Search

To develop and evaluate the performance of a 3-dimensional (3D) deep-learning-based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans.International, cross-sectional, multicenter study.A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively).For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference.The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated.In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933-0.953), 0.867 (0.838-0.895), and 0.878 (0.859-0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818-0.985), 0.900 (0.714-1.000), and 0.890 (0.841-0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836-0.933), 0.912 (0.816-1.000), and 0.700 (0.660-0.741), respectively, on the external testing set at clock-hour level.The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.

Purpose. To compare corneal deformation characteristics using ultra-high-speed Scheimpflug camera (Corvis ST) in patients with nonmyopic (NM), mild-to-moderate nonaxial myopic (MM), and high axial myopic (HM) eyes. Methods. In this cross-sectional study, normal subjects aged >40 years with no history of ocular laser/surgery were classified according to axial length (AL) and spherical equivalence (SE) into three groups: (1) NM (SE > −0.50 D and AL Results. A total of 180 eyes were recruited. 98 eyes were NM, 30 eyes were MM, and 52 eyes were HM. There were significant correlations of OCV to the degree of refractive error (r = 0.203, p<0.001) and AL (r = −0.242, p<0.001). After adjusting for age, sex, intraocular pressure, and corneal thickness, there was significantly higher CDA (β = 0.07, p<0.001), faster OCV (β = −0.08, p<0.001), and smaller radius (β = −0.39, p=0.01) in the HM group compared to the NM group. Conclusion. The higher CDA, faster OCV, and smaller radius found in the HM may suggest that these eyes have reduced ocular stiffness and may be less stable and more prone to stress.

Purpose We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes. Methods This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD). Results Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = -0.105, P < 0.001) in the POAG group. Within the nonglaucoma group, myopic eyes had a significantly lower OCV (adjusted effect = -0.086, P < 0.001) and higher CDA (adjusted effect = 0.079, P = 0.001). All parameters except PD suggested that glaucoma modified the effect of myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively. Conclusions Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.

Purpose The effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes. Methods Medical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity. Results In total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P = .013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P = .026). There were no significant between-group differences in mean IOPs or number of medications (both P > .05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P = .014) and bleb-needling procedures (P = .031). Conclusions This study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures.

PURPOSE To determine factors related to prostaglandin-associated periorbitopathy (PAP) and its prevalence in glaucoma or ocular hypertension (OHT) patients using prostaglandins analogs (PGAs). DESIGN A cross-sectional study. METHODS A study of glaucoma or OHT patients, using topical PGAs for at least 3 months, was performed. Eyes treated with PGAs were photoraphed and independently evaluated for PAP by 2 glaucoma specialists using at least 4 out of 7 clinical appearances. The factors of interest were sex, age, body mass index (BMI), types of glaucoma, types of PGAs, duration of PGA use, and concurrent 0.5% timolol. Univariate (χ2 test) and multivariate (multiple logistic regression) analyses assessing risk factors for PAP were performed to estimate the odds ratios (OR) with 95% conidence intervals (CIs). RESULTS One hundred thirty-four eyes from 134 patients were included. Seventy (52.2%), 21 (15.7%), and 43 (32%) eyes received components of latanoprost, travoprost, and bimatoprost, respectively. Prevalence of PAP was 44.8% (95% CI, 36.3 to 53.3). Older age >60 years (OR, 3.0; 95% CI, 1.2 to 7.8), bimatoprost (OR, 4.0; 95% CI, 1.6 to 9.5), travoprost (OR, 3.3; 95% CI, 1.1 to 10.1), and timolol (OR, 2.9; 95% CI, 1.3 to 6.8) were at risk of PAP development. In addition, BMI ≥23 kg/㎡ (OR, 0.3; 95% CI, 0.1 to 0.7) was reversely associated with PAP. CONCLUSIONS Older age, bimatoprost, or travoprost were associated with PAP, whereas high BMI was found as a protective factor. Interestingly, timolol possibly precipitated periorbital change when in use with prostaglandins.

