June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Diagnostic Efficacy of RNFL Thickness Sectors for Glaucoma Detection
Author Affiliations & Notes
  • Gary Lee
    Carl Zeiss Meditec, Inc, Dublin, CA
  • Donald Budenz
    Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, NC
  • Robert Chang
    Stanford Eye Institute, Stanford University, Stanford, CA
  • Alan Crandall
    Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT
  • Christopher Girkin
    Ophthalmology, University of Alabama at Birmingham, Birmingham, AL
  • Christopher Leung
    3/F University Eye Center, Hong Kong Eye Hospital, Hong Kong, China
  • Arvind Neelakantan
    Glaucoma Associates of Texas, Dallas, TX
  • James Peace
    Ophthalmology and Vision Science, United Medical Research Institute, Inglewood, CA
  • John Werner
    Ophthalmology and Vision Science, UC Davis Eye Center, Sacramento, CA
  • Gadi Wollstein
    UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
  • Footnotes
    Commercial Relationships Gary Lee, Carl Zeiss Meditec, Inc (E); Donald Budenz, None; Robert Chang, None; Alan Crandall, None; Christopher Girkin, SOLX (F), Heidelberg Engineering (F); Christopher Leung, Carl Zeiss Meditec (F), Carl Ziess Meditec (R), Alcon (C), Alcon (R), Alcon (F), Allergan (C), Allergan (R), Tomey (F), Optovue (F); Arvind Neelakantan, None; James Peace, B and L (C), merck (C), alcon (C), allergan (C); John Werner, None; Gadi Wollstein, Allergan (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 96. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Gary Lee, Donald Budenz, Robert Chang, Alan Crandall, Christopher Girkin, Christopher Leung, Arvind Neelakantan, James Peace, John Werner, Gadi Wollstein; Diagnostic Efficacy of RNFL Thickness Sectors for Glaucoma Detection. Invest. Ophthalmol. Vis. Sci. 2013;54(15):96.

      Download citation file:

      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

To compare the diagnostic ability of zones typically used in structure-function mapping against various standard sectors of peripapillary retinal nerve fiber layer (RNFL) measurements in glaucoma.


SD-OCT data from 140 Glaucoma (MD Mean±SD: -8.4±7.4 dB; 74 mild, 30 moderate, 36 severe by Hodapp-Anderson-Parrish criteria) and 191 age-matched Normal eyes (331 patients total) combined from three prior studies were analyzed post-hoc to generate peripapillary RNFL thickness maps. RNFL TSNIT profiles were extracted and used to generate various sectors, including Average RNFL thickness, quadrants, and clock hours. In addition, sectors proposed by Garway-Heath (GH) for mapping structure to function [1], equivalent sectors used in scanning laser polarimetry (GDx), and mean RNFL thicknesses within all possible combinations of Superior (1-180°) and Inferior (181-360°) sectors were computed. Area under ROC curve (AUC) values and sensitivities at fixed 95% specificity were then calculated from each sector. Pairwise comparisons between AUCs were computed using the standard method of Delong et al (significance at P < 0.05). For comparison purposes, a set of Optimal Superior and Inferior sectors were defined by averaging the endpoints of sectors with AUCs greater than 99.95% of the maximum AUC.


The 99.95% Optimal Superior (41-149°) and Inferior (262-306°) sectors had AUC values of 0.924 and 0.941, respectively, and were significantly better than any other individual sectors in the corresponding hemisphere, except for Average RNFL thickness (0.929), Superior Quadrant (0.922), Inferior Quadrant (0.933), Temporal-Inferior GH sector (0.936), Superior GDx sector (0.919), and Inferior GDx sector (0.929). The sensitivities of those sectors at 95% specificity ranged from 80.0% (Average RNFL thickness) to 75.7% (Temporal-Inferior GH). The AUCs of the four superior/inferior GH sectors (Zones 1-4) were also not significantly worse than any of the 6 standard superior/inferior clock hours (11-1, 5-7 o’clock).


Existing Cirrus sector definitions and Garway-Heath zone-derived RNFL thickness sectors both show good diagnostic ability for glaucoma detection. One GH sector, Temporal-Inferior (Zone 2), is comparable to the best possible RNFL sector (Optimal Inferior). [1] Garway-Heath, DF et al., 2000. Ophthalmology, 107(10).

Table 1: AUCs and sensitivities.
Table 1: AUCs and sensitivities.
Fig 1: RNFL sectors (right eye orientation) .
Fig 1: RNFL sectors (right eye orientation) .
Keywords: 610 nerve fiber layer • 550 imaging/image analysis: clinical • 627 optic disc  

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.