Diagnostic Capability of Ganglion Cell Complex Thickness Using Spectral Domain Optical Coherence Tomography in Glaucoma

Diagnostic Capability of Ganglion Cell Complex Thickness Using Spectral Domain Optical Coherence Tomography in Glaucoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Capability of Ganglion Cell Complex Thickness Using Spectral Domain Optical Coherence Tomography in Glaucoma Poudel Arika, Gautam Adhikari Pragati, Ghimire Biplav, Thapa Madhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9295594/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background This study aimed to document the normal values of Macular Ganglion Cell Complex (GCC) thickness among control eyes and glaucoma suspects and to evaluate the diagnostic ability of GCC parameters in distinguishing Primary Open Angle Glaucoma (POAG), Glaucoma Suspects and Controls in a tertiary eye centre in Nepal. Methods A hospital-based cross-sectional observational study was conducted in Kathmandu, Nepal, from June 2020 to June 2021. GCC parameters (Average GCC, Superior GCC, and Inferior GCC) were measured using spectral-domain Optical Coherence Tomography (OCT). Mean values were compared among groups using one-way Analysis of Variance (ANOVA) and Scheffé post hoc analysis. Receiver operating characteristic (ROC) curves were constructed, and area under the curve (AUC) values were calculated to assess diagnostic performance. Results A total of 203 patients (406 eyes) were included − 76 with POAG, 62 Glaucoma suspects, and 65 Controls. Average GCC, superior GCC and Inferior GCC thickness were 96.54 ± 10.09 µm, 96.68 ± 10.91 µm and 96.43 ± 9.60 µm, in controls; 83.30 ± 11.46 µm, 83.88 ± 12.29 µm, and 81.94 ± 13.19 µm in POAG, and 93.76 ± 7.74 µm, 94.02 ± 8.03 µm, and 93.82 ± 8.27 µm, respectively in glaucoma suspects. All GCC parameters were significantly lower in the POAG group compared with both glaucoma suspects and controls (p < 0.05). The highest diagnostic accuracy was observed for average GCC and inferior GCC, both demonstrating excellent discrimination between POAG and controls (AUC = 0.83). Conclusions All GCC parameters demonstrated a significant diagnostic capability in detecting POAG, with average GCC and inferior GCC thickness showing the best performance. The single-centre cross-sectional study design, and lack of randomisation were the main limitations of this study. Primary open angle glaucoma Glaucoma suspects Spectral domain optical coherence tomography Ganglion cell complex Figures Figure 1 Background The ganglion cell is a complex neuronal structure that extends from the retina to the midbrain.[ 1 ] The thickness of the ganglion cell layer is measured over the macular region, taking into account the fact that more than half of the ganglion cells are localized at the macula. The ganglion cell complex (GCC) is affected by glaucoma in all of its components: cell bodies, dendrites, and axons.[ 2 ] Depletion in retinal nerve fibre layer thickness is an early sign of glaucoma, and it can progress to a large reduction in retinal ganglion cells (RGC) density before visual field abnormalities are noticed.[ 2 ] It has been reported that up to 25–35% of RGCs may be lost before observable visual field defects appear. To avoid visual damage, it is critical to recognize the structural alterations caused by RGC loss as soon as possible.[ 3 , 4 ] To evaluate ganglion cell damage, various methods are available. Optic disc evaluation shows structural losses at the optic nerve head (for example, higher C/D ratio, neuro-retinal rim thinning, or notching). Structural changes can be identified by tests like Retinal Nerve Fibre Layer (RNFL) and GCC analysis and functional assessment of ganglionic cells can be detected by automated visual field deficits. But the capacity of existing clinical methods is limited to detect ganglion cell injury until there is a significant loss.[ 4 , 5 ] OCT is a non-invasive optical imaging technology that has been used to assess in vivo morphologic changes in the optic nerve head, retina, and macular region.[ 6 ] While the relationship between the RNFL and the visual field has been thoroughly documented, the predictability of GCC and its relationship with retinal sensitivity is yet to be investigated. Reliance on automated visual field testing alone might miss the diagnosis, so GCC analysis should be incorporated to evaluate the structural damage.[ 7 ] The goal of this study was to find out the normal values of GCC parameters among control eyes and glaucoma suspects, and to compare thickness of various GCC parameters assessed by spectral-domain OCT among POAG, glaucoma suspect, and control groups, and evaluate diagnostic capability of macular GCC thickness in glaucoma, which have not been previously reported from Nepal. Methods A hospital-based cross-sectional observational study was conducted in a tertiary eye care centre at Kathmandu, Nepal, from June 2020 to June 2021. The patients aged 18–80 years, who visited General Ophthalmology Outpatient Department (OPD) and Glaucoma OPD, and provided consent, were included as the study population. The subjects were divided into the POAG, Glaucoma suspects and control groups. Those with glaucomatous optic nerve head changes, with or without high Intraocular Pressure (IOP), field defects, and gonioscopically open angles were grouped as POAG, as per Anderson criteria.[ 8 , 9 ] Those with suspicious optic disc appearance for glaucoma, i.e., increased cup-disc ratio for the size of the optic disc, disc haemorrhages without visual field change, or a family history of glaucoma were classified as glaucoma suspects. Similarly, age and sex matched individuals with IOP < 21 mm Hg, normal optic nerve head, no significant anterior or posterior segment abnormality and a refractive error within +3D to -3D, were the controls. Those with angle closure glaucoma, secondary open angle glaucoma, hypertensive or diabetic retinopathies, visually significant cataracts or media opacities, other retinal or macular diseases, refractive error beyond +3D or -3D, and history of intraocular surgery or cryotherapy were excluded from the study. A minimum of 52 samples for each of the three groups were calculated based on AUC estimates from a previous study.[ 10 ] Data Collection The patients in this study were examined in general as well as the glaucoma clinic of BPKLCOS. Patient findings were recorded at the presentation. Proforma designed for this study was used to record the relevant history and clinical findings. History Detailed clinical and required ophthalmic histories were taken. All relevant risk factors for POAG were assessed, and detailed family and treatment histories of glaucoma were obtained. Examination Best unaided and corrected visual acuity was recorded and retinoscopy done by a qualified optometrist. These findings were also converted to logMAR for the purpose of statistical analysis.[ 11 ] Detailed ocular examination, including slit lamp examination, anterior and posterior segment evaluation, IOP measurement by Goldmann Applanation Tonometer, indirect ophthalmoscopy and pachymetry (using Bon Sirius corneal topographer). POAG patients and glaucoma suspects underwent special clinically required investigations, namely gonioscopy, by Goldmann single mirror lens, and automated visual field analysis by SITA standard 24 − 2 perimetry (2010 Carl Zeiss Meditec HFAII 750-41686–5.1.2/ 5.1.2). However, AVF done within 6 months prior to the study were included. All subjects were scanned using RTVue XR Avanti Edition OCT.