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S. L. Mansberger, H. Nguyen, R. Torres, S. Demirel, B. A. Fortune, S. K. Gardiner, G. A. Cioffi, C. A. Johnson; Patterns of Optic Disc Change in Early Glaucoma and Glaucoma Suspect Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3338.
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To determine the most common patterns of optic disc change in early glaucoma and glaucoma suspect patients
We prospectively enrolled both eyes of patients into the Perimetry and Psychophysics in Glaucoma (PPIG) study and obtained yearly optic disc photographs using simultaneous stereo-paired photography (Nidek 3-DX Stereo Disk Camera, Tokyo, Japan). Two glaucoma specialists independently graded the baseline and most recent optic disc photographs for glaucomatous changes (optic disc progression). When disagreement occurred, the specialists re-graded these photos together attempting to achieve consensus; a third glaucoma specialist adjudicated any continuing disagreements to arrive at a final determination. The specialists categorized the type of optic disc progression as follows: increased rim thinning (two or more clock hours), new notching (one clock hour or less) of the neuroretinal rim, increased excavation (undermining of the optic disc margin), and new or increased nerve fiber layer defect(s). They also determined the quadrant(s) that these changes occurred. We also determined the sensitivity and specificity for detecting optic disc progression, and the reproducibility of the final determination.
We enrolled 168 patients (96 female, 72 male, 336 eyes) into the study with a follow-up time of at least 4 years (median = 6.1 yrs). Average age at baseline was 58 (range: 35 - 87) yrs. The sensitivity, specificity, and reproducibility of the final determination were each 80%. The specialists determined that 91 eyes (27%) showed optic disc progression. Of those eyes with progression, the most common changes were increased excavation (82%), rim thinning (43%), and notching (10%), with some patients having two or more changes. The most common location for progression was the inferior temporal quadrant. Excavation and rim thinning occurred in two or more quadrants in 33% and 31%, respectively, of eyes with optic disc progression.
Optic disc progression occurred frequently in this cohort of glaucoma suspects and early glaucoma patients. When evaluating the optic disc for glaucomatous progression in a similar cohort, eye care providers should pay particular attention to increased excavation and neuroretinal rim thinning.
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