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J.A. Giaconi, K. Nouri–Mahdavi, D.C. Hoffman, S.K. Law, J. Caprioli; Evaluation of Clinical Disc Asymmetry in Glaucoma With Nerve Fiber Layer Imaging . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4818.
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Purpose: To determine the performance of nerve fiber layer (NFL) imaging techniques for evaluating clinical asymmetry of the optic nerves. Methods: Ninety–seven patients with clinically evident disc asymmetry were identified. Inclusion criteria were visual acuity 20/40 or better, visual field mean deviation better than –6dB in one eye, anisometropia≤1D, and age>30 years, in the absence of other ocular or neurologic disease. Three clinicians reviewed stereo disc photos and identified the eye with the larger disc, thinner neuroretinal rim, the location of neuroretinal rim defect, and graded the discs as normal, indeterminate or glaucomatous. Statistically significant asymmetry of NFL thickness, which is defined against a normal database in HRT2, GDx–VCC, and STRATUS OCT, was compared to clinician grading in various patient groups: one normal eye and one glaucomatous eye (group A, 7 patients), one normal eye and one glaucoma suspect eye (group B, 13 patients), one glaucoma suspect eye and one glaucomatous eye (group C, 25 patients). Results: Based on evaluation of disc photos, optic disc size was asymmetric in 36 patients (37.1%). Agreement between the clinicians was poor to moderate for disc–size (kappa 0.22 to 0.45), neuroretinal rim (kappa 0.12 to 0.40), and diagnosis (kappa 0.18 to 0.50). The agreement of HRT and clinicians for presence of disc size asymmetry (defined by a difference in HRT size > 10%) was fair (agreement 63.9%, kappa 0.24). Neuroretinal rim asymmetry was found qualitatively in 63 patients (64.9%). In group A, the HRT, GDx, and OCT detected asymmetric glaucomatous damage in 80%, 60%, and 57% respectively. In group B the respective numbers were 30%, 25%, and 67%. In group C, the agreement for presence of asymmetric damage was 48%, 47%, and 100%, for HRT, GDx, and OCT. When location of glaucomatous damage in eyes with localized neuroretinal rim damage was compared, HRT, GDX and OCT agreed with clinical evaluation of focal defects in 59% to 63% of the patients, respectively. Conclusions: Agreement of clinicians for detection of disc size and neuroretinal rim asymmetry was only fair. The same was true for agreement of disc and NFL imaging techniques with clinical evaluation of the discs for detection of inter–eye asymmetry. OCT may be superior to other devices for detection of NFL asymmetry.
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