{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T17:33:50Z","timestamp":1784396030862,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T00:00:00Z","timestamp":1589846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Primary open-angle glaucoma (POAG) is considered one of the main causes of blindness. Detection of POAG at early stages and classification into evolutionary stages is crucial to blindness prevention. Methods: 1001 patients were enrolled, of whom 766 were healthy subjects and 235 were ocular hypertensive or glaucomatous patients in different stages of the disease. Spectral domain optical coherence tomography (SD-OCT) was used to determine Bruch\u2019s membrane opening-minimum rim width (BMO-MRW) and the thicknesses of peripapillary retinal nerve fibre layer (RNFL) rings with diameters of 3.0, 4.1 and 4.7 mm centred on the optic nerve. The BMO-MRW rim and RNFL rings were divided into seven sectors (G-T-TS-TI-N-NS-NI). The k-means algorithm and linear discriminant analysis were used to classify patients into disease stages. Results: We defined four glaucoma stages and provided a new model for classifying eyes into these stages, with an overall accuracy greater than 92% (88% when including healthy eyes). An online application was also implemented to predict the probability of glaucoma stage for any given eye. Conclusions: We propose a new objective algorithm for classifying POAG into clinical-evolutionary stages using SD-OCT.<\/jats:p>","DOI":"10.3390\/jcm9051530","type":"journal-article","created":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T10:37:38Z","timestamp":1589971058000},"page":"1530","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical-Evolutionary Staging System of Primary Open-Angle Glaucoma Using Optical Coherence Tomography"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1678-7488","authenticated-orcid":false,"given":"Alfonso","family":"Parra-Blesa","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Policl\u00ednica Baza, 18800 Baza (Granada), Spain"},{"name":"CEINDO, San Pablo CEU University, 28668 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8950-2044","authenticated-orcid":false,"given":"Alfredo","family":"Sanchez-Alberca","sequence":"additional","affiliation":[{"name":"Department of Statistics and Applied Maths, San Pablo CEU University, 28668 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-7271","authenticated-orcid":false,"given":"Jose Javier","family":"Garcia-Medina","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, General University Hospital Morales Meseguer, 30100 Murcia, Spain"},{"name":"Department of Ophthalmology and Optometry, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"No authors listed (2017). European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 2: Classification and terminologySupported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 2 Classification and Terminology. Br. J. Ophthalmol., 101, 73\u2013127.","DOI":"10.1136\/bjophthalmol-2016-EGSguideline.002"},{"key":"ref_2","first-page":"323","article-title":"The global impact of glaucoma","volume":"72","author":"Thylefors","year":"1994","journal-title":"Bull. World Health Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1001\/archopht.1982.01030030137016","article-title":"Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy","volume":"100","author":"Quigley","year":"1982","journal-title":"Arch. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1126\/science.1957169","article-title":"Optical coherence tomography","volume":"254","author":"Huang","year":"1991","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1001\/archopht.1995.01100050054031","article-title":"Quantification of nerve fiber layer thickness in normal and glaucomatous eyes using optical coherence tomography","volume":"113","author":"Schuman","year":"1995","journal-title":"Arch. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1755-3768.2010.01977.x","article-title":"Performance of time-domain and spectral-domain Optical Coherence Tomography for glaucoma screening","volume":"90","author":"Bengtsson","year":"2012","journal-title":"Acta Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/ICU.0b013e32835d9e27","article-title":"Diagnosis of glaucoma and detection of glaucoma progression using spectral domain optical coherence tomography","volume":"24","author":"Grewal","year":"2013","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/IJG.0b013e3181ca7cbe","article-title":"Reproducibility of retinal nerve fiber thickness measurements using the test-retest function of spectral OCT\/SLO in normal and glaucomatous eyes","volume":"19","author":"Lee","year":"2010","journal-title":"J. Glaucoma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s00417-011-1811-9","article-title":"Repeatability of nerve fiber layer thickness measurements in patients with glaucoma and without glaucoma using spectral-domain and time-domain OCT","volume":"250","author":"Sturm","year":"2012","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_10","first-page":"132","article-title":"Comparison of the diagnostic ability of retinal nerve fiber layer thickness measured using time domain and spectral domain optical coherence tomography in primary open angle glaucoma","volume":"26","author":"Huang","year":"2011","journal-title":"Eye Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ajo.2013.04.016","article-title":"From clinical examination of the optic disc to clinical assessment of the optic nerve head: A paradigm change","volume":"156","author":"Chauhan","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ajo.2017.09.020","article-title":"Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field","volume":"184","author":"Zhang","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_13","first-page":"170","article-title":"Bringing R to non-expert users with the package RKTeaching","volume":"31","year":"2015","journal-title":"Boletin de Estadistica e Investigacion Operativa (BEIO)"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Friedman, J. (2009). The Elements of Statistical Learning, Springer.","DOI":"10.1007\/978-0-387-84858-7"},{"key":"ref_15","unstructured":"Kassambara, A. (2020, May 19). Available online: https:\/\/www.datanovia.com\/en\/wp-content\/uploads\/dn-tutorials\/book-preview\/clustering_en_preview.