Vertical Cup-to-disc Ratio Research Articles

Glaucoma Workup in Congenital Zika Syndrome.

The main aim of this study was to perform a glaucoma workup in infants with congenital Zika syndrome (CZS). This cross-sectional study included 188 eyes of 107 children (1.1±0.3 y; range, 0.3 to 1.8 y) with CZS. The confirmation of the syndrome was possible in 77 of 107 (72.0%) of the enrolled infants based on positive immunoglobulin M antibody capture enzyme-linked immunosorbent assay for Zika virus in the cerebrospinal fluid. All infants underwent a complete ophthalmic examination and bilateral fundus imaging was captured using a wide-angle digital fundus camera (RetCam). Five eyes (2.6%) presented 2 criteria for glaucoma diagnosis: 1 eye (0.5%) presented increased intraocular pressure and increased vertical cup-to-disc ratio (CDR); 3 eyes (1.6%) presented increased horizontal corneal diameter and increased vertical, and 1 eye (0.5%) presented myopia related to increased axial length and increased vertical CDR. When excluding the CDR criterion, there was no case of glaucoma in this sample. A significant correlation was observed between high vertical CDR and small cephalic perimeter at birth (P=0.002) and the presence of clinical macular lesions (P=0.031). Although childhood glaucoma was not detected in this sample, increased vertical CDR is present in children with CZS, associated with microcephaly and clinical macular lesions at birth. This finding may lead to a misdiagnosis of glaucoma.

The Relationship Between the Sighting Eye and Functional and Structural Asymmetries in Glaucoma.

To determine the relationship between the sighting eye choice and functional and structural asymmetries in open-angle glaucoma (OAG). Two hundred patients with bilateral OAG underwent dominant eye testing using a hole-in-a-card test. The paired eyes were divided into worse and better eyes according to the mean deviation (MD) of visual field (VF) results. Based on the results, patients whose sighting eyes corresponded to eyes with a better VF were designated as group 1, and those whose sighting eyes corresponded to eyes with a worse VF as group 2. The sighting eye corresponded predominantly to eyes with better VFs (P < 0.001). The MD of the worse eye was significantly lower (P = 0.008), and the intereye difference in MD was significantly larger in group 1 than in group 2 (P < 0.001). In a comparison of regional VF threshold values and corresponding retinal nerve fiber layer thickness (RNFLT), the superior and inferior VF threshold values were consistently more deteriorated in the nonsighting worse eyes in group 1 (P = 0.009 and 0.003), compared with the sighting worse eyes in group 2, whereas the corresponding RNFLT was not significantly different between the groups. Multiple linear regression analysis showed that the sighting eye choice (P = 0.047), higher vertical cup-to disc ratio (P = 0.042), older age (P = 0.044), thinner average RNFLT (P = 0.007), and average ganglion cell-inner plexiform layer thickness of worse eyes (P < 0.001) were significantly associated with the MD of the worse eyes. The sighting eye choice was associated with functional asymmetry between eyes with glaucoma. The functional deterioration was evident in nonsighting eyes with worse VFs.

Diffusion Tensor Imaging Detects Microstructural Differences of Visual Pathway in Patients With Primary Open-Angle Glaucoma and Ocular Hypertension.

