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Abstract
To map ganglion cell complex (GCC) thickness with high-speed Fourier-domain optical
coherence tomography (FD-OCT) and compute novel macular parameters for glaucoma diagnosis.
Observational, cross-sectional study.
One hundred seventy-eight participants in the Advanced Imaging for Glaucoma Study,
divided into 3 groups: 65 persons in the normal group, 78 in the perimetric glaucoma
group (PG), and 52 in the preperimetric glaucoma group (PPG).
The RTVue FD-OCT system was used to map the macula over a 7 x 6 mm region. The macular
OCT images were exported for automatic segmentation using software we developed. The
program measured macular retinal (MR) thickness and GCC thickness. The GCC was defined
as the combination of nerve fiber, ganglion cell, and inner plexiform layers. Pattern
analysis was applied to the GCC map and the diagnostic powers of pattern-based diagnostic
parameters were investigated. Results were compared with time-domain (TD) Stratus
OCT measurements of MR and circumpapillary nerve fiber layer (NFL) thickness.
Repeatability was assessed by intraclass correlation, pooled standard deviation, and
coefficient of variation. Diagnostic power was assessed by the area under the receiver
operator characteristic (AROC) curve. Measurements in the PG group were the primary
measures of performance.
The FD-OCT measurements of MR and GCC averages had significantly better repeatability
than TD-OCT measurements of MR and NFL averages. The FD-OCT GCC average had significantly
(P = 0.02) higher diagnostic power (AROC = 0.90) than MR (AROC = 0.85 for both FD-OCT
and TD-OCT) in differentiating between PG and normal. One GCC pattern parameter, global
loss volume, had significantly higher AROC (0.92) than the overall average (P = 0.01).
The diagnostic powers of the best GCC parameters were statistically equal to TD-OCT
NFL average.
The higher speed and resolution of FD-OCT improved the repeatability of macular imaging
compared with standard TD-OCT. Ganglion cell mapping and pattern analysis improved
diagnostic power. The improved diagnostic power of macular GCC imaging is on par with,
and complementary to, peripapillary NFL imaging. Macular imaging with FD-OCT is a
useful method for glaucoma diagnosis and has potential for tracking glaucoma progression.