Neuro-ophthalmological Diseases Research Articles

Discriminating Diseases Mimicking Normal-Tension Glaucoma (NTG) from NTG.

Background/Objectives: The aim of this study was to identify the most reliable ocular exam and establish a threshold for deciding whether to perform neuroimaging in order to screen for diverse diseases other than normal-tension glaucoma (NTG). A retrospective, observational, comparative study was used. Methods: In total, 106 individuals with atypical features of NTG who underwent glaucoma assessments and contrast-enhanced MRI of the brain or orbit were included. The criteria for atypical NTG included the following: (1) unilateral normal-tension glaucoma, (2) visual field (VF) damage inconsistent with optic disc appearance, (3) fast VF progression, (4) worsening of visual acuity, (5) optic disc pallor, (6) scotoma restricted by a vertical line, and (7) central scotoma. Glaucoma evaluations included measurements of visual acuity, intraocular pressure, central corneal thickness, axial length, cup-disc ratio, retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, mean deviation (MD), and visual field index (VFI). Statistical analyses involved independent t-tests, receiver operating characteristic (ROC) curves, and area under the curve (AUC) in order to differentiate neuro-ophthalmological conditions from NTG, compare the diagnostic power of each factor, and determine the cut-off value. Results: Relatively fewer diagnoses of non-glaucomatous diseases were associated with unilateral NTG, the worsening of VA, and central scotoma. Factors such as rapid visual field progression, optic disc pallor, and scotoma restricted by a vertical line had a relatively higher diagnostic rate of non-glaucomatous diseases. There were significant differences in average RNFL and GCIPL thicknesses at the nasal quadrant between NTG and NTG-mimicking conditions. Only the GCIPL thickness at the nasal quadrant had reliable power for discriminating between neuro-ophthalmological disease and NTG. For the GCIPL thickness at the nasal quadrant, the AUC was 0.659, and the cut-off value was 65.75. Conclusions: When deciding whether to proceed with imaging, such as carrying out an MRI test, for NTG patients with atypical NTG characteristics, it would be advisable to consider the nasal sector cut-off value of GCIPL thickness.

ChatGPT Assisting Diagnosis of Neuro-Ophthalmology Diseases Based on Case Reports

Background: To evaluate the accuracy of Chat Generative Pre-Trained Transformer (ChatGPT), a large language model (LLM), to assist in diagnosing neuro-ophthalmic diseases based on case reports. Methods: We selected 22 different case reports of neuro-ophthalmic diseases from a publicly available online database. These cases included a wide range of chronic and acute diseases commonly seen by neuro-ophthalmic subspecialists. We inserted each case as a new prompt into ChatGPTs (GPT-3.5 and GPT-4) and asked for the most probable diagnosis. We then presented the exact information to 2 neuro-ophthalmologists and recorded their diagnoses, followed by comparing responses from both versions of ChatGPT. Results: GPT-3.5 and GPT-4 and the 2 neuro-ophthalmologists were correct in 13 (59%), 18 (82%), 19 (86%), and 19 (86%) out of 22 cases, respectively. The agreements between the various diagnostic sources were as follows: GPT-3.5 and GPT-4, 13 (59%); GPT-3.5 and the first neuro-ophthalmologist, 12 (55%); GPT-3.5 and the second neuro-ophthalmologist, 12 (55%); GPT-4 and the first neuro-ophthalmologist, 17 (77%); GPT-4 and the second neuro-ophthalmologist, 16 (73%); and first and second neuro-ophthalmologists 17 (77%). Conclusions: The accuracy of GPT-3.5 and GPT-4 in diagnosing patients with neuro-ophthalmic diseases was 59% and 82%, respectively. With further development, GPT-4 may have the potential to be used in clinical care settings to assist clinicians in providing quick, accurate diagnoses of patients in neuro-ophthalmology. The applicability of using LLMs like ChatGPT in clinical settings that lack access to subspeciality trained neuro-ophthalmologists deserves further research.