Ocular hypertension (OHT), the common situation in adult patients in the outpatients, occurs ∼5% worldwide. However, there are still some practical problems in differentiation of OHT with early primary open-angle glaucoma (POAG) using current standard methods. Application of high resolution diffusion tensor imaging (DTI) enables us to the differentiate axonal architecture of visual pathway between POAG and OHT subjects. Among 32 POAG patients recruited (15 OHT and 14 control subjects), 62.5% of glaucoma were in early stage for the current study. All subjects underwent ophthalmological assessments with standard automated perimetry and optical coherence tomography (OCT). DTI was applied to measure fraction anisotropy (FA) and mean diffusivity (MD) of optic tract (OT), lateral geniculate body (LGN) and optic radiation (OR) using voxel-based analysis. Our data demonstrated that FA values of bilateral OR in POAG were significantly lower in the right or left than that of OHT patients (left OR: 0.51 ± 0.04 vs. 0.54 ± 0.03, p < 0.05; right OR: 0.51 ± 0.05 vs. 0.54 ± 0.03, p < 0.05). In right LGN, MD values were higher in POAG patients compared with OHT subjects (9.81 ± 1.45 vs. 8.23 ± 0.62, p < 0.05). However, no significant difference of all of the DTI parameters was observed between OHT and control subjects. DTI parameters in POAG patients were positively correlated with morphological and functional measurements (p < 0.05). Vertical cup to disc ratio (VCDR) was correlated with ipsilateral FA of OT (p < 0.05), ipsilateral MD of OT (p < 0.05), ipsilateral MD of LGN (p < 0.05), and contralateral MD of OT (p < 0.05). Mean deviation of visual field (MDVF) was correlated with ipsilateral FA of OT (p < 0.05), ipsilateral MD of OT (p < 0.05), and ipsilateral FA of LGN (p < 0.05). Our study demonstrated that DTI can differentiate POAG from OHT subjects in optic pathway, particularly in early POAG, and DTI parameters can quantify the progression of POAG.

Variability of vertical cup to disc ratio measurement and the effects of glaucoma 5-year risk estimation in untreated ocular hypertensive eyes

AimTo compare the vertical cup to disc ratio (VCDR) measurements obtained with optical coherence tomography (OCT), Heidelberg retina tomography (HRT) and stereophotography of the optic nerve head (ONH) in patients...

Validation of the UNC OCT Index for the Diagnosis of Early Glaucoma.

PurposeTo independently validate the performance of the University of North Carolina Optical Coherence Tomography (UNC OCT) Index in diagnosing and predicting early glaucoma.MethodsData of 118 normal subjects (118 eyes) and 96 subjects (96 eyes) with early glaucoma defined as visual field mean deviation (MD) greater than −4 decibels (dB), aged 40 to 80 years, and who were enrolled in the Full-Threshold Testing Size III, V, VI comparison study were used in this study. CIRRUS OCT average and quadrants' retinal nerve fiber layer (RNFL); optic disc vertical cup-to-disc ratio (VCDR), cup-to-disc area ratio, and rim area; and average, minimum, and six sectoral ganglion cell-inner plexiform layer (GCIPL) measurements were run through the UNC OCT Index algorithm. Area under the receiver operating characteristic curve (AUC) and sensitivities at 95% and 99% specificity were calculated and compared between single parameters and the UNC OCT Index.ResultsMean age was 60.1 ± 11.0 years for normal subjects and 66.5 ± 8.1 years for glaucoma patients (P < 0.001). MD was 0.29 ± 1.04 dB and −1.30 ± 1.35 dB in normal and glaucomatous eyes (P < 0.001), respectively. The AUC of the UNC OCT Index was 0.96. The best single metrics when compared to the UNC OCT Index were VCDR (0.93, P = 0.054), average RNFL (0.92, P = 0.014), and minimum GCIPL (0.91, P = 0.009). The sensitivities at 95% and 99% specificity were 85.4% and 76.0% (UNC OCT Index), 71.9% and 62.5% (VCDR, all P < 0.001), 64.6% and 53.1% (average RNFL, all P < 0.001), and 66.7% and 58.3% (minimum GCIPL, all P < 0.001), respectively.ConclusionsThe findings confirm that the UNC OCT Index may provide improved diagnostic perforce over that of single OCT parameters and may be a good tool for detection of early glaucoma.Translational RelevanceThe UNC OCT Index algorithm may be incorporated easily into routine clinical practice and be useful for detecting early glaucoma.

