results: Comparative analysis of OCT parameters revealed statistically significant differences in all seven ONH parameters in both PG and FE groups (and only in one ONH measurement in the ocular hypertensive group) when compared with normal eyes. Most of the RNFL parameters demonstrated statistically significant differences in all of the study groups when compared with the control group. The max‐min parameter (0.835), inferior quadrant (0.833) and average RNFL thickness (0.829) obtained the highest AUC values in the whole glaucoma suspect group. The rim area had the best diagnostic accuracy among the ONH parameters (AUC = 0.817). The AUC values of the four LDF were: 0.825 (LDF 1), 0.882 (LDF 2), 0.902 (LDF 3) and 0.888 (LDF 4). Statistically significant differences were found between the AUC values of the single best ONH and RNFL parameters and LDF 3 and LDF 4.Conclusions: In the present study, RNFL parameters presented with better discriminatory abilities than ONH parameters in the OHT and FE groups. The ONH parameters demonstrated better diagnostic precision in differentiating between PG and normal eyes. The average RNFL thickness, max–min parameter and inferior quadrant RNFL thickness had the best abilities among single OCT measurements for discriminating between glaucoma suspect (including all ocular hypertensive, PG and FE eyes) and normal eyes. The combination of RNFL parameters only or both ONH and RNFL parameters, using linear discriminant analysis, provided the best classification results, improving the diagnostic accuracy of the instrument.

To study the relationship between retinal nerve fiber layer (RNFL) thickness and brain atrophy using magnetic resonance imaging (MRI) with bicaudate ratio (BCR) in patients with multiple sclerosis (MS) with different levels of disease severity. We also assessed whether RNFL thickness correlated with Expanded Disability Status Scale (EDSS) score. The participants consisted of 88 patients with MS and 59 age- and sex-matched healthy control subjects. Eleven patients had clinically isolated syndrome (CIS), 68 patients had relapsing-remitting MS (RR-MS), and 9 patients had secondary progressive MS. Patients and controls were evaluated using optical coherence tomography (OCT, Cirrus) and scanning laser polarimetry with variable corneal compensation (GDx VCC). Patients underwent the same brain MRI scanning protocol. Disability was evaluated according to the EDSS. The BCR was calculated by dividing the minimum intercaudate distance by brain width along the same level. The BCR was higher in patients with MS (0.12 ± 0.03) than in controls (0.08 ± 0.009) (P < 0.001). OCT average RNFL thickness in patients with MS was significantly lower (84.51 ± 14.27 μm) than in control subjects (98.44 ± 6.83 μm). BCR was correlated with OCT average RNFL thickness (r = -0.48, P = 0.002) in patients with MS without optic neuritis. Significant correlations were found between average RNFL thickness and EDSS (r = -0.43, P = 0.003). Additionally, there were correlations between BCR with GDx parameters in patients with MS without optic neuritis. This study shows that RNFL thickness correlates with BCR and with MS subtypes. Additionally, our study indicates that OCT is better suited for MS assessment than GDx. We conclude that the damage of retinal axons appears related to brain damage in patients with MS.