International audience; Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

Background Intraocular tuberculosis is uncommon and has various clinical presentations. Lack of specific clinical clues can make the diagnosis challenging. The purpose of this study is to report a clinical presentation of tuberculous iridocyclitis that mimics phacolytic glaucoma and has a distinctive inflammatory deposit in the inner side of the cornea. This report is the first to describe the progression of tuberculous iridocyclitis to nodular scleritis without evidence for extraocular tuberculous infection. Case presentation A 78-year-old, immunocompetent woman presented with subacute intraocular inflammation with high intraocular pressure, mimicking phacolytic glaucoma. Distinct pigment keratic precipitates were noted on the first visit. Even though the cataract extraction was uneventful and adequate anti-inflammatory drugs were given, the inflammation did not subside as expected. Seven weeks later, she developed two scleral abscesses, which were subsequently explored for microbiological investigation. The smears of the pus revealed positive acid-fast bacilli stain and PCR for Mycobacterium tuberculosis complex. Eventually, the pus culture grew Mycobacterium tuberculosis. Anti-tuberculosis medications were prescribed. After 1 month of treatment, the abscesses were cured. However, her visual acuity did not improve at the last visit. Conclusions This case revealed an unusual presentation and untreated course of tuberculosis iridocyclitis. Pattern of keratic precipitates may indicate the presence of tuberculosis.

To compare the patterns of retinal nerve fiber layer (RNFL) thickness loss in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography (OCT). Forty-three participants with PACG and 60 with POAG underwent fast RNFL thickness measurement by OCT. Eyes were classified according to the visual field mean deviation (VF-MD) into mild (>−8 dB), moderate (−8 dB to >−16 dB), and advanced (≤−16 dB) glaucoma subgroups. The raw RNFL thickness data were compared with data from the Thai normative database. Mean (SD) age was 67.0 (9.6) and 64.1 (11.6) years in the PACG and POAG groups, respectively (P = 0.19). In the mild subgroups, a focal RNFL thickness loss was found in the inferior area in the POAG group, but not in the PACG group. The RNFL defect involved sectors 1, 6, and 7 in the moderately advanced disease subgroups of both PACG and POAG and extended through almost all sectors in the advanced disease subgroups. The deepest RNFL defect, −17.25 μm, was found in sector 6 of the mild POAG subgroup, compared with −8.78 μm in the PACG group (P = 0.04). The number of affected points in each sector in the mild subgroups was greater in the POAG group than in the PACG group. Participants with mild POAG had deeper and more localized RNFL defects than did participants with PACG. The pattern was similar in participants with moderate or advanced disease.

Optic disc assessment is an important structural measure in the detection and management of glaucoma. Accurate recognition of the disc margin is necessary for various disc assessment methods, including clinical examination, planimetry with optic disc photography (DP), Heidelberg retina tomography (HRT), and optical coherence tomography (OCT).1-5 Unfortunately, no standardized method is available across all technologies for defining the disc margin because each imaging modality provides a unique view of the optic disc. Both DP and HRT provide a conventional en face view of the optic disc region, but each uses a different light source or scanning method; DP uses either white light or red-free light illumination, whereas the HRT reflection image is a false-color representation of reflectance measured using confocal scanning with a 670-nm diode laser. The current iteration of the commercial OCT (Stratus OCT, software version 4.0; Carl Zeiss Meditec, Dublin, California) defines the disc margin as the end points of the retinal pigment epithelium (RPE) in cross-sectional retinal images.6 The machine acquires 6 radial linear cross-sectional OCT images, and the software defines a disc margin by interpolating among 12 detected points around the optic disc (2 points for each cross section). Stratus OCT disc parameters that are calculated based on this disc margin have been reported as sensitive parameters in glaucoma discrimination.7 However, whether the location of the disc margin identified by RPE termination correlates with the location subjectively identified on a DP image remains unknown. Barkana et al8 reported that vertical disc diameters measured using DP, HRT, and OCT showed a large range of differences, suggesting limited interchangeability of these measures. A new high-speed ultrahigh-resolution OCT (hsUHR-OCT) device acquires scans with an axial resolution of 3.4 μm and a 24 000-Hz sampling rate, which is more than twice the resolution and 60 times faster than the Stratus OCT.9 This high-speed scanning makes it possible to acquire a series of cross-sectional images (raster scanning) that can then be displayed as an en face OCT fundus image, similar to conventional DP (Figure 1). In addition, hsUHR-OCT creates a series of conventional OCT cross-sectional images. The OCT fundus images can be used to check eye motion during scanning, since any eye motion is visualized as distortion and discontinuity within OCT fundus images. The OCT fundus images also provide a pixel-by-pixel correspondence between the cross-sectional and DP images. This approach eliminates the registration error (eg, scanning path deviated from the planned path) inherent to the Stratus OCT. This approach also provides a unique opportunity to investigate the relationship between the RPE and the planimetrically defined disc margin on the same image. Figure 1 Three types of optic disc images from a single study participant. Although the color disc photograpy image (A) and the optical coherence tomography (OCT) fundus image (B) were not of the same size and orientation, vessel patterns and overall appearance ... On a more fundamental level, disc margins defined by DP and hsUHR-OCT could be different from each other. In other words, the color or gray scale gradient, which we rely on for disc boundary definition, could represent different optical properties because the image acquisition principles of these 2 techniques are different (eg, light source wavelengths and photosensors). Before applying hsUHR-OCT optic disc analysis to clinical data, it is important to know its characteristics compared with conventional DP. The purpose of this study was to determine the correspondence between disc margins as defined by DP and OCT (en face OCT fundus and OCT cross-sectional images) in terms of disc size (disc area and horizontal and vertical diameters) and location (geometric center).

