The application of advanced imaging techniques in glaucoma

ABSTRACT Introduction Imaging technologies, especially optical coherence tomography (OCT), have an important role in glaucoma diagnosis and monitoring. This review aims to critically appraise recent developments in imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macula in glaucoma. Areas covered The review focuses on imaging of the ONH, retina, and associated structures, identifying five broad themes; 1) imaging of the RNFL, ONH and macula; 2) OCT angiography (OCTA); 3) structure function analysis; 4) novel methods of retinal imaging (beyond OCT and OCTA); and 5) artificial intelligence (AI). The use of imaging for glaucoma diagnosis and progression analysis is discussed. Expert opinion Measurements of RNFL, macular, and ONH have shown similar ability to detect glaucoma, though the majority of OCT diagnostic ability studies are limited by case-control design. Macular and ONH parameters such as Bruch’s membrane opening-minimum rim width (BMO-MRW) may be more useful in eyes with unusual optic disc appearance or high myopia, though the limitations of normative reference databases should be appreciated. Imaging should not replace perimetry, particularly for monitoring progression. Devices are likely to be developed that test structure and function concurrently, with results integrated using Bayesian statistical approaches.