Abstract
The Glaucoma Stereo Analysis Study (GSAS) is a multicenter collaborative study of the characteristics of glaucomatous optic disc morphology using a stereo fundus camera. Using GSAS dataset, the formulas for predicting different glaucomatous optic disc appearances were established. The GSAS dataset containing three-dimensionally-analyzed optic disc topographic parameters from 187 eyes with primary open-angle glaucoma was assessed with discrimination analyses to obtain formulas predictive of glaucomatous optic disc appearances: focal ischemic (FI); generalized enlargement (GE), myopic glaucomatous (MY), and senile sclerotic (SS). Using 38 optic disc parameters-substituted discrimination analyses with a stepwise forward-selection method, six parameters (temporal and nasal rim-disc ratios, mean cup depth, height variation contour, disc tilt angle, and rim decentering absolute) were selected into the formulas. The area under the receiver operating characteristic curves for predicting the four disc types with established formulas were 0.88, 0.91, 0.93, and 0.86 for FI, MY, SS, and GE, respectively. Age, visual acuity, refractive error, glaucoma (normal or high-tension glaucoma), and baseline intraocular pressure differed significantly among the four optic disc types, suggesting the appearances represent different clinical glaucoma phenotypes. Using six optic disc topographic parameters obtained by stereo fundus camera, the GSAS classification formulas predicted and quantified each component of different optic disc appearances in each eye and provided a novel parameter to describe glaucomatous optic disc characteristics.
Highlights
Glaucoma is a leading cause of irreversible blindness worldwide[1] including Japan[2]
By discrimination analyses with a stepwise variable-selection method, among 38 optic disc parameters, six parameters, i.e., the rim-disc ratio of section 1, rim-disc ratio of section 4, mean cup depth, height variation contour, disc tilt angle, and rim decentering absolute values were selected for the Glaucoma Stereo Analysis Study (GSAS) classification formulas (Table 1)
Discrimination analysis showed six of 38 parameters selected for the GSAS classification model of different optic disc appearances
Summary
Glaucoma is a leading cause of irreversible blindness worldwide[1] including Japan[2]. Topographic analysis of optic discs using a simultaneous stereo fundus camera, a noninvasive, noncontact imaging technique that does not require pupillary dilation, has been reported to have excellent reproducibility and interexaminer consistency[6], making it a promising tool to objectively assess morphologic changes in GON. The patterns and progression of visual field defects and the prevalence of risk factors, e.g., intraocular pressure (IOP) and refractive error, vary among patients with glaucoma[8, 9]. Patients with different optic disc appearances, selected only by assessment of fundus photographs, had different demographic characteristics, prevalence rates of certain systemic and ocular risk factors, IOP levels, and patterns of visual field damage[3, 10,11,12,13,14,15,16,17,18]. Classification of GONs by optic disc appearance represents different pathologic mechanisms of glaucoma and might facilitate more accurate diagnoses and better disease management
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