[ 5 , 12 ] Ganglion cell complex thickness was measured in all participants by GCC scan protocol, which consisted of one horizontal line with a 7 mm scan length (934 A-scans) and 15 vertical lines with a 7 mm scan length, and a 0.5 mm interval (800 A-scans) centred at 1 mm temporally to the fovea. GCC thickness was defined as the distance from the internal limiting membrane to the outer boundary of the inner plexiform layer and was calculated automatically by the device. Eyes were divided into two sectors, superior and inferior. GCC was expressed as the average thickness of both sectors (Avg GCC) and separately as the thickness of the superior (Sup GCC) and inferior (Inf GCC). The OCT by RTVue contains a normative database only between 18–80 years, hence the reason for exclusion of subjects below or above this age range. Statistical Analysis and Data Management All the proformas were thoroughly reviewed for completeness of data. Data were entered in MS Excel version 10. Proper data cleaning was done. Then the data was transferred to SPSS software version 23 and analysed. Comparison of average GCC, superior GCC, inferior GCC was done by comparison of means and the difference between GCC thickness among POAG, glaucoma suspects and control. The significance of various GCC thicknesses in the diagnosis of glaucoma was evaluated by one way ANOVA and Scheffe post hoc multiple comparisons Test. ROC curves were drawn for each GCC parameter with the purpose of discrimination between POAG and control, POAG and Glaucoma suspects, and between Glaucoma suspects and control. Areas under the Curve (AUC) were calculated along with 95% Confidence Intervals (CI) and p values, and interpreted accordingly. Results 203 patients (406 eyes) were included in the study. 76 (37.50%) were in the POAG group, 62 (30.50%) in the Glaucoma suspect group, and 65 (32.00%) in the controls group. The baseline demographic and clinical characteristics of the subjects are listed in Table 1 . Table 1 Baseline demographic and clinical characteristics of study participants (n = 203). Age in years POAG Glaucoma Suspects Controls Total Median 61.00 42.00 39.00 46.00 Age in years Mean ± S.D. 57.28 ± 14.10 41.05 ± 16.11 38.92 ± 13.75 46.44 ± 16.83 Gender Males 40 (47.37%) 29 (46.77%) 30 (46.15%) 99 (48.8%) Gender Females 36 (52.63%) 33 (53.23%) 35 (53.85%) 104 (51.2%) BCVA in LOG MAR RE 0.16 ± 0.22 0.06 ± 0.11 0.03 ± 0.11 0.088 ± 0.17 BCVA in LOG MAR LE 0.15 ± 0.20 0.08 ± 0.13 0.03 ± 0.09 0.090 ± 0.158 IOP (mm Hg) 16.37 ± 4.43 16.13 ± 2.86 15.70 ± 2.88 16.09 ± 3.54 CCT (µm) 525.64 ± 31.44 536.31 ± 31.07 537.91 ± 28.99 532.47 ± 28.99 Values are presented as mean ± SD unless otherwise stated. BCVA = best corrected visual acuity; IOP = intraocular pressure; CCT = central corneal thickness; RE = right eye; LE = left eye. Similarly, Table 2 shows the assessed means of various GCC parameters among the three groups. Table 2 Mean macular ganglion cell complex (GCC) thickness in primary open-angle glaucoma (POAG), glaucoma suspects, and controls. Values presented as mean ± SD (range). Parameters POAG Glaucoma Suspects Controls Average GCC (µm) 83.30 ± 11.46 (53–118) 93.76 ± 7.74 (70–114) 96.54 ± 10.09 (76–163) Superior GCC (µm) 83.88 ± 12.29 (53–128) 94.02 ± 8.03 (71–127) 96.68 ± 10.91 (76–179) Inferior GCC (µm) 81.94 ± 13.19 (52–114) 93.82 ± 8.27 (69–115) 96.43 ± 9.60 (73–147) Statistical analysis of findings of measurements of Average GCC, Superior GCC, and Inferior GCC and comparison among the three groups were done by one-way ANOVA, followed by Scheffe post hoc multiple comparison tests, and has been depicted in Table 3 . Average GCC, Superior GCC and Inferior GCC thickness of POAG groups were significantly lower than that of glaucoma suspects (p-value < 0.05) as well as that of Controls (p-value < 0.05). The Average GCC, Superior GCC, and Inferior GCC thicknesses of glaucoma suspects were also seen to be lower than those of controls, but these differences were not significant statistically (p-value > 0.05). Table 3 Comparison of GCC thickness among POAG, glaucoma suspects, and controls using one-way ANOVA and Scheffé post hoc tests. Dependent Variable (I) Diagnosis (J) Diagnosis Mean Difference (I-J) p-value RE Average GCC (µm) POAG Glaucoma Suspect -10.39 0.000 RE Average GCC (µm) POAG Control -14.48 0.000 RE Average GCC (µm) Glaucoma Suspect Control -4.09 0.090 LE Average GCC (µm) POAG Glaucoma Suspect -10.52 0.000 LE Average GCC (µm) POAG Control -11.99 0.000 LE Average GCC (µm) Glaucoma Suspect Control -1.47 0.680 RE Superior GCC (µm) POAG Glaucoma Suspect -9.51 0.000 RE Superior GCC (µm) POAG Control -13.15 0.000 RE Superior GCC (µm) Glaucoma Suspect Control -3.63 0.200 LE Superior GCC (µm) POAG Glaucoma Suspect -10.76 0.000 LE Superior GCC (µm) POAG Control -12.45 0.000 LE Superior GCC (µm) Glaucoma Suspect Control -1.69 0.650 RE Inferior GCC (µm) POAG Glaucoma Suspect -12.65 0.000 RE Inferior GCC (µm) POAG Control -15.78 0.000 RE Inferior GCC (µm) Glaucoma Suspect Control -3.13 0.290 LE Inferior GCC (µm) POAG Glaucoma Suspect -11.11 0.000 LE Inferior GCC (µm) POAG Control -13.19 0.000 LE Inferior GCC (µm) Glaucoma Suspect Control -2.09 0.530 (Values represent mean differences (µm) between groups (I–J) and p values. Statistically significant differences (p < 0.05) are highlighted in bold.) Moreover, ROC Curves were plotted and the Area under the Curve was calculated for each of the Average GCC, Superior GCC, and Inferior GCC thicknesses of both eyes between POAG and Controls, POAG and Glaucoma suspects, and between glaucoma suspects and Controls, as demonstrated in Fig. 1 . The values of AUC and their significance on discrimination of relationship were evaluated as follows:[ 13 , 14 ] AUC = 0.5 – No Discrimination 0.5 ≤ AUC < 0.7 – Poor Discrimination 0.7 ≤ AUC < 0.8 – Acceptable Discrimination 0.8 ≤ AUC < 0.9 – Excellent Discrimination AUC ≥ 0.9 – Outstanding Discrimination As depicted in the Table 4 , the largest AUC for discrimination of POAG eyes from normal eyes (controls) were that of Average GCC thickness and Inferior GCC thickness in the right eye. Similarly, the largest AUC for discrimination between POAG and Glaucoma suspects was of Inferior GCC for the Right eye. These findings were also statistically significant in differentiating the POAG eyes from those of glaucoma suspects. However, AUC discriminated poorly between Glaucoma suspects and Controls and were statistically insignificant. These AUC values have been listed in the Table 4 . Table 4 Area under the Curve (AUC) for GCC parameters in discriminating POAG, Glaucoma suspects and Controls. Values shown include both eyes. Parameters AUC for POAG/Control groups AUC for POAG/ Glaucoma Suspects AUC for Glaucoma Suspects/Controls RE Average GCC 0.83 (95% CI = 0.77–0.90, p < 0.05) 0.77 (95% CI = 0.69–0.85, p < 0.05) 0.61 (95% CI = 0.51–0.70, p < 0.05) RE Superior GCC 0.82 (95% CI = 0.75–0.89, p < 0.05) 0.78 (95% CI = 0.70–0.85, p 0.05) RE Inferior GCC 0.83 (95% CI = 0.76–0.90, p < 0.05) 0.79 (95% CI = 0.72–0.86, p 0.05) LE Average GCC 0.81 (95% CI = 0.74 − .88, p < 0.05) 0.79 (95% CI = 0.71–0.86, p 0.05) LE Superior GCC 0.82 (95% CI = 0.76–0.89, p < 0.05) 0.78 (95% CI = 0.70–0.86, p 0.05) LE Inferior GCC 0.80 (95% CI = 0.73–0.87, p < 0.05) 0.76 (95% CI = 0.68–0.84, p 0.05) Discussions Glaucoma is a progressive optic neuropathy characterised by the gradual degeneration of neuronal tissue, including retinal ganglion cells, often preceding detectable visual field deficits.