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This study investigates whether a novel index of macular atrophy patterns can discriminate between chiasmal compression and glaucoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective series of patients with preoperative chiasmal compression, primary open-angle glaucoma (POAG) and healthy controls. Macular optical coherence tomography (OCT) images were analysed for the macular ganglion cell and inner plexiform layer (mGCIPL) thickness. The nasal hemi-macula was compared with the temporal hemi-macula to derive the macular naso-temporal ratio (mNTR). Differences between groups and diagnostic accuracy were explored with multivariable linear regression and the area under the receiver operating characteristic curve (AUC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 111 individuals (31 with chiasmal compression, 30 with POAG and 50 healthy controls). Compared with healthy controls, the mNTR was significantly greater in POAG cases (\u03b2=0.07, 95%\u2009CI 0.03 to 0.11, p=0.001) and lower in chiasmal compression cases (\u03b2=\u22120.12, 95%\u2009CI \u22120.16 to \u20130.09, p&lt;0.001), even though overall mGCIPL thickness did not discriminate between these pathologies (p=0.36). The mNTR distinguished POAG from chiasmal compression with an AUC of 95.3% (95% CI 90% to 100%). The AUCs when comparing healthy controls to POAG and chiasmal compression were 79.0% (95% CI 68% to 90%) and 89.0% (95% CI 80% to 98%), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The mNTR can distinguish between chiasmal compression and POAG with high discrimination. This ratio may provide utility over-and-above previously reported sectoral thinning metrics. Incorporation of mNTR into the output of OCT instruments may aid earlier diagnosis of chiasmal compression.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjo-2023-323529","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T04:55:14Z","timestamp":1688014514000},"page":"695-701","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio"],"prefix":"10.1136","volume":"108","author":[{"given":"Iris","family":"Kleerekooper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4915-4353","authenticated-orcid":false,"given":"Siegfried K","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Anand","family":"Trip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon T","family":"Plant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0344-9749","authenticated-orcid":false,"given":"Axel","family":"Petzold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9239-745X","authenticated-orcid":false,"given":"Pearse A","family":"Keane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony P","family":"Khawaja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"2024082217252058000_108.5.695.1","doi-asserted-by":"publisher","DOI":"10.1080\/02688699550041485"},{"key":"2024082217252058000_108.5.695.2","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s11102-018-0906-2","article-title":"Optical coherence tomography retinal ganglion cell complex analysis for the detection of early Chiasmal compression","volume":"21","author":"Blanch","year":"2018","journal-title":"Pituitary"},{"key":"2024082217252058000_108.5.695.3","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1076\/noph.24.2.357.7156","article-title":"Failure to detect bitemporal field defects due to Chiasmal compression on a screening Perimetry protocol","volume":"24","author":"Petzold","year":"2000","journal-title":"Neuro-Ophthalmology"},{"key":"2024082217252058000_108.5.695.4","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/WNO.0000000000001173","article-title":"Three red lines for pattern recognition-based differential diagnosis using optical coherence tomography in clinical practice","volume":"41","author":"Petzold","year":"2021","journal-title":"J Neuroophthalmol"},{"key":"2024082217252058000_108.5.695.5","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2021-320563"},{"key":"2024082217252058000_108.5.695.6","doi-asserted-by":"crossref","unstructured":"Mahroo OA , Shalchi Z , Kisimbi J , et al . 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