To investigate the distribution of retinal nerve fiber layer (RNFL) and macular retinal thickness measured by optical coherence tomography (OCT) in a Thai population.We studied one eye each of 250 healthy subjects [ageor = 18 years; spherical refractive error within +/-6 diopters (D); astigmatismor =3 D; no ocular pathology]. A complete eye examination, standard automated perimetry, and fast RNFL and macular thickness measurement by OCT were performed, and a disc photograph was taken. The distributions of both thicknesses, including their relationship with demographic data, were analyzed.The mean +/- SD age of the study population was 44.7 +/- 12.2 years. The mean +/- SD RNFL thickness was 109.3 +/- 10.5 m, which was 10% thicker than that in the OCT normative database. RNFL decreased 2.3 m per decade (P0.001). Sex and spherical equivalent were not associated with RNFL thinning. The mean +/- SD central foveal thickness was 183.2 +/- 1.3 m. The macular thickness in the outer area was significantly thinner than that in the inner area (P0.001). The temporal regions were the thinnest among the four quadrants (P0.001). Thinning of all macular areas, except the center, was found to be associated with advancing age (P0.05).RNFL thickness in the measured Thai population was about 10% thicker than that in the original normative database. Macular thickness and RNFL thickness in the superior and inferior quadrants decreased with advancing age.

To compare the ability of short-wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP) to detect early glaucoma damage.Prospective case-control study using a comparative case series.Forty-two patients with preperimetric glaucomatous optic nerve damage and a normal standard achromatic perimetry (SAP) in 1 eye, but with contralateral SAP abnormalities, and 35 normals.Forty-two patients and 35 normals underwent SWAP and FDP (Humphrey 24-2; Carl Zeiss Meditec, Inc., Dublin, CA). Correlations of mean deviation (MD) and pattern standard deviation (PSD) of the 2 groups were calculated. The number of defects at P0.05 and P0.01 on total deviation (TD) and pattern deviation (PD) plots were compared. Diagnostic precision and agreement on location of abnormalities were determined.Correlations and comparisons of global indices between SWAP and FDP: MD, PSD, TD, and PD abnormal number of points.Significant correlations in the glaucoma group were found between SWAP and FDP for MD (r = 0.54; P0.008) and PSD (r = 0.49; P0.001). Defects on the TD and PD plots were detected more frequently by FDP in the glaucoma group, although they were significant only for PD at P0.01 (P = 0.024). Areas under receiver operator characteristic curves for MD of SWAP and PSD of FDP were 0.74 and 0.67, respectively (P = 0.37). Using defined defect criteria, FDP had a significantly higher sensitivity (72% vs. 54%; P = 0.02) and similar specificity (53% vs. 44%; P = 0.12) compared with SWAP. Agreement on defect location was moderate (kappa, 0.46). Testing time for SWAP was longer than for FDP in both glaucomatous and normal eyes (P0.001).Short-wavelength automated perimetry and FDP showed similar ability to detect visual dysfunction in patients with preperimetric glaucoma. Long-term follow-up is required to define their role in predicting subsequent SAP defects.