[ 3 – 5 ] Therefore, it is important to identify the structural changes resulting from RGC loss as early as possible to prevent visual damage. In the presence of normal visual field tests, clinical evaluation can be complemented with additional evaluation of the RNFL thinning with quantitative imaging techniques. In this study, we evaluated the diagnostic performance of macular GCC thickness in differentiating POAG, glaucoma suspects, and healthy controls. The demographic characteristics of our study population were broadly comparable to previous studies. The average age of the POAG group was older than the other two groups, a finding comparable to previous studies, consistent with the known age-related rise in glaucoma prevalence.[ 12 , 15 ] POAG cases showed a slight male predominance, contrary to the normally observed higher incidence of glaucoma among females.[ 16 – 18 ] This may reflect differences in healthcare access and health-seeking behaviour. The average total IOP was similar to the findings of previous studies.[ 15 , 19 , 20 ] The similar average IOP across the three groups, however, might be due to inclusion of known patients under treatment. The significantly lower mean CCT in the POAG group also aligns with prior findings.[ 21 , 22 ] Our findings demonstrate that all GCC parameters (average, superior, and inferior) were significantly reduced in POAG compared with both glaucoma suspects and controls. These results are consistent with previous studies reporting GCC thinning as an early structural marker of glaucomatous damage.[ 7 , 18 , 19 , 23 – 26 ] Furthermore, average GCC and inferior GCC showed the highest diagnostic accuracy, with excellent AUC values for distinguishing POAG from controls. Most of these studies have also identified average GCC and inferior GCC to have the best diagnostic values. Some studies, however have identified superior GCC to have the best diagnostic performance.[ 18 ] Such variations may be due to methodological differences, disease state or patient selection. The diagnostic performance of GCC parameters in differentiating POAG from glaucoma suspects was acceptable but lower than that observed for POAG versus controls. This likely reflects the intermediate structural status of glaucoma suspects, in whom early or subclinical changes may not yet be sufficiently pronounced. Additionally, GCC parameters demonstrated poor discrimination between glaucoma suspects and controls, suggesting limited utility in this specific comparison. Overall, our results support GCC measurement as a sensitive tool for early glaucoma detection, particularly average and inferior GCC thickness. While GCC assessment could not reliably distinguish glaucoma suspects from healthy eyes, it remains valuable for identifying early structural changes before functional loss becomes evident. This study was a hospital-based study, so randomization of samples was not possible. As the patients visiting the eye OPD were taken as the sample population, the controls could not be fully matched for age and gender, possibly affecting its external validity. The POAG group was older than controls and suspects, which may influence GCC thickness as age-related retinal thinning occurs. A multicentric, longitudinal study with a larger sample size and a longer duration of study might be required for validation and generalisation of these findings. Both eyes from the same participant were included, which may introduce inter-eye correlation and could influence statistical independence. Moreover, the thinning of macular GCC can sometimes occur in causes other than POAG, e.g. Myopia, Macular degeneration, and thus should be interpreted with caution.[ 26 , 27 ] Conclusions This study showed that the thickness of all the GCC parameters, namely Average GCC, Superior GCC, and Inferior GCC are considerably lower in POAG eyes as compared to Control eyes and that of Glaucoma suspects, with Average GCC and Inferior GCC having the best discriminating ability. While GCC assessment cannot reliably distinguish glaucoma suspects from healthy eyes, it remains valuable for identifying early structural changes before functional loss becomes evident. Thus, GCC parameters can be extremely useful in the early identification of glaucoma suspects and glaucoma patients, and thus timely evaluation and initiation of treatment. Abbreviations ANOVA Analysis of Variance AUC Area Under the Curve AVF Automated Visual Field Avg Average BCVA Best corrected visual acuity BPKLCOS BP Koirala Lions Club for Ophthalmic Studies CCT Central Corneal Thickness CI Confidence Interval GCC Ganglion Cell Complex Inf Inferior IOP Intra–ocular Pressure LE Left Eye OCT Optical Coherence Tomography OPD Outpatient Department POAG Primary Open Angle Glaucoma RE Right Eye RGC Retinal Ganglion Cells RNFL Retinal Nerve Fibre Layer ROC Receiver Operating Characteristic SD Standard Deviation SPSS Statistical Package for Social Sciences Sup Superior Declarations Ethics Approval and Consent to participate This study was conducted in accordance with the tenets of the Declaration of Helsinki, and was approved by the Institutional Review Committee of the Institute of Medicine, Tribhuvan University on June 8, 2020, reference number - 987/(6-11)E 2 /076/077. Written informed consent was obtained from all the participants. Availability of data and materials The data supporting the findings of this study have been deposited in Dryad. The dataset will be made publicly available via “https://doi.org/10.5061/dryad.xwdbrv1tn” upon acceptance of the dataset. Competing Interests: The authors declare that they have no competing interests. Use of LLM: ChatGPT was used for minor language editing and rephrasing. Funding: This was not a funded study. Authors’ Contributions: AP – conceptualization, study design, ethical approval, data collection, manuscript write-up PGA – Study design, ethical approval, patient recruitment, critical manuscript review BG – write up of protocol, literature review, data analysis, manuscript drafting MT – supervision of design and ethical approval, detailed methodological guidance, manuscript review and editing Acknowledgements: We would like to express our sincere gratitude to Prof. Dr. Sagun Narayan Joshi and the entire BPKLCOS team for their continuous guidance, encouragement, and unwavering support throughout the course of this study. Their expertise and mentorship were invaluable in shaping this work. We are also deeply thankful to all the ophthalmology resident doctors, optometry students, and the entire staff of BPKLCOS for their cooperation, assistance, and dedication, which greatly facilitated the successful completion of this study. 