Optic nerve head sector analysis recognizes glaucoma most effectively around disc poles

PURPOSE: To analyze the topography of normal and glaucomatous discs with the goal of developing improved strategies to discriminate between normal and glaucomatous eyes. SUBJECTS AND METHODS: Raster tomography was performed in both eyes of 225 healthy subjects and in 296 eyes of 214 glaucoma patients. Cup area, average cup radius, rim area and minimal rim width were measured in 24 sectors around the optic nerve head at nine different depths from the reference plane. Receiver Operating Curves (ROC) for numerous combinations of parameter, sector and depth were calculated and compared. RESULTS: Discrimination between glaucomatous and normal eyes varied widely between single sectors of the optic disc, and was best at the vertical poles of the disc, intermediate in nasal sectors and worst in temporal sectors. When single sectors or combinations of sectors at the superior pole were combined with their counterparts at the inferior pole of the optic nerve, the gain in sensitivity exceeded the loss in specificity, and discrimination improved. Separation declined dramatically if any of the 8 temporal sectors were involved in such analysis. Depth influenced discrimination only slightly. CONCLUSION: Single sectors located close to the vertical meridian yielded better discrimination than global measurements. When two or more sectors at the superior pole were combined with each other, as well as with their counterparts at the inferior pole, discrimination improved even further. Localized changes concurred frequently, but asymmetrically at both poles of the disc. The depth from reference plane used to define the cup was not critical for separation between normal and glaucomatous eyes.