PURPOSE. To compare the performance of point-wise linear regression analysis (PLR) with total deviation (TD) versus corrected or pattern deviation (PD) threshold sensitivities for detection of visual field progression. METHODS. Four hundred two eyes (402 patients) enrolled in the Advanced Glaucoma Intervention Study (AGIS) were selected. Criteria for progression according to PLR were a slope ≤ -1 dB/year with P ≤ 0.01 with ≥2 worsening points within the same Glaucoma Hemifield Test cluster. PLR was performed on TD and PD threshold sensitivities and compared to clinical evaluation. Eyes were classified into three groups based on mean deviation (MD): mild (MD ≥ -6 dB), moderately advanced (-6 dB > MD ≥ -12 dB), and advanced (MD < -12 dB) glaucoma. RESULTS. Visual field progression was observed in 154 (38%), 85 (21%), and 175 (44%) eyes, according to PLR(TD) and PLR(PD), and clinical evaluation. The pair-wise agreement between clinicians and PLR(TD) was significantly greater than that of clinicians and PLR(PD) (κ = 0.48, 95% CI: 0.44-0.52 vs. K = 0.31, 95% CI: 0.27-0.35). Agreement between PLR(TD) and PLR(PD) decreased with increasing glaucoma severity: K (95% CI) = 0.60 (0.52-0.67), 0.41 (0.35-0.47), and 0.33 (0.27-0.40) for mild, moderately advanced, and advanced glaucoma, respectively. CONCLUSIONS. Point-wise linear regression analysis on TD threshold sensitivities performed better than the same analysis on PD when clinical evaluation was used as a reference. Agreement between the two methods was less in moderately advanced and advanced glaucoma.

To assess the prevalence of visual impairment and ocular abnormalities among schoolchildren in Chiang Mai.A community-based survey.The vision screening project was conducted from June 2000 to March 2002. Students in grade I in the Chiang Mai municipal area were examined for visual acuity (VA), color vision, ocular alignment, anterior segment and fundus. Subjective refraction was done in students with subnormal vision (VA 20/30 or less). Referral to the hospital for further evaluation and treatment was made for students with strabismus, amblyopia and other ocular abnormalities.A total of 3,431 and 3,467 students were enrolled in 2000 and 2001, respectively. The prevalence of normal vision (VA 20/20), VA 20/30 or better in at least one eye and 20/40 or less in at least one eye were similar in both years (87%, 5.7%, 7.3% and 85%, 6.4%, 8.7%, respectively). There was no statistically significant difference in visual acuity among boys and girls in either year (p = 0.6 and p = 0.2). Prevalence of abnormal color vision was 4.2%. Other causes of visual impairment in both years included strabismus (1.5% and 6.2%), amblyopia (1.1% and 1.4%) and some congenital abnormalities. Most cases of amblyopia were due to uncorrected refractive errors.The authors found that over 10% of school-aged children had subnormal vision. The important causes of visual deterioration came from refractive errors, strabismus and amblyopia. The authors concluded that vision screening is a cost-effective way of reducing visual morbidity from preventable visual impairment, which is a tragedy that cannot be ignored.

To present the benefit of preserved sclera for immediately repairing perforated corneal ulcer and report the clinical outcome of patients undergoing penetrating keratoplasty after scleral patch graft.The results of perforated corneal ulcer patients, who underwent penetrating keratoplasty after scleral patch graft between January 1996 and December 2002, were reviewed retrospectively. The causes of the corneal ulcer were also included.Penetrating keratoplasty was performed after scleral patch graft for perforated corneal ulcer on four patients, three males and one female. The culture results from corneal scraping showed Fusarium spp in two cases and Streptococus pneumoniae in one. One patient had a presumed bacterial corneal ulcer. The post-penetrating keratoplasty visual acuity ranged from hand motions to 20/40.The scleral patch graft procedure for perforated corneal ulcer may benefit in circumstances of unavailable corneal donors. The results of penetrating keratoplasty after scleral patch graft were favorable.