Genetic Risk Score Is Associated with Vertical Cup-to-Disc Ratio and Improves Prediction of Primary Open-Angle Glaucoma in Latinos

Genome-wide association studies have identified multiple genetic variants associated with vertical cup-to-disc ratio (VCDR). Genetic risk scores (GRS) examine the aggregate genetic effect of individual variants on a trait by combining these separate genetic variants into a single measure. The purpose of this study was to construct GRS for VCDR and to determine whether the GRS are associated with VCDR and whether the GRS increase the discriminatory ability for primary open-angle glaucoma (POAG) in a Latino population. Population-based genetic association study. A total of 4018 Latino participants recruited from Los Angeles. Weighted and unweighted GRS were constructed using 68 previously reported VCDR single nucleotide polymorphisms (SNPs), as well as SNPs from our own genome-wide association data. Linear and logistic regression analyses examined the associations of GRS with VCDR and POAG, respectively. To evaluate the discriminatory ability of the GRS for POAG, we conducted receiver operating characteristic (ROC) analyses. The relationship between GRS and VCDR in Latinos. The GRS were associated significantly with VCDR (P < 0.0001), after adjusting for age, gender, central corneal thickness, intraocular pressure, and education. The weighted GRS explained an additional 2.74% of the variation in VCDR. Adding the weighted GRS derived from previously reported SNPs resulted in a moderate improvement in the discriminatory ability for POAG during ROC analyses, yielding an area under the ROC curve (AUC) of 0.735 (95% CI, 0.701-0.768). When our own SNPs were used, the AUC increased significantly to 0.809 (95% CI, 0.781-0.837; P < 0.0001). We obtained similar results for the unweighted GRS. To our knowledge, we identified a novel association between GRS and VCDR and its improvement in the discriminatory ability of POAG in a Latino population.

A Genome-Wide Scan for MicroRNA-Related Genetic Variants Associated With Primary Open-Angle Glaucoma.

PurposeTo identify microRNAs (miRNAs) involved in primary open-angle glaucoma (POAG), using genetic data. MiRNAs are small noncoding RNAs that posttranscriptionally regulate gene expression. Genetic variants in miRNAs or miRNA-binding sites within gene 3′-untranslated regions (3′UTRs) are expected to affect miRNA function and contribute to disease risk.MethodsData from the recent genome-wide association studies on intraocular pressure, vertical cup-to-disc ratio (VCDR), cupa area and disc area were used to investigate the association of miRNAs with POAG endophenotypes. Putative targets of the associated miRNAs were studied according to their association with POAG and tested in cell line by transfection experiments for regulation by the miRNAs.ResultsOf 411 miRNA variants, rs12803915:A/G in the terminal loop of pre–miR-612 and rs2273626:A/C in the seed sequence of miR-4707 were significantly associated with VCDR and cup area (P values < 1.2 × 10−4). The first variant is demonstrated to increase the miR-612 expression. We showed that the second variant does not affect the miR-4707 biogenesis, but reduces the binding of miR-4707-3p to CARD10, a gene known to be involved in glaucoma. Moreover, of 72,052 miRNA-binding-site variants, 47 were significantly associated with four POAG endophenotypes (P value < 6.9 × 10−6). Of these, we highlighted 10 variants that are more likely to affect miRNA-mediated gene regulation in POAG. These include rs3217992 and rs1063192, which have been shown experimentally to affect miR-138-3p– and miR-323b-5p–mediated regulation of CDKN2B.ConclusionsWe identified a number of miRNAs that are associated with POAG endophenotypes. The identified miRNAs and their target genes are candidates for future studies on miRNA-related therapies for POAG.

Can ultra-wide field retinal imaging replace colour digital stereoscopy for glaucoma detection?

