Comparisons of methods to detect glaucomatous optic nerve damage.

PURPOSE Various techniques of optic disc and nerve fiber layer evaluation may be used to detect structural glaucomatous damage. The authors compared several qualitative and quantitative methods to determine their relative sensitivities and specificities to detect the presence of glaucomatous visual field loss. METHODS Fifty-one healthy eyes, 169 ocular hypertensive eyes with normal visual fields, and 132 glaucomatous eyes with early visual field defects were evaluated with qualitative and quantitative measures of structural damage to the optic nerve and nerve fiber layer. Qualitative evaluations were performed by three experienced masked observers who independently graded stereoscopic color disc and monochromatic nerve fiber layer photographs. Quantitative measurements of disc rim area and nerve fiber layer height were made with digitized image analysis of videographic images. Manual planimetric measurements of disc rim area were made from enlarged prints of stereoscopic optic disc photographs. Diagnostic precision was defined as the total proportion of correct diagnoses for the presence or absence of visual field loss. RESULTS The diagnostic precision of results of a quantitative disc examination (81%) was greater than those of a qualitative nerve fiber layer examination (75%). Quantitative nerve fiber height measurement had the highest sensitivity rate (73%) and results of the qualitative disc examination had the highest specificity rate (87%) of the methods tested. CONCLUSION The diagnostic precision of disc evaluation was superior to other methods, including nerve fiber layer examination, in correctly determining the presence of structural glaucomatous damage at the early visual field loss stage.