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Ganglion cell complex. thickness in nonexudative age-related macular degeneration | Eye. https://www.nature.com/articles/eye201586 . Accessed 27 Mar 2026. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 29 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 04 Apr, 2026 Editor assigned by journal 03 Apr, 2026 Submission checks completed at journal 03 Apr, 2026 First submitted to journal 01 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9295594","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621205635,"identity":"cadc5a88-cdae-438f-89f0-b89c79b8b838","order_by":0,"name":"Poudel Arika","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDCCAyDCIAHMlmAosAFSjI0HSNBikAbS0kCEFga4lsNIgjgA3+0DjJ8rCtLkzdl7DG98MDhvt7b9MNCWGptoXFokzyUwS54xyDHc2XPG2HKGwe3kbWcSgVqOpeU24NBicAaorcGggnHDjRwzaR6gFrMDQC2MDYfxaWH+CdRiD9byx+Bcstn5hwS1sAFtyUkEa2EwOGBndoOALZJnGNssGwzSknf2HCu27DFITjC7AbQlAY9f+M4wH77Z8CfZdjt788YbPyrs7M3Opz988KHGBqcWUMRBXAjlJoK5CTiVI3sKStsTo3gUjIJRMApGFgAASwpkA6470I4AAAAASUVORK5CYII=","orcid":"","institution":"Bajrabarahi Chapagaun Hospital","correspondingAuthor":true,"prefix":"","firstName":"Poudel","middleName":"","lastName":"Arika","suffix":""},{"id":621205636,"identity":"13130feb-5226-418d-8ba4-da97fafa6bd9","order_by":1,"name":"Gautam Adhikari Pragati","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gautam","middleName":"Adhikari","lastName":"Pragati","suffix":""},{"id":621205637,"identity":"12ff9170-3f60-4c28-b425-34c743413c61","order_by":2,"name":"Ghimire Biplav","email":"","orcid":"","institution":"Kanti Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ghimire","middleName":"","lastName":"Biplav","suffix":""},{"id":621205639,"identity":"cf5de77f-aa3b-4e6a-97d9-a3beb95e3e46","order_by":3,"name":"Thapa Madhu","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thapa","middleName":"","lastName":"Madhu","suffix":""}],"badges":[],"createdAt":"2026-04-01 19:39:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9295594/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9295594/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106870903,"identity":"f9eb24e6-3065-48ef-8408-5d7220ca3814","added_by":"auto","created_at":"2026-04-14 09:43:52","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":562788,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReceiver Operating Characteristic (ROC) curves of GCC parameters\u003c/strong\u003e\u003cbr\u003e\n \u003cstrong\u003e(a)\u003c/strong\u003e ROC curves comparing average, superior, and inferior GCC thickness between POAG and Controls.\u003cbr\u003e\n \u003cstrong\u003e(b)\u003c/strong\u003e ROC curves comparing average, superior, and inferior GCC thickness between POAG and Glaucoma Suspects.\u003cbr\u003e\n \u003cstrong\u003e(c)\u003c/strong\u003e ROC curves comparing average, superior, and inferior GCC thickness between Glaucoma Suspects and Controls.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9295594/v1/41a0c8a036e7d01d0e79eb82.jpeg"},{"id":106871132,"identity":"bdf50396-d72a-48d8-87f3-297d00159b46","added_by":"auto","created_at":"2026-04-14 09:44:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1390898,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9295594/v1/1b783e7d-7ab7-4530-b93d-2e8339d53eba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Capability of Ganglion Cell Complex Thickness Using Spectral Domain Optical Coherence Tomography in Glaucoma","fulltext":[{"header":"Background","content":"\u003cp\u003eThe ganglion cell is a complex neuronal structure that extends from the retina to the midbrain.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The thickness of the ganglion cell layer is measured over the macular region, taking into account the fact that more than half of the ganglion cells are localized at the macula. The ganglion cell complex (GCC) is affected by glaucoma in all of its components: cell bodies, dendrites, and axons.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDepletion in retinal nerve fibre layer thickness is an early sign of glaucoma, and it can progress to a large reduction in retinal ganglion cells (RGC) density before visual field abnormalities are noticed.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] It has been reported that up to 25\u0026ndash;35% of RGCs may be lost before observable visual field defects appear. To avoid visual damage, it is critical to recognize the structural alterations caused by RGC loss as soon as possible.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo evaluate ganglion cell damage, various methods are available. Optic disc evaluation shows structural losses at the optic nerve head (for example, higher C/D ratio, neuro-retinal rim thinning, or notching). Structural changes can be identified by tests like Retinal Nerve Fibre Layer (RNFL) and GCC analysis and functional assessment of ganglionic cells can be detected by automated visual field deficits. But the capacity of existing clinical methods is limited to detect ganglion cell injury until there is a significant loss.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOCT is a non-invasive optical imaging technology that has been used to assess in vivo morphologic changes in the optic nerve head, retina, and macular region.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] While the relationship between the RNFL and the visual field has been thoroughly documented, the predictability of GCC and its relationship with retinal sensitivity is yet to be investigated. Reliance on automated visual field testing alone might miss the diagnosis, so GCC analysis should be incorporated to evaluate the structural damage.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe goal of this study was to find out the normal values of GCC parameters among control eyes and glaucoma suspects, and to compare thickness of various GCC parameters assessed by spectral-domain OCT among POAG, glaucoma suspect, and control groups, and evaluate diagnostic capability of macular GCC thickness in glaucoma, which have not been previously reported from Nepal.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA hospital-based cross-sectional observational study was conducted in a tertiary eye care centre at Kathmandu, Nepal, from June 2020 to June 2021.\u003c/p\u003e \u003cp\u003eThe patients aged 18\u0026ndash;80 years, who visited General Ophthalmology Outpatient Department (OPD) and Glaucoma OPD, and provided consent, were included as the study population.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe subjects were divided into the POAG, Glaucoma suspects and control groups. Those with glaucomatous optic nerve head changes, with or without high Intraocular Pressure (IOP), field defects, and gonioscopically open angles were grouped as POAG, as per Anderson criteria.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Those with suspicious optic disc appearance for glaucoma, i.e., increased cup-disc ratio for the size of the optic disc, disc haemorrhages without visual field change, or a family history of glaucoma were classified as glaucoma suspects. Similarly, age and sex matched individuals with IOP\u0026thinsp;\u0026lt;\u0026thinsp;21 mm Hg, normal optic nerve head, no significant anterior or posterior segment abnormality and a refractive error within +3D to -3D, were the controls.