Background: To report the applicability of ISNT (inferior>superior>nasal>temporal) and IST (inferior>superior>temporal) rules on the retinal nerve fibre layer (RNFL) using spectral domain optical coherence tomography (SD-OCT) for detecting early glaucoma.
Methods: A prospective, cross-sectional study which included 80 eyes of 80 normal subjects and 76 eyes of 76 patients with early glaucoma by Hodapp-Anderson-Parrish classification. All subjects were of age more than 18 years, best corrected visual acuity 20/40 or better and a refractive error within ±5 dioptres (D) sphere and ±3 D cylinder. Control subjects had a normal ocular examination, intraocular pressure <22 mm Hg, no past history of high intraocular pressure, no family history of glaucoma, normal optic disc morphology and visual field. All eyes underwent SD-OCT examination for RNFL analysis. The sensitivity, specificity and likelihood ratio for violation of ISNT and IST rules was calculated for early glaucoma diagnosis.
Results: The ISNT rule was followed by 44 (55%) normal and 28 (36.84%) early glaucoma eyes. The IST rule was followed by 48 (60%) normal and 40 (52.63%) early glaucoma eyes. The sensitivity/specificity for violation of ISNT and IST rules for early glaucoma diagnosis was 63.2%/55% and 47.4%/60% respectively. The positive/negative likelihood ratio for ISNT and IST rules was 1.4/0.67 and 1.2/0.88, respectively, for diagnosing early glaucoma.
Conclusions: Even though useful during ophthalmoscopy, ISNT and IST rules by themselves don't clearly distinguish normal eyes from those with glaucoma when applied to the quadrant values on RNFL on SD-OCT examination.
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