Aptel 2010.

Study characteristics
Patient Sampling	Prospective investigation conducted in a French university‐affiliated glaucoma centre. 166 patients were initially screened. One eye from each of 120 patients were finally included in the analysis: 40 with glaucoma, 40 with suspected glaucoma, and 40 healthy participants.
Patient characteristics and setting	Sample size: 166 patients initially screened, 120 eyes of 120 patients included in the analysis (40 glaucoma, 40 suspected glaucoma, 40 controls). Age: glaucoma patients mean ± SD, 63.4 ± 11.2 years; suspected glaucoma 61.7 ± 12.7 years; controls 60.9 ± 13.1. Sex: 46 men (14 glaucoma, 15 suspected glaucoma, 17 controls) and 74 women (26 glaucoma, 25 suspected glaucoma, 23 controls). Ocular comorbidities: no retinal disease, BCVA < 20/40, SE < ‐6 or > +3 D, non‐glaucomatous optic neuropathy or intraocular surgery except for uncomplicated cataract surgery. Setting: French university‐affiliated glaucoma centre. Country: France. Spectrum of glaucoma severity: mean ± SD MD and PSD on the VF test were ‐9.88 ± 6.93 dB and 4.42 ± 4.85 dB for glaucoma, ‐1.73 ± 2.16 dB and 2.06 ± 0.54 dB for suspected glaucoma. Control participants: IOP < 22 mmHg, normal optic disc appearance and no repeatable abnormal SAP results.
Index tests	Scanning laser polarimetry: GDx VCC, software version 5.5.0 (Carl Zeiss Meditec, Inc.). Only well‐focused, well‐centred images with a quality scan score >8 were used. Optical coherence tomography: Cirrus OCT, software version 3.0 (Carl Zeiss Meditec, Inc, Dublin, California, USA). Imaging was performed using the 200 x 200 protocol optic disc cube. Only well‐focused, well‐centred images, without eye movement and with a signal strength of 7/10 or more, were used. The authors indicate no financial conflict of interest.
Target condition and reference standard(s)	Manifest glaucoma: abnormal SAP result (GHT and PSD outside 95% of normal limits), and optic nerve damage (asymmetric cup‐to‐disc ratio > 0.2, rim thinning, notching, excavation, or RNFL defect). Suspected glaucoma: glaucomatous optic nerve damage (asymmetric cup‐to‐disc ratio > 0.2, rim thinning, notching, excavation, or retinal nerve fibre layer defect) without repeatable abnormal SAP results. Visual field testing: Humphrey Field Analyzer, 24‐2 SITA–standard strategy (Zeiss‐Humphrey Systems, Dublin, CA, USA). Optic disc evaluation: dilated fundus was examined by indirect ophthalmoscopy.
Flow and timing	Time interval between reference standard and index tests was not reported. 14 patients were excluded from the analysis for poor OCT quality criteria, 23 for poor GDx VCC quality criteria, and 28 for poor VF quality or reliability criteria.
Comparative
Notes	None.
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a case‐control design avoided?	No
Did the study avoid inappropriate exclusions?	Yes
Could the selection of patients have introduced bias?		High risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index Test (All tests)
If a threshold was used, was it pre‐specified?	Yes
Were imaging test's quality assessed?	Yes
Were any conflict of interest avoided	Yes
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Could the reference standard, its conduct, or its interpretation have introduced bias?		Low risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Low concern
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Unclear
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
Did all patients receive a reference standard	Yes
Could the patient flow have introduced bias?		High risk