Comparison of sensitivities for detecting diffuse and localized retinal nerve fiber layer defects with time-domain optical coherence tomography in patients with glaucoma.

Purpose: To compare the ability of time-domain optical coherence tomography (OCT) to detect diffuse and localized retinal nerve fiber layer (RNFL) defects using a built-in normative database in patients with early to moderate glaucoma.

Methods: Subjects with localized visual field defects confined to either hemifield were consecutively recruited. Only 1 eye per subject was considered. Among the 91 eyes with localized RNFL defects, 46 eyes with mean deviations matched to those of the 46 eyes with diffuse RNFL defects were selected for statistical analysis. This case-control study included 46 eyes with diffuse RNFL defects and 46 eyes with localized RNFL defects. The fast RNFL thickness protocol of Stratus OCT was used. The clock-hour and quadrant sector parameters corresponding to the hemifield with the visual field defect were evaluated at P<0.05 with regard to the built-in normative database. The sensitivities of these parameters were compared between diffuse and localized RNFL defects.

Results: The sensitivity of the clock-hour sector parameter for diffuse RNFL defects (84.8%) was not significantly different than that for localized RNFL defects (80.4%) (P=0.78). The sensitivity of the quadrant sector parameter for diffuse RNFL defects (74.9%) was significantly higher than that for localized RNFL defects (52.3%) (P=0.04).

Conclusions: The clock-hour parameter of time-domain OCT detected RNFL defects without significant difference in sensitivities between diffuse and localized patterns of RNFL loss in glaucomatous eyes. However, the quadrant parameter of OCT showed better sensitivity for diffuse RNFL defects than for localized RNFL defects.