Examining the competence of artificial intelligence programs in neuro-ophthalmological disorders and analyzing their comparative superiority

Abstract: BACKGROUND: This study aims to evaluate the knowledge levels of chat generative pretrained transformer (ChatGPT), Bing, and Bard programs, which are three different artificial intelligence chatbots offered to the market free of charge by various manufacturers, regarding neuro-ophthalmological diseases, to examine their usability, and to investigate the existence of their superiority to each other. MATERIALS AND METHODS: Forty questions related to neuro-ophthalmological diseases were obtained from the study questions’ section of the American Academy and Ophthalmology 2022–2023 Basic and Clinical Science Course Neuro-ophthalmology Book. The questions were posed to the ChatGPT, Bing, and Bard artificial intelligence chatbots. The answers were evaluated as correct or incorrect. The statistical relationship between the correct and incorrect answer rates offered by the artificial intelligence programs was tested. RESULTS: The correct answer rates were given by the artificial intelligence programs to the questions asked: ChatGPT – 52.5%; Bing – 55%; and Bard – 65%. There was no statistically significant difference between the correct answer rates of the three artificial intelligence programs (P = 0.489, Pearson’s Chi-square test). CONCLUSION: Although information about neuro-ophthalmological diseases can be accessed quickly and accurately using up-to-date artificial intelligence programs, the answers given may not always be correct. Care should always be taken when evaluating the answers to the questions.

MRNA: a Physiological Multipurpose Tool for Hitherto Hard-to-treat Neurological and Neuro-Ophthalmological Diseases

Interdisciplinary translational research between physiologists and clinicians based on mRNA technology has opened and shall open treatment perspectives for a broad range of diseases, many of them hitherto hard to treat or not treatable at all. In this overview, various options for applications of mRNA technology are presented for the treatment of quite different neurological and neuro-ophthalmological disease categories such as metabolic and neurodegenerative diseases, infectious diseases, and tumors, illustrated by a few selected examples of current clinical trials and experimental approaches. mRNA technology allows for developing tailor-made individualized therapies by which the body may even produce the remedies itself according to the physiological recipe of the mRNA assembly instructions.

Development of a Smartphone-Based System for Intrinsically Photosensitive Retinal Ganglion Cells Targeted Chromatic Pupillometry.

Chromatic Pupillometry, used to assess Pupil Light Reflex (PLR) to a coloured light stimulus, has regained interest since the discovery of melanopsin in the intrinsically photosensitive Retinal Ganglion Cells (ipRGCs). This technique has shown the potential to be used as a screening tool for neuro-ophthalmological diseases; however, most of the pupillometers available are expensive and not portable, making it harder for them to be used as a widespread screening tool. In this study, we developed a smartphone-based system for chromatic pupillometry that allows targeted stimulation of the ipRGCs. Using a smartphone, this system is portable and accessible and takes advantage of the location of the ipRGCs in the perifovea. The system incorporates a 3D-printed support for the smartphone and an illumination system. Preliminary tests were carried out on a single individual and then validated on eleven healthy individuals with two different LED intensities. The average Post-Illumination Pupil Light Response 6 s after the stimuli offsets (PIPR-6s) showed a difference between the blue and the red stimuli of 9.5% for both intensities, which aligns with the studies using full-field stimulators. The results validated this system for a targeted stimulation of the ipRGCs for chromatic pupillometry, with the potential to be a portable and accessible screening tool for neuro-ophthalmological diseases.

Monoclonal antibodies in neuro-ophthalmology.