Detection of a Y-specific sequence in either amniotic cells or the maternal circulation has clinical importance for prenatal sex diagnosis, especially in mothers with severe X-linked disorders. Deoxyribonucleic acid sequences of human ZFY (zinc-finger-Y) gene, a Y-chromosome-specific gene and candidate for the testis-determining factor, were amplified by in vitro nested PCR technique, in amniotic cells or peripheral blood of Thai pregnant subjects carrying male fetuses. This technique permits detection of ZFY gene DNA sequences in as few as a single male cell among 100,000 female cells. The subjects in this study were a group of Thai pregnant women who had been given prenatal fetal sex diagnosis by the cytogenetic method. The results herein demonstrated the usefulness of PCR detection of Y-specific sequences in amniotic cells. The ZFY gene detection method for prenatal sex prediction by nested PCR has been developed experimentally. However, further investigation is necessary to increase reliability of clinical application. With properly designed guidelines, the established nested-PCR technique may be an alternative for the determination of the fetal sex for those pregnancies at risk of X-linked genetic disorders.

The study of the diagnosis of ectopic pregnancy was carried out during the whole year of 1988 in the Department of ObstetricsGynaecology, Siriraj Hospital, in order to find out the characteristics of ultrasonographic findings by using real time ultrasound. Real time ultrasound examination was carried out on 121 patients with suspicion of ectopic pregnancy. The final diagnosis among these patients was ectopic pregnancy, ruptured corpus luteum, ruptured appendicitis, normal pregnancy, abortion, adnexal mass and no gynecologic abnormality encountered in 21 (17.35%), 3 (2.48%), 1 (0.83%), 27 (22.31%), 4 (3.3%), 43 (35.54%) and 22 (18.18%) respectively. Of 21 patients with ectopic pregnancy 17 (80.95%) cases were between 15-30 years of age with the gestational age ranging from 6 to 12 weeks in 16 patients (76.19%). The majority of the patients 18 (85.7%) were para 0-3. The ultrasonographic findings were pelvic mass and fluid in the cul de sac, pelvic mass and fluid in the cul de sac, pelvic mass only and the presence of free fluid alone encountered in 17 (80.95%), 3 (14.28%) and 1 (4.76%) cases respectively.

Purpose To compare the performance of the retinal nerve fiber layer (RNFL) thickness and optic disk algorithms as determined by optical coherence tomography to detect glaucoma. Design Observational cross-sectional study. Methods setting: Academic tertiary-care center. study population: One eye from 42 control subjects and 65 patients with open-angle glaucoma with visual acuity of ≥20/40, and no other ocular pathologic condition. observation procedures: Two optical coherence tomography algorithms were used: "fast RNFL thickness" and "fast optic disk." main outcome measures: Area under the receiver operating characteristic curves and sensitivities at fixed specificities were used. Discriminating ability of the average RNFL thickness and RNFL thickness in clock-hour sectors and quadrants was compared with the parameters that were derived from the fast optic disk algorithm. Classification and regression trees were used to determine the best combination of parameters for the detection of glaucoma. Results The average visual field mean deviation (±SD) was 0.0 ± 1.3 and −5.3 ± 5.0 dB in the control and glaucoma groups, respectively. The RNFL thickness at the 7 o'clock sector, inferior quadrant, and the vertical C/D ratio had the highest area under the receiver operating characteristic curves (0.93 ± 0.02, 0.92 ± 0.03, and 0.90 ± 0.03, respectively). At 90% specificity, the best sensitivities (±SE) from each algorithm were 86% ± 3% for RNFL thickness at the 7 o'clock sector and 79% ± 4% for horizontal integrated rim width (estimated rim area). The combination of inferior quadrant RNFL thickness and vertical C/D ratio achieved the best classification (misclassification rate, 6.2%). Conclusion The fast optic disk algorithm performs as well as the fast RNFL thickness algorithm for discrimination of glaucoma from normal eyes. A combination of the two algorithms may provide enhanced diagnostic performance.