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Robert N. Weinreb, MD; Linda Zangwill, PhD; Charles C. Berry, PhD; Renuka Bathija, MD; Pamela A. Sample, PhD

Arch Ophthalmol. 1998;116:1583-1589.

Objective  To determine which retinal nerve fiber layer (RNFL) measures obtained with scanning laser polarimetry are most useful in detecting early to moderate glaucomatous visual field loss.

Subjects and Methods  One eye from 84 healthy individuals and 83 patients with early to moderate glaucomatous visual field loss (167 eyes) was assessed with a scanning laser polarimeter (Laser Diagnostic Technologies, San Diego, Calif). Three separate scans were obtained, and a baseline scan was created and used in the analyses. Integrated software (program GDx, version 1.0.02; Laser Diagnostic Technologies) was evaluated by assessing its sensitivity and specificity for detecting early and moderate glaucomatous visual field loss. Fisher linear discriminant functions also were developed in this population to assess sensitivity and specificity and were compared with the GDx analyses.

Results  There were statistically significant differences between the healthy and glaucomatous eyes for 14 of the 15 RNFL measures (P=.001). However, considerable overlap in measurements between groups was found. With the GDx number, the area under the receiver operator characteristic (ROC) curve was 0.78, and the sensitivity and specificity were 82% and 62%, respectively. Applying the best discriminant function using 3 variables (average thickness, ellipse modulation, and average ellipse thickness) to our study population resulted in an area under the ROC curve of 0.89 and a sensitivity and specificity of 74% and 92%, respectively.

Conclusions  A combination of RNFL measures obtained using the scanning laser polarimeter improved the ability to differentiate between healthy eyes and eyes with early and moderate glaucomatous visual field loss. Analyses using GDx software did not differentiate between healthy and glaucomatous eyes as well as the discriminant analysis function did.

From the Glaucoma Center (Drs Weinreb, Zangwill, Bathija, and Sample) and the Departments of Ophthalmology (Drs Weinreb, Zangwill, Bathija, and Sample) and Family and Preventive Medicine (Dr Berry), University of California, San Diego. The authors have no proprietary interest in the methods or instruments mentioned in this article.

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