AUTHOR=Wu Yali , Cun Qing , Tao Yijin , Yang Wenyan , Wei Jia , Fan Daoqing , Zhang Ying , Chen Qin , Zhong Hua 

TITLE=Evaluation of Macular and Retinal Ganglion Cell Count Estimates for Detecting and Staging Glaucoma

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.740761

DOI=10.3389/fmed.2021.740761

ISSN=2296-858X

ABSTRACT=Purpose: To investigate the clinical significance of macular estimated retinal ganglion cell (mRGC) and estimated retinal ganglion cell (eRGC) in the diagnosis and staging of glaucoma.
Methods: This is a cross-section study. All enrolled subjects underwent standard automated perimetry (SAP) and optical coherence tomography (OCT) examination. Swedish Interactive Threshold Algorithm, SITA-FAST detection strategy and 24-2, 10-2 detection programs were employed in SAP assessment. The visual-field parameters and OCT parameters were calculated according to three formulas to obtain the estimated retinal ganglion cell (eRGC) and estimated macular retinal ganglion cell (mRGC1 or mRGC2). The efficiency of eRGC, mRGC1, mRGC2 estimates for staging of glaucoma were compared. The sensitivity and specificity of each parameter for diagnosis of glaucoma were analyzed using receiver operating characteristic curve (ROC).
Results: A total of 119 eyes were included in the analysis. Compared with the healthy controls, eRGC, mRGC1, and mRGC2 estimates were significantly decreased in glaucoma patients. As glaucoma progressed, eRGC, mRGC1, and mRGC2 estimates were gradually reduced. In preperimetric glaucoma, mRGC1, mRGC2, eRGC were reduced by 13.2%, 14.5%, 18%, respectively; In mild stage of glaucoma, mRGC1, mRGC2, eRGC were reduced by 28%, 34%, 38%, respectively; In advanced stage, mRGC1, mRGC2 and eRGC were reduced by 81%, 85%, 92% respectively. The proportion of RGC loss in the macula were close to that outside the macula. The specificity at 95% gave a sensitivity of 95.51%, 86.52%, 87.64% for eRGC, mRGC1, mRGC2. The sensitivity of structural parameters GCC and RNFL were 98.88% and 95.51%. The sensitivity of functional parameters MD (24-2) and VFI were 80.90% and 73.03%. The area under ROC curve (AUC) of mRGC1, mRGC2 and eRGC were 0.982, 0.972, 0.995 (P <0.0001).
Conclusion:  eRGC, mRGC1 and mRGC2 provides value to staging of glaucoma as well as better diagnostic performance. Macular RGC estimates that integrate both structural and functional damage in macular may serve as a sensitive indicator for assessing macular damage in glaucoma and are of importance for the diagnosis and progression management of glaucoma.