ABSTRACTPurpose: Ultra-wide field (UWF) retinal imaging (Optomap, Optos plc, Dunfermline, UK) is a novel technique to image the peripheral fundus. The goal of this study was to explore the potential use of UWF imaging to detect glaucoma, and specifically to evaluate the reproducibility of measures of vertical cup-to-disc ratio (VCDR) using ultra-wide field (UWF), and the agreement between UWF and standard colour digital stereoscopy (CDS).Methods: An observational study. From a population-based epidemiological study we selected 100 eyes from 100 consecutive participants who were imaged using both standard CDS and UWF retinal imaging. Estimation of the VCDR using both modalities was made by a masked glaucoma specialist and two masked independent observers. Reliability and agreement between colour digital stereoscopy and the UWF imaging was assessed by Bland-Altman scatterplots.Results: Intra-observer reproducibility of the UWF imaging in estimating VCDRs produced Limits of Agreement (LOA) ranging from −0.13 to 0.1 (mean 0.02) and −0.14 to 0.14 (mean 0.0004) for observer 1 and 2 respectively. Inter-observer reliability between observer 1 and the glaucoma specialist for VCDR measurements using CDS and UWF produced LOA ranging from −0.37 to 0.15 (mean −0.11) and −0.24 to 0.26 (mean 0.0005) respectively. Bland Altman plots produced LOA of −0.16 to 0.20 (mean 0.02) between the two imaging methods for assessing VCDR when carried out by a glaucoma specialist.Conclusion: Grading of UWF imaging has high reproducibility in evaluating VCDR and agreement with stereoscopic optic disc imaging and may be suitable for glaucoma diagnosis in situations where CDS is not available.

Additive effects of genetic variants associated with intraocular pressure in primary open-angle glaucoma.

To investigate the association between the additive effects of genetic variants associated with intraocular pressure (IOP) and IOP, vertical cup-to-disc ratio (VCDR), and high tension glaucoma (HTG) or normal tension glaucoma (NTG) as phenotypic features of primary open-angle glaucoma (POAG), and to evaluate the clinical usefulness of the additive effects of IOP-related genetic variants for predicting IOP elevation, Japanese patients with HTG (n = 255) and NTG (n = 261) and 246 control subjects were genotyped for nine IOP-related genetic variants near CAV2, GAS7, GLCCI1/ICA1, ABCA1, ARHGEF12, FAM125B, FNDC3B, ABO, and PTPRJ/AGBL2. The total number of risk alleles of these genetic variants was calculated for each participant as a genetic risk score (GRS), and the association between the GRS and the maximum IOP, mean VCDR, and phenotype (HTG or NTG) of POAG was evaluated. As the GRS increased, the maximum IOP (P = 0.012) and VCDR (P = 0.010) significantly increased. The GRS (9.1±1.9) in patients with HTG was significantly higher (P = 0.011) than that (8.7±1.8) in control subjects. The patients with GRS≥12 as a cut-off value had a 2.54 times higher (P = 0.0085) risk on HTG (maximum IOP≥22mmHg) compared with all patients. The IOP-related GRS approach substantiated that the IOP and VCDR were increased by the additive effects of IOP-related genetic variants in POAG. The high IOP-related GRS in patients with HTG but not NTG shows that there are differences in the genetic background between HTG and NTG and supports the notion that the phenotype (HTG or NTG) in patients with POAG depends on the additive effects of IOP-related genetic variants. The above-mentioned cut-off value of IOP-related GRS may be clinically useful for predicting the risk of IOP elevation.

Compressed 3D and 2D digital images versus standard 3D slide film for the evaluation of glaucomatous optic nerve features

SynopsisClinicians can feel confident compressed three-dimensional digital (3DD) and two-dimensional digital (2DD) imaging evaluating important features of glaucomatous disc damage is comparable to the previous gold standard of stereoscopic slide...

The impact of anthropometric and ocular parameters on optic cup-to-disc ratio

Background/aimsTo assess a relationship between vertical cup-­to-­disc ratio (VCDR), which is a useful tool to assist in the diagnosis of glaucoma in the early to medium­-advanced stages, and intraocular pressure...

Crowdsourcing to Evaluate Fundus Photographs for the Presence of Glaucoma.

