Measuring Hemoglobin Levels in the Optic Nerve Head: Comparisons with Other Structural and Functional Parameters of Glaucoma

PURPOSE. We evaluated and compared the ability of a new method for measuring hemoglobin (Hb) levels at the optic nerve head (ONH) to that of visual field evaluation, scanning laser ophthalmoscopy (HRT), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) for diagnosing glaucoma. METHODS. Healthy eyes (n = 102) and glaucomatous eyes (n = 101) underwent reliable Oculus Spark perimetry, and imaging with the HRT, GDx, and Cirrus OCT. In addition, ONH color images were acquired with a non-mydriatic fundus camera. The Laguna ONhE program then was used to calculate the Hb amount in each of 24 sectors of the ONH. Sensitivities at 95% fixed specificity, diagnostic agreement, and linear correlations between parameters with the best diagnostic ability were calculated. RESULTS. The glaucoma discriminant function (GDF) of the Laguna program, evaluating Hb in the vertical intermediate sectors and center/periphery Hb amount slope, yielded an 89.1% sensitivity and 95.1% specificity, which was superior or similar to the other tests. The best GDF diagnostic agreement was for the OCT-vertical cup-to-disc (C/D) ratio (kappa = 0.772) and the final phase Spark pattern SD (kappa = 0.672). Hb levels correlated strongly with the Spark mean sensitivity (first phase 0.70, final phase 0.71). Hb also correlated well with the Reinhard OW Burk discriminant function of the HRT (0.56), nerve fiber indicator of GDx (-0.64), and vertical C/D ratio of OCT (0.71). CONCLUSIONS. Hb levels evaluated by color analysis of ONH photographs had high reproducibility, a high sensitivity-specificity balance, and moderate to strong agreement with other structural and functional tests. (Invest Ophthalmol Vis Sci. 2013;54:482-489) DOI: 10.1167/iovs.12-10761