Evaluation of Nerve Fiber Layer Assessment

More than 1,400 eyes with either ocular hypertension glaucomatous visual field loss, or normal pressures and fields (controls) were studied prospectively in standardized, masked fashion. The appearance of the nerve fiber layer was evaluated independently from red-free photographs with the discs blocked-out by two observers. The vast majority of photographs could be evaluated, the proportion varying with the observer and with the age and clinical status of the subject. Sensitivity (proportion of glaucomatous eyes with nerve fiber defects) and specificity (proportion of normal control eyes without defects) averaged 80% to 94%, varying with the observer and with the age, race, and severity of field loss. In two thirds of presumed false-positive eyes, but only 5% of true-positive eyes, the abnormalities were limited to focal slitlike defects. The prevalence of nerve fiber defects in eyes with elevated pressure and normal visual fields was similar to that in control eyes, approximately 10%. However, the proportion of eyes in which these defects included diffuse loss was considerably higher among the hypertensive eyes.