\u003c/p\u003e\u003cp\u003eThose with angle closure glaucoma, secondary open angle glaucoma, hypertensive or diabetic retinopathies, visually significant cataracts or media opacities, other retinal or macular diseases, refractive error beyond +3D or -3D, and history of intraocular surgery or cryotherapy were excluded from the study.\u003c/p\u003e\u003cp\u003eA minimum of 52 samples for each of the three groups were calculated based on AUC estimates from a previous study.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe patients in this study were examined in general as well as the glaucoma clinic of BPKLCOS. Patient findings were recorded at the presentation. Proforma designed for this study was used to record the relevant history and clinical findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHistory\u003c/h3\u003e\n\u003cp\u003eDetailed clinical and required ophthalmic histories were taken.\u003c/p\u003e \u003cp\u003eAll relevant risk factors for POAG were assessed, and detailed family and treatment histories of glaucoma were obtained.\u003c/p\u003e\n\u003ch3\u003eExamination\u003c/h3\u003e\n\u003cp\u003eBest unaided and corrected visual acuity was recorded and retinoscopy done by a qualified optometrist. These findings were also converted to logMAR for the purpose of statistical analysis.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDetailed ocular examination, including slit lamp examination, anterior and posterior segment evaluation, IOP measurement by Goldmann Applanation Tonometer, indirect ophthalmoscopy and pachymetry (using Bon Sirius corneal topographer).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePOAG patients and glaucoma suspects underwent special clinically required investigations, namely gonioscopy, by Goldmann single mirror lens, and automated visual field analysis by SITA standard 24\u0026thinsp;\u0026minus;\u0026thinsp;2 perimetry (2010 Carl Zeiss Meditec HFAII 750-41686\u0026ndash;5.1.2/ 5.1.2). However, AVF done within 6 months prior to the study were included.\u003c/p\u003e \u003cp\u003eAll subjects were scanned using RTVue XR Avanti Edition OCT.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Ganglion cell complex thickness was measured in all participants by GCC scan protocol, which consisted of one horizontal line with a 7 mm scan length (934 A-scans) and 15 vertical lines with a 7 mm scan length, and a 0.5 mm interval (800 A-scans) centred at 1 mm temporally to the fovea. GCC thickness was defined as the distance from the internal limiting membrane to the outer boundary of the inner plexiform layer and was calculated automatically by the device. Eyes were divided into two sectors, superior and inferior. GCC was expressed as the average thickness of both sectors (Avg GCC) and separately as the thickness of the superior (Sup GCC) and inferior (Inf GCC). The OCT by RTVue contains a normative database only between 18\u0026ndash;80 years, hence the reason for exclusion of subjects below or above this age range.\u003c/p\u003e\n\u003ch3\u003eStatistical Analysis and Data Management\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAll the proformas were thoroughly reviewed for completeness of data. Data were entered in MS Excel version 10. Proper data cleaning was done. Then the data was transferred to SPSS software version 23 and analysed. Comparison of average GCC, superior GCC, inferior GCC was done by comparison of means and the difference between GCC thickness among POAG, glaucoma suspects and control. The significance of various GCC thicknesses in the diagnosis of glaucoma was evaluated by one way ANOVA and Scheffe post hoc multiple comparisons Test. ROC curves were drawn for each GCC parameter with the purpose of discrimination between POAG and control, POAG and Glaucoma suspects, and between Glaucoma suspects and control. Areas under the Curve (AUC) were calculated along with 95% Confidence Intervals (CI) and p values, and interpreted accordingly.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e203 patients (406 eyes) were included in the study. 76 (37.50%) were in the POAG group, 62 (30.50%) in the Glaucoma suspect group, and 65 (32.00%) in the controls group.\u003c/p\u003e \u003cp\u003eThe baseline demographic and clinical characteristics of the subjects are listed in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eBaseline demographic and clinical characteristics of study participants (n\u0026thinsp;=\u0026thinsp;203).\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlaucoma Suspects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46.00\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.28\u0026thinsp;\u0026plusmn;\u0026thinsp;14.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.05\u0026thinsp;\u0026plusmn;\u0026thinsp;16.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.92\u0026thinsp;\u0026plusmn;\u0026thinsp;13.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46.44\u0026thinsp;\u0026plusmn;\u0026thinsp;16.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (47.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (46.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (46.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (52.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (53.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (53.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e104 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA in LOG MAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA in LOG MAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.090\u0026thinsp;\u0026plusmn;\u0026thinsp;0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOP (mm Hg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.37 \u0026plusmn; 4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCT (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e525.64 \u0026plusmn; 31.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e536.31 \u0026plusmn; 31.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e537.91 \u0026plusmn; 28.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e532.47 \u0026plusmn; 28.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD unless otherwise stated. BCVA\u0026thinsp;=\u0026thinsp;best corrected visual acuity; IOP\u0026thinsp;=\u0026thinsp;intraocular pressure; CCT\u0026thinsp;=\u0026thinsp;central corneal thickness; RE\u0026thinsp;=\u0026thinsp;right eye; LE\u0026thinsp;=\u0026thinsp;left eye.\u003c/p\u003e \u003cp\u003eSimilarly, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the assessed means of various GCC parameters among the three groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMean macular ganglion cell complex (GCC) thickness in primary open-angle glaucoma (POAG), glaucoma suspects, and controls.\u003c/em\u003e Values presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (range).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e83.30\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46 (53\u0026ndash;118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e93.76\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74 (70\u0026ndash;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e96.54\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09 (76\u0026ndash;163)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e83.