Diagnosing and understanding glaucomatous damage based upon a single ssOCT wide-field scan.
Donald C. Hood
James F. Bender Professor of Psychology
Professor of Ophthalmic Sciences (Ophthalmology)
Columbia University, New York, NY, USA
The Topcon “3D Wide Glaucoma Report with VF test points (Hood Report)” is a new single-page report designed to help clinicians quickly diagnosis and understand glaucomatous damage. This report is based upon a single wide-field (12 x 9 mm) scan and 5 principles. The principles are: 1. You should examine an image of the circumpapillary scan large enough to see details; 2. This image and the plot of the circumpapillary retinal nerve fiber layer (cpRNFL) thickness should be shown as a NSTIN (Nasal-to-Superior-to-Inferior-to Nasal), not a TSNIT, plot; 3. To detect glaucomatous damage to the macula, you need a ganglion cell layer (GCL) thickness map of the macula; 4. In addition, damage is often easier to see on RNFL and GCL probability maps; and 5. Damage can be confirmed by topographically comparing OCT and visual field (VF) probability maps. After a brief review of background information, the one-page report and these principles are described. These principles, which guided the development of this report, also provide an approach or method to quickly detect and understand glaucomatous damage. This approach, which differs from that typically used in the clinic to diagnosis glaucoma, will be illustrated with clinical examples. A particular emphasis will be made placed on understanding how well abnormalities seen on structural (OCT) and behavioral (visual fields) tests agree as long as a topographical, as opposed to a metric, approach is taken.