Neuro-ophthalmologic diseases include a broad range of disorders affecting the afferent and efferent visual pathways. Recently, monoclonal antibody (mAb) therapies have emerged as a promising targeted approach in the management of several of these complex conditions. Here, we describe the mechanism-specific applications and advancements in neuro-ophthalmologic mAb therapies. The application of mAbs in neuro-ophthalmologic diseases highlights our increasing understanding of disease-specific mechanisms in autoimmune conditions such as neuromyelitis optica, thyroid eye disease, and myasthenia gravis. Due to the specificity of mAb therapies, applications in neuro-ophthalmologic diseases have yielded exceptional clinical outcomes, including both reduced rate of relapse and progression to disability, visual function preservation, and quality of life improvement. These advancements have not only expanded the range of treatable neuro-ophthalmologic diseases but also reduced adverse events and increased the response rate to treatment. Further research into neuro-ophthalmologic disease mechanisms will provide accurate and specific targeting of important disease mediators through applications of future mAbs. As our understanding of these diseases and the relevant therapeutic targets evolve, we will continue to build on our understanding of how mAbs interfere with disease pathogenesis, and how these changes improve clinical outcomes and quality of life for patients.

Identification of the characteristic visual field loss patterns in optic neuropathies

Visual fields support physicians in the diagnosis and progression tracking of optic neuropathies, enabling the visualization of the site of the optic nerve or optic pathways damage. Furthermore, the identification of the underlying patterns of different optic neuropathies can strengthen the diagnosis or help the clinicians for the patient's prognosis. Different abnormalities have been described and associated to neuroophthalmological diseases, such as central and ceco‐central scotomas related to hereditary optic neuropathies as Leber and dominant optic atrophy diseases which are mostly affected in the macular retinal ganglion cells and the papillomacular bundle. Altitudinal defects are usually associated with ischemic optic neuropathies, and in the big field of glaucoma the most commonly abnormalities are the arcuate and the nasal step.Related to this topic, artificial Intelligence is gaining traction, implementing, and testing different approaches to the automatic detection of visual field loss patterns in distinct diseases. For example, application of archetype analysis for the detection of glaucoma progression or for the assessment of efficacy in idiopathic intracranial hypertension treatment trial.

Neuro-ophthalmological Consultations in the Emergency Department of a Tertiary Referral Emergency Center

Purpose: We report the clinical features, diagnoses, and treatments of patients with neuro-ophthalmological diseases presenting to a tertiary referral center emergency room (ER) of South Korea.Methods: We retrospectively analyzed the medical records of 205 patients who visited the ER of the Asan Medical Center and then were referred to our neuro-ophthalmology department from May 2020 to April 2022. The initial diagnoses of ophthalmology residents were compared to the final diagnoses of neuro-ophthalmologists. We describe the symptoms, diagnoses, and treatments.Results: The median time from the onset of symptoms to the ER visit was 3 days; diplopia (49.1%) and vision loss/a visual field defect (38.9%) were the chief complaints. The most common causes of diplopia were isolated cranial nerve 4 (37.5%), 6 (22.9%), and 3 palsy (18.4%) and supranuclear palsy (9.2%). In patients with vision loss/visual field defect, the most common causes were optic (20.5%), ischemic (17.1%), and compressive (8.0%) optic neuropathies. For 121 cases (59.0%), multidisciplinary consultations with the departments of neurology, neurosurgery, and internal medicine were scheduled. After initial management in the ER, 38 diagnoses (18.5%) changed after evaluation by neuro-ophthalmologists.Conclusions: Over half of all neuro-ophthalmology patients presenting to an ER required comprehensive interdisciplinary evaluation and over a third required inpatient treatment.

Disminución de la agudeza visual. Estrategias diagnósticas, tratamiento y manejo en urgencias

A decrease in visual acuity is a common symptom of many ophthalmologic and neuro-ophthalmologic diseases. The origin of the disease may be located at any point of the visual pathway that sends luminous stimuli from the ocular surface to the occipital cortex. A careful case history and systematic eye examination are essential for establishing a diagnosis or for guiding the additional tests in order to reach a diagnosis, thus avoiding unnecessary additional examinations. Some diseases that are accompanied by decreased vision have a visual and even vital prognosis that depends on the early establishment of appropriate treatment. Therefore, they must be identified and assessed urgently by ophthalmologists and/or neurologists.

The OSCAR-MP Consensus Criteria for Quality Assessment of Retinal Optical Coherence Tomography Angiography.

Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment. To establish criteria through (1) extensive literature review on OCTA artifacts and image quality to generate standardized and easy-to-apply OCTA QC criteria, (2) application of OCTA QC criteria to evaluate interrater agreement, (3) identification of reasons for interrater disagreement, revision of OCTA QC criteria, development of OCTA QC scoring guide and training set, and (4) validation of QC criteria in an international, interdisciplinary multicenter study. We identified 7 major aspects that affect OCTA quality: (O) obvious problems, (S) signal strength, (C) centration, (A) algorithm failure, (R) retinal pathology, (M) motion artifacts, and (P) projection artifacts. Seven independent raters applied the OSCAR-MP criteria to a set of 40 OCTA scans from people with MS, Sjogren syndrome, and uveitis and healthy individuals. The interrater kappa was substantial (κ 0.67). Projection artifacts were the main reason for interrater disagreement. Because artifacts can affect only parts of OCTA images, we agreed that prior definition of a specific region of interest (ROI) is crucial for subsequent OCTA quality assessment. To enhance artifact recognition and interrater agreement on reduced image quality, we designed a scoring guide and OCTA training set. Using these educational tools, 23 raters from 14 different centers reached an almost perfect agreement (κ 0.92) for the rejection of poor-quality OCTA images using the OSCAR-MP criteria. We propose a 3-step approach for standardized quality control: (1) To define a specific ROI, (2) to assess the occurrence of OCTA artifacts according to the OSCAR-MP criteria, and (3) to evaluate OCTA quality based on the occurrence of different artifacts within the ROI. OSCAR-MP OCTA QC criteria achieved high interrater agreement in an international multicenter study and is a promising QC protocol for application in the context of future clinical trials and studies.

Visual field defects in neuro-ophthalmological diseases at a tertiary hospital in Nepal

Visual field defects in neuro-ophthalmological diseases at a tertiary hospital in Nepal

A New Era in Ocular Therapeutics: Advanced Drug Delivery Systems for Uveitis and Neuro-Ophthalmologic Conditions.

The eye's intricate anatomical barriers pose significant challenges to the penetration, residence time, and bioavailability of topically applied medications, particularly in managing uveitis and neuro-ophthalmologic conditions. Addressing this issue, polymeric nano-based drug delivery systems (DDS) have surfaced as a promising solution. These systems enhance drug bioavailability in hard-to-reach target tissues, extend residence time within ocular tissues, and utilize biodegradable and nanosized polymers to reduce undesirable side effects. Thus, they have stimulated substantial interest in crafting innovative treatments for uveitis and neuro-ophthalmologic diseases. This review provides a comprehensive exploration of polymeric nano-based DDS used for managing these conditions. We discuss the present therapeutic hurdles posed by these diseases and explore the potential role of various biopolymers in broadening our treatment repertoire. Our study incorporates a detailed literature review of preclinical and clinical studies from 2017 to 2023. Owing to advancements in polymer science, ocular DDS has made rapid strides, showing tremendous potential to revolutionize the treatment of patients with uveitis and neuro-ophthalmologic disorders.

Ocular Torsional Instability-A Neurodiagnostic Sign of Prenuclear Disease.

Accurate diagnosis of efferent visual system disease in neuro-ophthalmology involves the classification of clinical signs as prenuclear, nuclear, or infranuclear in origin. Over many years, I have come to recognize ocular torsional instability as a clinical sign of prenuclear disease. Retrospective chart review of patients in whom ocular torsional instability was diagnosed using indirect ophthalmoscopy. Twenty patients were diagnosed as having ocular torsional instability (OTI). Eight had neuro-ophthalmologic disease caused by structural injury to prenuclear ocular motor areas. Six of these had structural lesions primarily involving the cerebellum, one had a midbrain glioma, and one had traumatic encephalomalacia. Eight additional patients had infantile strabismus (esotropia in 7, exotropia in 1) associated with various combinations of monocular nasotemporal optokinetic asymmetry, latent nystagmus, and dissociated vertical divergence (DVD), indicating prenuclear involvement of subcortical visuovestibular pathways within the brain. Three additional patients presented with intermittent exotropia with DVD signifying early onset, while 2 had acquired esotropia that was noninfantile in origin. One had partially accommodative esotropia with bilateral inferior oblique overaction, and one presented with acquired esotropia followed by spontaneous secondary exotropia. OTI provides a useful clinical sign of prenuclear ocular motor dysfunction. When detected in patients without any signs of infantile or early-onset strabismus, OTI signifies the need for neuroimaging to rule out neurovestibular or cerebellar causes of prenuclear disease.