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.29 (53\u0026ndash;128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e94.02\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03 (71\u0026ndash;127)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e96.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91 (76\u0026ndash;179)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e81.94\u0026thinsp;\u0026plusmn;\u0026thinsp;13.19 (52\u0026ndash;114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e93.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27 (69\u0026ndash;115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e96.43\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60 (73\u0026ndash;147)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStatistical analysis of findings of measurements of Average GCC, Superior GCC, and Inferior GCC and comparison among the three groups were done by one-way ANOVA, followed by Scheffe post hoc multiple comparison tests, and has been depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAverage GCC, Superior GCC and Inferior GCC thickness of POAG groups were significantly lower than that of glaucoma suspects (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as well as that of Controls (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The Average GCC, Superior GCC, and Inferior GCC thicknesses of glaucoma suspects were also seen to be lower than those of controls, but these differences were not significant statistically (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eComparison of GCC thickness among POAG, glaucoma suspects, and controls using one-way ANOVA and Scheff\u0026eacute; post hoc tests.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(I) Diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(J) Diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003cp\u003e (I-J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-11.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Average GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-9.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-13.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-12.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Superior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-12.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-15.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePOAG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-13.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Inferior GCC (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlaucoma Suspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e(Values represent mean differences (\u0026micro;m) between groups (I\u0026ndash;J) and p values. Statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) are highlighted in bold.)\u003c/p\u003e \u003cp\u003eMoreover, ROC Curves were plotted and the Area under the Curve was calculated for each of the Average GCC, Superior GCC, and Inferior GCC thicknesses of both eyes between POAG and Controls, POAG and Glaucoma suspects, and between glaucoma suspects and Controls, as demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The values of AUC and their significance on discrimination of relationship were evaluated as follows:[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAUC\u0026thinsp;=\u0026thinsp;0.5 \u0026ndash; No Discrimination\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e0.5\u0026thinsp;\u0026le;\u0026thinsp;AUC\u0026thinsp;\u0026lt;\u0026thinsp;0.7 \u0026ndash; Poor Discrimination\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e0.7\u0026thinsp;\u0026le;\u0026thinsp;AUC\u0026thinsp;\u0026lt;\u0026thinsp;0.8 \u0026ndash; Acceptable Discrimination\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e0.8\u0026thinsp;\u0026le;\u0026thinsp;AUC\u0026thinsp;\u0026lt;\u0026thinsp;0.9 \u0026ndash; Excellent Discrimination\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAUC\u0026thinsp;\u0026ge;\u0026thinsp;0.9 \u0026ndash; Outstanding Discrimination\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAs depicted in the Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the largest AUC for discrimination of POAG eyes from normal eyes (controls) were that of Average GCC thickness and Inferior GCC thickness in the right eye. Similarly, the largest AUC for discrimination between POAG and Glaucoma suspects was of Inferior GCC for the Right eye. These findings were also statistically significant in differentiating the POAG eyes from those of glaucoma suspects.\u003c/p\u003e \u003cp\u003eHowever, AUC discriminated poorly between Glaucoma suspects and Controls and were statistically insignificant.\u003c/p\u003e \u003cp\u003eThese AUC values have been listed in the Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eArea under the Curve (AUC) for GCC parameters in discriminating POAG, Glaucoma suspects and Controls.\u003c/em\u003e Values shown include both eyes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC for POAG/Control groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAUC for POAG/ Glaucoma Suspects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAUC for Glaucoma Suspects/Controls\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Average GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.83\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.77\u0026ndash;0.90, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.69\u0026ndash;0.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.61\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.51\u0026ndash;0.70, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Superior GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.82\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.75\u0026ndash;0.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.70\u0026ndash;0.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.50\u0026ndash;0.70, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRE Inferior GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.83\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.76\u0026ndash;0.90, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.72\u0026ndash;0.86, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.47\u0026ndash;0.67, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Average GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.74 \u0026minus;\u0026thinsp;.88, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.71\u0026ndash;0.86, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.44\u0026ndash;0.64, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Superior GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.82\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.76\u0026ndash;0.