To assess the accuracy of crowdsourcing for grading optic nerve images for glaucoma using Amazon Mechanical Turk before and after training modules. Images (n=60) from 2 large population studies were graded for glaucoma status and vertical cup-to-disc ratio (VCDR). In the baseline trial, users on Amazon Mechanical Turk (Turkers) graded fundus photos for glaucoma and VCDR after reviewing annotated example images. In 2 additional trials, Turkers viewed a 26-slide PowerPoint training or a 10-minute video training and passed a quiz before being permitted to grade the same 60 images. Each image was graded by 10 unique Turkers in all trials. The mode of Turker grades for each image was compared with an adjudicated expert grade to determine accuracy as well as the sensitivity and specificity of Turker grading. In the baseline study, 50% of the images were graded correctly for glaucoma status and the area under the receiver operating characteristic (AUROC) was 0.75 [95% confidence interval (CI), 0.64-0.87]. Post-PowerPoint training, 66.7% of the images were graded correctly with AUROC of 0.86 (95% CI, 0.78-0.95). Finally, Turker grading accuracy was 63.3% with AUROC of 0.89 (95% CI, 0.83-0.96) after video training. Overall, Turker VCDR grades for each image correlated with expert VCDR grades (Bland-Altman plot mean difference=-0.02). Turkers graded 60 fundus images quickly and at low cost, with grading accuracy, sensitivity, and specificity, all improving with brief training. With effective education, crowdsourcing may be an efficient tool to aid in the identification of glaucomatous changes in retinal images.

Visual Field Progression in Patients with Primary Angle-Closure Glaucoma Using Pointwise Linear Regression Analysis

To evaluate visual field (VF) progression and rate of glaucomatous VF loss in patients with primary angle-closure glaucoma (PACG) using pointwise linear regression (PLR) trend analysis. Clinic-based retrospective study. Primary angle-closure glaucoma patients with 5 or more reliable VF tests and with 5 years or more of follow-up. Visual field progression was assessed by PROGRESSOR software version 3.7 (Medisoft, Leeds, United Kingdom) and was defined by the presence of at least 2 adjacent testing points located within the same hemifield that showed progression with a change of -1 dB/year or more (P < 0.01) for inner points or -2 dB/year or more (P < 0.01) for edge points. We also performed a logistic regression analysis to determine the variables associated with rapid progression (defined as mean slope of progressing points ≥-1.5 dB/year). Visual field progression and rate of VF loss. Of the 1296 patients who were assessed, 398 (30.7%) fulfilled the inclusion criteria of 5 or more VFs and 5 years or more of follow-up. Visual field progression was observed in 63 of 398 eyes (15.8%) according to the PLR criteria. The overall mean rate of VF change for these patients was -0.12±0.51 dB/year over a mean follow-up period of 10.4±3.7 years. There were no significant differences in the age, gender distribution, follow-up duration, or number of VFs between those who showed progression and those who did not (all P > 0.05). The most common sector of VF progression was the superior arcuate area (65%). Rapid progression was found in 36 patients (57%). Multiple logistic regression analysis revealed older age and higher vertical cup-to-disc ratio (VCDR) at presentation as predictors of rapid progression (all P < 0.005) in the progressing group (n= 63). In patients with PACG being managed in a hospital setting, VF progression was noted in 15.8%, and the overall rate of VF loss was -0.12±0.51 dB/year. The superior arcuate was the most common sector of progression. Older age and higher VCDR at presentation were associated with rapid progression.

Agreement in Measurement of Optic Cup-to-Disc Ratio with Stereo Biomicroscope Funduscopy and Digital Image Analysis: Results from the Nigeria National Blindness and Visual Impairment Survey