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/IJG.0000000000000671","article-title":"Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity","volume":"26","author":"Germano","year":"2017","journal-title":"J. Glaucoma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.1007\/s00417-013-2490-5","article-title":"A modified glaucoma staging system based on visual field index","volume":"251","author":"Hirasawa","year":"2013","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/IJG.0b013e31821dac66","article-title":"Comparison of visual field severity classification systems for glaucoma","volume":"21","author":"Ng","year":"2012","journal-title":"J. Glaucoma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.sjopt.2018.09.006","article-title":"Optical coherence tomography angiography measured capillary density in the normal and glaucoma eyes","volume":"32","author":"Mansoori","year":"2018","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1136\/bjophthalmol-2018-313461","article-title":"Diagnostic performance of optical coherence tomography angiography in glaucoma: A systematic review and meta-analysis","volume":"103","author":"Miguel","year":"2019","journal-title":"Br. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rabiolo, A., Gelormini, F., Sacconi, R., Cicinelli, M.V., Triolo, G., Bettin, P., Nouri-Mahdavi, K., Bandello, F., and Querques, G. (2018). Comparison of methods to quantify macular and peripapillary vessel density in optical coherence tomography angiography. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205773"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4274\/tjo.53179","article-title":"Optical Coherence Tomography Angiography in Glaucoma","volume":"48","author":"Hollo","year":"2018","journal-title":"Turk J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1002\/jemt.23094","article-title":"Fundus image classification methods for the detection of glaucoma: A review","volume":"81","author":"Saba","year":"2018","journal-title":"Microsc. Res. Tech."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ophtha.2012.09.055","article-title":"Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter","volume":"120","author":"Chauhan","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1167\/iovs.15-17820","article-title":"Diagnostic Accuracy of Glaucoma With Sector-Based and a New Total Profile-Based Analysis of Neuroretinal Rim and Retinal Nerve Fiber Layer Thickness","volume":"57","author":"Danthurebandara","year":"2016","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/IJG.0000000000000647","article-title":"Enhanced Diagnostic Capability for Glaucoma of 3-Dimensional Versus 2-Dimensional Neuroretinal Rim Parameters Using Spectral Domain Optical Coherence Tomography","volume":"26","author":"Fan","year":"2017","journal-title":"J. Glaucoma"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1136\/bjophthalmol-2018-313581","article-title":"Diagnostic criteria for detection of retinal nerve fibre layer thickness and neuroretinal rim width abnormalities in glaucoma","volume":"104","author":"Zheng","year":"2019","journal-title":"Br. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/ICU.0000000000000552","article-title":"Artificial intelligence in glaucoma","volume":"30","author":"Zheng","year":"2019","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6886","DOI":"10.1167\/iovs.15-16701","article-title":"Structural Measurements for Monitoring Change in Glaucoma: Comparing Retinal Nerve Fiber Layer Thickness With Minimum Rim Width and Area","volume":"56","author":"Gardiner","year":"2015","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chauhan, B., Danthurebandara, V., Sharpe, G., Demirel, S., Girkin, C., Mardin, C., Scheuerle, A., and Burgoyne, C. (2015). Bruch\u2019s Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population: A Multicenter Study. Ophthalmology, 122.","DOI":"10.1016\/j.ophtha.2015.06.001"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6596","DOI":"10.1167\/iovs.16-20561","article-title":"Novel Bruch\u2019s Membrane Opening Minimum Rim Area Equalizes Disc Size Dependency and Offers High Diagnostic Power for Glaucoma","volume":"57","author":"Enders","year":"2016","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Malik, R., Belliveau, A., Sharpe, G., Shuba, L., Chauhan, B., and Nicolela, M. (2016). Diagnostic Accuracy of Optical Coherence Tomography and Scanning Laser Tomography for Identifying Glaucoma in Myopic Eyes. Ophthalmology, 123.","DOI":"10.1016\/j.ophtha.2016.01.052"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bambo, M., Fuentemilla, E., Cameo, B., Fuertes Lazaro, I., Ferrandez, B., G\u00fcerri, N., Polo, V., Larrosa, J., Pablo, L., and Garcia-Martin, E. (2020). Diagnostic capability of a linear discriminant function applied to a novel Spectralis OCT glaucoma-detection protocol. BMC Ophthalmol., 20.","DOI":"10.1186\/s12886-020-1322-8"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1038\/eye.2017.159","article-title":"OCT Glaucoma Staging System: A new method for retinal nerve fiber layer damage classification using spectral-domain OCT","volume":"32","author":"Brusini","year":"2018","journal-title":"Eye (Lond)"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1530\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:30:24Z","timestamp":1760175024000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,19]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["jcm9051530"],"URL":"https:\/\/doi.org\/10.3390\/jcm9051530","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,19]]}}}