Purpose: Evaluation of the relationship between Optical Coherence Tomography (OCT) and retinal nerve fiber layer (RNFL) photography in glaucoma, ocular hypertensives, glaucoma suspects and normals. Methods: In 4 age matched groups (127 cases), RNFL was assessed with OCT and red free photography, using a standardized scoring method. Results: There was significant correlation between OCT measurements and the photographic scores. Correlation coefficient for total, upper and lower quadrants was (0.61, 0.62 and 0.67 respectively) in the glaucoma group (all P < 0.01), and 0.70, 0.49 and 0.60 in ocular hypertensive (all P < 0.01) and 0.43, 0.34 & 0.42 in normals (P = 0.05 except for the upper quadrant). Both OCT and scoring system were able to significantly discriminate between glaucoma and normal (all P=0.000 for both), glaucoma and ocular hypertensive (P=0.000 for both), glaucoma and suspects (P=0.000 for both). However, neither of them was able to discriminate between ocular hypertensive, suspects and normal. Area under the Receiver Operating Characteristic curve (ROC curve) was 88% and 79% respectively for OCT average and RNFL total score, 83% and 72% for OCT upper quadrant and RNFL upper score and 83% & 81% for OCT lower quadrant and RNFL lower score. Conclusion: There is a significant correlation between OCT and standardized photographic scoring system. The diagnostic power of OCT measurements was higher than that of the RNFL scoring system.