ABSTRACTPurpose: To determine agreement in estimations of vertical cup-to-disc ratio (VCDR) between clinical stereo-biomicroscopic funduscopy and digital fundus image analysis.Methods: Systematic sampling of 1-in-7 from a sample of 13,591 participants aged ≥40 years gave a subsample who were examined in detail. VCDR was estimated clinically by 60 diopter aspheric lens biomicroscopic funduscopy (c-VCDR) and by digital fundus images (i-VCDR) graded at the Moorfields Eye Hospital Reading Centre. Spearman’s correlation coefficient, paired t-test and the Bland-Altman method to assess limits of agreement (LOA) between the two methods were applied.Results: Of 1759 participants in the subsample, 848 participants (48%) with normal frequency doubling technology (FDT) visual fields and data for i-VCDR and c-VCDR in both eyes (n = 1696 eyes) were included in the analysis. By absolute difference of VCDR values for each eye between the two methods, 1585 eyes (94%) differed by ≤0.2. Mean i-VCDR was 0.381 (standard deviation, SD 0.156), and mean c-VCDR 0.321 (SD 0.145). i-VCDRs were significantly larger by a mean difference of 0.061 (SD 0.121; 95% confidence interval, CI, 0.055–0.066; p < 0.001). The 95% LOA assessed by the Bland-Altman method were lower limit −0.182 (95% CI −0.192 to −0.172) and upper limit 0.303 (95% CI 0.293–0.313). The 95% LOA intervals narrowed with higher VCDR.Conclusion: Digital image analysis and clinical assessment are two distinct methods to measure VCDR; with larger i-VCDRs in this survey. Applying i-VCDR cut-off values to c-VCDR measurements in the Nigeria Blindness Survey might have underestimated glaucoma prevalence. It is recommended that all participants in glaucoma surveys have VCDR by digital image measurement.

Distribution of intraocular pressure, central corneal thickness and vertical cup-to-disc ratio in a healthy Iranian population: the Yazd Eye Study.

To determine the distribution of intraocular pressure (IOP), central corneal thickness (CCT) and vertical cup-to-disc ratio (VCDR) in the healthy Iranian population. This population-based, epidemiologic study evaluated Iranian aged 40-80years, residing in Yazd, Iran, in 2010-2011. Eligible subjects were selected by cluster random sampling. Each participant underwent an interview and ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, stereoscopic fundus photography, ultrasonic pachymetry and visual field testing. Of 2320 eligible individuals, 2098 subjects (response rate of 90.4%) participated in the study. One eye from 1159 subjects (total of 2262 normal eyes) were randomly selected for the purpose of the study. Mean age was 53.1±9.6years. Mean IOP, CCT and VCDR were 14.2±2.5mmHg, 543±37μm and 0.32±0.14, respectively. Multiple regression analysis showed a significant correlation between IOP and age (regression coefficient=0.02 per year, p=0.015), CCT (regression coefficient=0.02 per micron, p<0.001), Spherical equivalent (regression coefficient=-0.15 per dioptre, p=0.0.024) and smoking (regression coefficient=0.89 higher for smokers, p=0.009); it also showed a significant correlation between CCT with spherical equivalent (regression coefficient=3.6 per dioptre, p=0.002) and IOP (regression coefficient=3.6 per mmHG, p<0.001). There was no significant correlation with VCDR. Mean IOP, CCT and VCDR were 14.2±2.5mmHg, 543±35μm and 0.32±0.14, respectively, in healthy Iranians that is different from other ethnicities. It seems advisable to pay attention to ethnicity for interpretation of each person's variables.

Agreement in optic disc measurements between Cirrus HD-OCT and Heidelberg retinal tomograph II in myopic eyes