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.70\u0026ndash;0.86, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.45\u0026ndash;0.65, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLE Inferior GCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.80\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.73\u0026ndash;0.87, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.68\u0026ndash;0.84, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003cp\u003e(95% CI\u0026thinsp;=\u0026thinsp;0.46\u0026ndash;0.66, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eGlaucoma is a progressive optic neuropathy characterised by the gradual degeneration of neuronal tissue, including retinal ganglion cells, often preceding detectable visual field deficits.[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Therefore, it is important to identify the structural changes resulting from RGC loss as early as possible to prevent visual damage. In the presence of normal visual field tests, clinical evaluation can be complemented with additional evaluation of the RNFL thinning with quantitative imaging techniques. In this study, we evaluated the diagnostic performance of macular GCC thickness in differentiating POAG, glaucoma suspects, and healthy controls.\u003c/p\u003e \u003cp\u003eThe demographic characteristics of our study population were broadly comparable to previous studies. The average age of the POAG group was older than the other two groups, a finding comparable to previous studies, consistent with the known age-related rise in glaucoma prevalence.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] POAG cases showed a slight male predominance, contrary to the normally observed higher incidence of glaucoma among females.[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] This may reflect differences in healthcare access and health-seeking behaviour.\u003c/p\u003e \u003cp\u003eThe average total IOP was similar to the findings of previous studies.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The similar average IOP across the three groups, however, might be due to inclusion of known patients under treatment. The significantly lower mean CCT in the POAG group also aligns with prior findings.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur findings demonstrate that all GCC parameters (average, superior, and inferior) were significantly reduced in POAG compared with both glaucoma suspects and controls. These results are consistent with previous studies reporting GCC thinning as an early structural marker of glaucomatous damage.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Furthermore, average GCC and inferior GCC showed the highest diagnostic accuracy, with excellent AUC values for distinguishing POAG from controls. Most of these studies have also identified average GCC and inferior GCC to have the best diagnostic values. Some studies, however have identified superior GCC to have the best diagnostic performance.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Such variations may be due to methodological differences, disease state or patient selection.\u003c/p\u003e \u003cp\u003eThe diagnostic performance of GCC parameters in differentiating POAG from glaucoma suspects was acceptable but lower than that observed for POAG versus controls. This likely reflects the intermediate structural status of glaucoma suspects, in whom early or subclinical changes may not yet be sufficiently pronounced. Additionally, GCC parameters demonstrated poor discrimination between glaucoma suspects and controls, suggesting limited utility in this specific comparison.\u003c/p\u003e \u003cp\u003eOverall, our results support GCC measurement as a sensitive tool for early glaucoma detection, particularly average and inferior GCC thickness. While GCC assessment could not reliably distinguish glaucoma suspects from healthy eyes, it remains valuable for identifying early structural changes before functional loss becomes evident.\u003c/p\u003e \u003cp\u003eThis study was a hospital-based study, so randomization of samples was not possible. As the patients visiting the eye OPD were taken as the sample population, the controls could not be fully matched for age and gender, possibly affecting its external validity. The POAG group was older than controls and suspects, which may influence GCC thickness as age-related retinal thinning occurs. A multicentric, longitudinal study with a larger sample size and a longer duration of study might be required for validation and generalisation of these findings. Both eyes from the same participant were included, which may introduce inter-eye correlation and could influence statistical independence. Moreover, the thinning of macular GCC can sometimes occur in causes other than POAG, e.g. Myopia, Macular degeneration, and thus should be interpreted with caution.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study showed that the thickness of all the GCC parameters, namely Average GCC, Superior GCC, and Inferior GCC are considerably lower in POAG eyes as compared to Control eyes and that of Glaucoma suspects, with Average GCC and Inferior GCC having the best discriminating ability. While GCC assessment cannot reliably distinguish glaucoma suspects from healthy eyes, it remains valuable for identifying early structural changes before functional loss becomes evident. Thus, GCC parameters can be extremely useful in the early identification of glaucoma suspects and glaucoma patients, and thus timely evaluation and initiation of treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea Under the Curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAVF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutomated Visual Field\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAvg\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBCVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBest corrected visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBPKLCOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBP Koirala Lions Club for Ophthalmic Studies\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentral Corneal Thickness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGanglion Cell Complex\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eInf\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInferior\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntra\u0026ndash;ocular Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft Eye\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOptical Coherence Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOutpatient Department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOAG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary Open Angle Glaucoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRight Eye\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRGC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRetinal Ganglion Cells\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRNFL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRetinal Nerve Fibre Layer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver Operating Characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSup\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the tenets of the Declaration of Helsinki, and was approved by the Institutional Review Committee of the Institute of Medicine, Tribhuvan University on June 8, 2020, reference number - 987/(6-11)E\u003csup\u003e2\u003c/sup\u003e/076/077. Written informed consent was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study have been deposited in Dryad. The dataset will be made publicly available via \u0026ldquo;https://doi.org/10.5061/dryad.xwdbrv1tn\u0026rdquo; upon acceptance of the dataset.