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E. Trastman-Caruso, A. P. Jindal, S. K. Jadico, J. Molineaux, B. E. Leiby, M. J. Pro, M. Moster, L. J. Katz, G. L. Spaeth, J. S. Myers; Performance of the Disc Damage Likelihood Scale, OCT III, and HRT III in the Diagnosis of Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5816.
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The DDLS is a clinical grading scale from 1-10 that characterizes the extent glaucomatous changes of the optic nerve and is correlated to visual field and HRT parameters. This study investigated the performance of DDLS, OCT III, and HRT III in evaluating optic nerves for glaucoma.
After IRB approval, 76 patients with open angle glaucoma (POAG, PXF, Pigmentary, and Low Tension Glaucoma) and 25 age-matched control subjects underwent HVF, OCT, and HRT and DDLS grading (GLS or JSM) on the same day. DDLS scores were then compared to HVF mean deviation(MD) and pattern standard deviation (PSD), OCT values including superior average and inferior average, and HRT values such as rim area and cup area.
101 patients were recruited (62 women, age 68.7+/-12.4 years). The glaucoma group included 54 subjects with POAG, 14 LTG, 5 exfoliative, and 3 pigmentary glaucoma. Average HVF MD(SD)/PSD(SD): glaucoma: -8.55(-11.69)/8.1(3.3) dB, and controls: 0.39(0.9)/1.4((0.31) dB.Area under the ROC curve values was found using logistic regression: DDLS 0.986(SE 0.10), HVF PSD 1.00 (SE 0), MD 0.956 (SE 0.019), OCT superior average 0.908(SE 0.029) and inferior average 0.99 (0.008), HRT rim area 0.825 (0.042) and cup area 0.897 (SE 0.031). There was a statistically significant (p<0.001) difference between glaucoma and controls for each of these parameters. A DDLS score of 4 or above was 96% sensitive and 97% specific for glaucoma.
Our study found that DDLS, a standardized optic nerve grading scale, had similar performance to HRT III and OCT III in distinguishing glaucoma from normal in this group of subjects.Supported in part by a research grant from the Investigator-Initiated Studies Program of Merck & Co., Inc. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck & Co., Inc.
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