Deep Learning Model for Static Ocular Torsion Detection Using Synthetically Generated Fundus Images.

The objective of the study is to develop deep learning models using synthetic fundus images to assess the direction (intorsion versus extorsion) and amount (physiologic versus pathologic) of static ocular torsion. Static ocular torsion assessment is an important clinical tool for classifying vertical ocular misalignment; however, current methods are time-intensive with steep learning curves for frontline providers. We used a dataset (n = 276) of right eye fundus images. The disc-foveal angle was calculated using ImageJ to generate synthetic images via image rotation. Using synthetic datasets (n = 12,740 images per model) and transfer learning (the reuse of a pretrained deep learning model on a new task), we developed a binary classifier (intorsion versus extorsion) and a multiclass classifier (physiologic versus pathologic intorsion and extorsion). Model performance was evaluated on unseen synthetic and nonsynthetic data. On the synthetic dataset, the binary classifier had an accuracy and area under the receiver operating characteristic curve (AUROC) of 0.92 and 0.98, respectively, whereas the multiclass classifier had an accuracy and AUROC of 0.77 and 0.94, respectively. The binary classifier generalized well on the nonsynthetic data (accuracy = 0.94; AUROC = 1.00). The direction of static ocular torsion can be detected from synthetic fundus images using deep learning methods, which is key to differentiate between vestibular misalignment (skew deviation) and ocular muscle misalignment (superior oblique palsies). Given the robust performance of our models on real fundus images, similar strategies can be adopted for deep learning research in rare neuro-ophthalmologic diseases with limited datasets.

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

BackgroundThere have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination.MethodsThis was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19.ResultsOne patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases.ConclusionAs COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients’ age and underlying diseases should be considered while administering them.

A narrative review of neuro-ophthalmologic disease in African Americans and Hispanics with multiple sclerosis.

Multiple sclerosis (MS) is the most common non-traumatic cause of disability in young people, with vision loss in the disease representing the second largest contributor to disability. In particular, African-American patients with MS are noted to have lower vision than their Caucasian counterparts. In this review, we examine the disparities in eye diseases in the MS population with our gaps in knowledge and discuss the underlying nature of pathological disparities.

Current usage of electrophysiological tests in a secondary referral hospital in Korea.

To investigate the current status of electrophysiological test use in ophthalmology. We analyzed 1057 electrophysiological tests conducted at Kim's Eye Hospital from January 1 to December 31, 2018. The included tests were electroretinogram (full-field, multifocal, and pattern ERG), electrooculogram (EOG), and visual evoked potential (pattern and flash VEP). To investigate the distribution of use of subspecialties, it was divided by subspecialties (retina, glaucoma, oculoplastic surgery, pediatric ophthalmology, neuro-ophthalmology, cornea, and external diseases). The patients were aged 50.6years on average and included 624 men and 433 women. Among the electrophysiological tests, VEP was the most common, with 567 cases (53.6%), followed by ERG with 311 cases (29.4%) and EOG with 98 cases (9.3%). Regarding the purpose of use, the objective of visual function evaluation was the highest at 56.3%, followed by the differential diagnosis of unknown causes (33.0%) and the confirmation of diagnoses (10.7%). Both VEP and ERG were used the most for visual function evaluation, and mfERG was most used for differential diagnosis of unknown etiology. Electrophysiological tests were most often used in the retina department, but VEPs were used in various fields such as neuro-ophthalmology, glaucoma, and oculoplastics. Electrophysiological tests are used to objectively evaluate visual function or discriminate diseases of unknown causes and are used in various departments. Electrophysiology testing is expected to be an additional test to assess visual function.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

Neuro-Ophthalmological Complications of the COVID-19 Vaccines: A Systematic Review.