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUse of LLM:\u0026nbsp;\u003c/strong\u003eChatGPT was used for minor language editing and rephrasing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This was not a funded study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAP \u0026ndash;\u0026nbsp;\u003c/strong\u003econceptualization, study design, ethical approval, data collection, manuscript write-up\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePGA \u0026ndash;\u0026nbsp;\u003c/strong\u003eStudy design, ethical approval, patient recruitment, critical manuscript review\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBG \u0026ndash;\u0026nbsp;\u003c/strong\u003ewrite up of protocol, literature review, data analysis, manuscript drafting\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMT \u0026ndash;\u0026nbsp;\u003c/strong\u003esupervision of design and ethical approval, detailed methodological guidance, manuscript review and editing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to Prof. Dr. Sagun Narayan Joshi and the entire BPKLCOS team for their continuous guidance, encouragement, and unwavering support throughout the course of this study. Their expertise and mentorship were invaluable in shaping this work. We are also deeply thankful to all the ophthalmology resident doctors, optometry students, and the entire staff of BPKLCOS for their cooperation, assistance, and dedication, which greatly facilitated the successful completion of this study. Most importantly, we extend our heartfelt appreciation to all the patients who generously consented to participate in this study. Their trust and willingness made this research possible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShin H-Y, Park H-YL, Jung KI, Park CK. Comparative Study of Macular Ganglion Cell\u0026ndash;Inner Plexiform Layer and Peripapillary Retinal Nerve Fiber Layer Measurement: Structure\u0026ndash;Function Analysis. 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BMC Ophthalmol. 2020;20:17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12886-020-1304-x\u003c/span\u003e\u003cspan address=\"10.1186/s12886-020-1304-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanglion cell complex. thickness in nonexudative age-related macular degeneration | Eye. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nature.com/articles/eye201586\u003c/span\u003e\u003cspan address=\"https://www.nature.com/articles/eye201586\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 27 Mar 2026.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Primary open angle glaucoma, Glaucoma suspects, Spectral domain optical coherence tomography, Ganglion cell complex","lastPublishedDoi":"10.21203/rs.3.rs-9295594/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9295594/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study aimed to document the normal values of Macular Ganglion Cell Complex (GCC) thickness among control eyes and glaucoma suspects and to evaluate the diagnostic ability of GCC parameters in distinguishing Primary Open Angle Glaucoma (POAG), Glaucoma Suspects and Controls in a tertiary eye centre in Nepal.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA hospital-based cross-sectional observational study was conducted in Kathmandu, Nepal, from June 2020 to June 2021. GCC parameters (Average GCC, Superior GCC, and Inferior GCC) were measured using spectral-domain Optical Coherence Tomography (OCT). Mean values were compared among groups using one-way Analysis of Variance (ANOVA) and Scheff\u0026eacute; post hoc analysis. Receiver operating characteristic (ROC) curves were constructed, and area under the curve (AUC) values were calculated to assess diagnostic performance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 203 patients (406 eyes) were included\u0026thinsp;\u0026minus;\u0026thinsp;76 with POAG, 62 Glaucoma suspects, and 65 Controls. Average GCC, superior GCC and Inferior GCC thickness were 96.54\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09 \u0026micro;m, 96.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91 \u0026micro;m and 96.43\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60 \u0026micro;m, in controls; 83.30\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46 \u0026micro;m, 83.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.29 \u0026micro;m, and 81.94\u0026thinsp;\u0026plusmn;\u0026thinsp;13.19 \u0026micro;m in POAG, and 93.76\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74 \u0026micro;m, 94.02\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03 \u0026micro;m, and 93.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27 \u0026micro;m, respectively in glaucoma suspects. All GCC parameters were significantly lower in the POAG group compared with both glaucoma suspects and controls (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The highest diagnostic accuracy was observed for average GCC and inferior GCC, both demonstrating excellent discrimination between POAG and controls (AUC\u0026thinsp;=\u0026thinsp;0.83).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAll GCC parameters demonstrated a significant diagnostic capability in detecting POAG, with average GCC and inferior GCC thickness showing the best performance. The single-centre cross-sectional study design, and lack of randomisation were the main limitations of this study.\u003c/p\u003e","manuscriptTitle":"Diagnostic Capability of Ganglion Cell Complex Thickness Using Spectral Domain Optical Coherence Tomography in Glaucoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:41:02","doi":"10.21203/rs.3.rs-9295594/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T08:46:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T17:17:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T18:26:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T22:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13901218110646928254331898438667336074","date":"2026-04-10T22:43:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4837536913206019714487166861072683626","date":"2026-04-09T09:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338538269286132126545807500532114542361","date":"2026-04-07T14:36:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T06:24:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-04T13:48:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-03T10:10:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-03T10:09:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-04-01T19:24:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36f7a189-77e0-44ae-a555-a3763797d764","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T08:46:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T17:17:14+00:00","index":42,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T08:55:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:41:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9295594","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9295594","identity":"rs-9295594","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}