Background As myopia is a common ocular condition which has been reported as the risk factor of primary open angle glaucoma, it is of great importance to evaluate the optic disc morphology in myopic eyes. Objective This study was to evaluate the agreement of optic disc measurements between Cirrus high-density optical coherence tomography (HD-OCT) and Heidelberg retina tomograph (HRT) in myopic eyes; and to investigate the relationships between axial length (AL) and differences of optic disc parameters measured with the two devices. Methods One hundred and fifty myopic subjects were included in this prospective cross-sectional study.One eye from each subject was randomly selected for optic disc imaging by Cirrus HD-OCT and HRT2 in Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong from September to December in 2010 under the approval of Ethic Committee of this hospital and informed consent of each patient was received.Each subject received complete ophthalmic examinations including intraocular pressure (IOP) measurement, visual acuity, refraction, slit lamp, dilated fundus examination and perimetry.The subjects were divided into low (≤-3.00 D, 35 eyes), moderate (-3.00 D<SE<-6.00 D, 60 eyes) and high myopia (SE≥-6.00 D, 55 eyes) groups according to the refractive status.Measurement of axial length was performed with IOL master.Optic disc parameters including disc area, rim area, cup volume, vertical cup-to-disc ratio (VCDR) and average cup-to-disc area ratio (ACDR) were measured by Cirrus HD-OCT and HRT2, respectively.The OCT measurements were corrected for ocular magnification using the Littman's formula, and the results were compared between the instruments.The measurement agreement was evaluated using Bland-Altman plots.Pearson correlation analysis was used to evaluate the associations between AL and the measurement differences of the two instruments. Results The mean axial length and refraction were (25.62±1.10) mm and (-5.22±2.34) D, respectively.The corrected optic disc parameters were significantly larger than those without adjustment by using Cirrus HD-OCT (all at P 0.05). Conclusions Optic disc parameters measured by Cirrus HD-OCT are affected by optical magnification in myopic eyes.Poor agreement is found across all of the disc measurements with Cirrus HD-OCT and HRT2.The two devices should not be used interchangeably for measurements of optic disc.Moreover, the differences between measurements of the two devices are significantly associated with AL. Key words: Diagnostic techniques, ophthalmological; Myopia; Optic disk/pathology; Tomography, optical coherence/methods; Microscopy, confocal; Human

Regression Analysis of Optical Coherence Tomography Disc Variables for Glaucoma Diagnosis.

To report diagnostic accuracy of optical coherence tomography (OCT) disc variables using both time-domain (TD) and Fourier-domain (FD) OCT, and to improve the use of OCT disc variable measurements for glaucoma diagnosis through regression analyses that adjust for optic disc size and axial length-based magnification error. Observational, cross-sectional. In total, 180 normal eyes of 112 participants and 180 eyes of 138 participants with perimetric glaucoma from the Advanced Imaging for Glaucoma Study. Diagnostic variables evaluated from TD-OCT and FD-OCT were: disc area, rim area, rim volume, optic nerve head volume, vertical cup-to-disc ratio (CDR), and horizontal CDR. These were compared with overall retinal nerve fiber layer thickness and ganglion cell complex. Regression analyses were performed that corrected for optic disc size and axial length. Area-under-receiver-operating curves (AUROC) were used to assess diagnostic accuracy before and after the adjustments. An index based on multiple logistic regression that combined optic disc variables with axial length was also explored with the aim of improving diagnostic accuracy of disc variables. Comparison of diagnostic accuracy of disc variables, as measured by AUROC. The unadjusted disc variables with the highest diagnostic accuracies were: rim volume for TD-OCT (AUROC=0.864) and vertical CDR (AUROC=0.874) for FD-OCT. Magnification correction significantly worsened diagnostic accuracy for rim variables, and while optic disc size adjustments partially restored diagnostic accuracy, the adjusted AUROCs were still lower. Axial length adjustments to disc variables in the form of multiple logistic regression indices led to a slight but insignificant improvement in diagnostic accuracy. Our various regression approaches were not able to significantly improve disc-based OCT glaucoma diagnosis. However, disc rim area and vertical CDR had very high diagnostic accuracy, and these disc variables can serve to complement additional OCT measurements for diagnosis of glaucoma.

Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma.