A worldwide mass vaccination campaign against the coronavirus disease 2019 (COVID-19) pandemic is currently underway. Although the safety data of the clinical trials did not report specific concerns regarding neuro-ophthalmological adverse events, they involved a limited number of individuals and were conducted over a relatively short time. The aim of the current review is to summarize the available postmarketing data regarding the occurrence of neuro-ophthalmological and other ocular complications of the COVID-19 vaccines. Electronic searches for published literature were conducted using Ovid MEDLINE, Embase, Web of Science, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search strategy incorporated controlled vocabulary and free-text synonyms for the concepts of COVID, vaccines, and visual and neuro-ophthalmologic diseases and symptoms. A total of 14 case reports and 2 case series have been selected for inclusion in the final report, reporting 76 cases of post-COVID-vaccination adverse events. The most common adverse event was optic neuritis (n = 61), followed by uveitis (n = 3), herpes zoster ophthalmicus (n = 2), acute macular neuroretinopathy (n = 2), optic disc edema as an atypical presentation of Guillain-Barré syndrome (n = 1), (arteritic anterior ischemic optic neuropathy; n = 1), abducens nerve palsy (n = 1), oculomotor nerve palsy (n = 1), Tolosa-Hunt syndrome (n = 1), central serous retinopathy (n = 1), acute zonal occult outer retinopathy (n = 1), and bilateral choroiditis (n = 1). Most cases were treated with high-dose steroids and had a favorable clinical outcome. Since the implementation of the COVID-19 vaccination campaign in the past year, several post-COVID-vaccination neuro-ophthalmological complications have been described. However, considering the number of individuals that have been exposed to the vaccines, the risk seems very low, and the clinical outcome in most cases is favorable. Therefore, on a population level, the benefits of the vaccines far outweigh the risk of neuro-ophthalmological complications.

DISCRIMINATION OF EYES WITH PRIMARY OPEN-ANGLE GLAUCOMA FROM NORMAL USING MACULAR GC-IPL THICKNESS

Objective: Primary open-angle glaucoma (POAG), a neuro-ophthalmological disease, is a condition of slowly progressive loss of retinal ganglion cells which are evident as characteristic optic nerve head vicissitudes and visual field defects, only after death of more than 40% of cells. This huge loss when witnessed is started to treat only if the patient approaches an ophthalmologist with a significant complaint, leading to optic nerve head examination, which means being an asymptomatic disease, it is usually left undiagnosed until advanced. An additional system of diagnosis of the disease earlier in the stage can aid reduce the burden of the blindness of POAG. Methods: Among a total of 62 eyes of 31 subjects, 40 eyes of 20 POAG subjects, and 22 eyes of 11 age-matched healthy subjects were recruited. All of them underwent Spectral Domain Optical Coherence Tomography macular and optic disk scans to note macular ganglion cell–inner plexiform layer (mGCIPL) and retinal nerve fiber layer (RNFL) thicknesses. Statistical analysis was did using an unpaired t-test and calculating a two-tailed p value, in which the significance was indicated by p<0.05. Results: Similar to peripapillary RNFL thickness, the mGCIPL parameters, that is, minimum GCIPL thickness and GCIPL thickness in all sectors decreased significantly in POAG eyes to be able to discriminate them from normal. mGCIPL and RNFL thickness decreased as the severity of glaucoma increased. Conclusion: The minimum GCIPL thickness and that in all sectors can discriminate POAG eyes from healthy eyes significantly and has comparable performance to that of peripapillary RNFL thickness.