Among all glaucoma suspects, eyes with optic nerve head features suspicious or suggestive of early glaucoma are probably those that offer the greatest challenge for clinicians. In contrast with the robust longitudinal data published on ocular hypertension, there is no specific management guideline for these patients. Therefore, evaluating eyes with suspicious optic disc appearance and normal intraocular pressure (IOP), we sought to investigate potential differences in clinical and epidemiological characteristics to differentiate those with normal-tension glaucoma (NTG) from those with presumed large physiological optic disc cups (pLPC). In this observational case-control study, we consecutively enrolled individuals with pLPC and NTG. All eyes had vertical cup-to-disc ratio (VCDR)≥0.6 and untreated IOP<21 mmHg. Glaucomatous eyes had reproducible visual field defects. Eyes with pLPC required normal visual fields and ≥30 months of follow-up with no evidence of glaucomatous neuropathy. Clinical and epidemiological parameters were compared between groups. Eighty-four individuals with pLPC and 40 NTG patients were included. Regarding our main results, NTG patients were significantly older and with a higher prevalence of Japanese descendants (p<0.01). Not only did pLPC eyes have smaller mean VCDR, but also larger optic discs (p≤0.04). There were no significant differences for gender, central corneal thickness, and spherical equivalent (p≥0.38). Significant odds ratios (OR) were found for race (OR = 2.42; for Japanese ancestry), age (OR = 1.05), VCDR (OR = 5.03), and disc size (OR = 0.04; p≤0.04). In conclusion, in patients with suspicious optic disc and normal IOP, those with older age, Japanese ancestry, smaller optic discs, and larger VCDR are more likely to have NTG, and therefore, deserve deeper investigation and closer monitoring.

Lamina Cribrosa Depth is Associated With the Cup-to-Disc Ratio in Eyes With Large Optic Disc Cupping and Cup-to-Disc Ratio Asymmetry.

To investigate the lamina cribrosa (LC) depth and its relationship with the cup-to-disc ratio (CDR) in the eyes with generalized increased optic disc cupping and CDR asymmetry. Glaucoma suspect subjects with a CDR≥0.7, CDR asymmetry ≥0.2 in the absence of visual field (VF) loss, and normal control subjects were enrolled. The optic nerve head was imaged using the enhanced depth imaging modes of Spectralis optical coherence tomography. The LC depth was determined at the mid-horizontal, and the superior and inferior mid-peripheral regions of the optic nerve head. Disc area and CDRs were larger in the glaucoma suspect group compared with the control group (P<0.001). The mean LC depth was significantly greater in the disc area-matched glaucoma suspect group compared with the normal control group (P<0.001). The mean LC depth was positively correlated with the average and vertical CDRs (r=0.755 and 0.664, respectively; both P<0.001), which was maintained after controlling for the disc area (r=0.756 and 0.645, respectively; both P<0.001). In eyes with CDR asymmetry, the LC was located more posteriorly in eyes with a higher CDR compared with fellow eyes with a lower CDR (P<0.001). The LC depth was greater in eyes with generalized increased cupping, as well as in eyes with a higher CDR than fellow eyes, and was significantly related to the CDR. These results suggest that the clinical appearance of cup enlargement or cupping has LC displacement components.

Morphometric Optic Nerve Head Analysis in Glaucoma Patients: A Comparison between the Simultaneous Nonmydriatic Stereoscopic Fundus Camera (Kowa Nonmyd WX3D) and the Heidelberg Scanning Laser Ophthalmoscope (HRT III).

Purpose. To investigate the agreement between morphometric optic nerve head parameters assessed with the confocal laser ophthalmoscope HRT III and the stereoscopic fundus camera Kowa nonmyd WX3D retrospectively. Methods. Morphometric optic nerve head parameters of 40 eyes of 40 patients with primary open angle glaucoma were analyzed regarding their vertical cup-to-disc-ratio (CDR). Vertical CDR, disc area, cup volume, rim volume, and maximum cup depth were assessed with both devices by one examiner. Mean bias and limits of agreement (95% CI) were obtained using scatter plots and Bland-Altman analysis. Results. Overall vertical CDR comparison between HRT III and Kowa nonmyd WX3D measurements showed a mean difference (limits of agreement) of −0.06 (−0.36 to 0.24). For the CDR < 0.5 group (n = 24) mean difference in vertical CDR was −0.14 (−0.34 to 0.06) and for the CDR ≥ 0.5 group (n = 16) 0.06 (−0.21 to 0.34). Conclusion. This study showed a good agreement between Kowa nonmyd WX3D and HRT III with regard to widely used optic nerve head parameters in patients with glaucomatous optic neuropathy. However, data from Kowa nonmyd WX3D exhibited the tendency to measure larger CDR values than HRT III in the group with CDR < 0.5 group and lower CDR values in the group with CDR ≥ 0.5.