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Elizabeth Mathenge, Jean-Claude Mwanza, Davinder Grover, Donald L Budenz; Comparison of Cup-to-Disc Ratio by Clinical Examination and Stereoscopic Disc Photography in the Tema Eye Survey. Invest. Ophthalmol. Vis. Sci. 2016;57(12):852. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Comparison of serial disc photos is the gold standard for glaucoma progression assessment. There is evidence that disc photos are not routinely obtained in practice. Alternatively, practitioners obtain photos at baseline only and compare them to their clinical examination over time. We compared grading of vertical cup-to-disc ratio (VCDR) at the slit-lamp and using disc photos to determine if there are systematic differences, which would affect the determination of progression.
The VCDR of subjects in the Tema Eye Survey were evaluated by glaucoma experts with at the slit-lamp. The results were compared with the assessment of disc stereoscopic photos by a disc reading center. To determine the possibility of systematic differences between the methods, we compared experts’ clinical grading with their reading of the disc photos.
Of 2200 eyes (testing set) used to compare clinical and the reading center gradings, 38% differed by ≥0.2; such a difference was observed in 50% of 505 eyes (validation set) selected to compare clinical and disc photo reading by experts (p<0.001). In the testing and validation sets 188 and 41 eyes were graded as having a CDR of 0.2 by the reading center and photo reading by experts, respectively. The average CDRs of these eyes at the slit-lamp were 0.36±0.11 and 0.33±0.16, respectively, all p<0.001). The 177 testing set subjects with a CDR of 0.8 estimated by the reading center had an average CDR of 0.66±0.09 at the slit-lam, p<0.001. Subjects with CDR of 0.8 per photo reading by clinicians had an average CDR of 0.81±0.19 at the slit-lamp, p=0.66.
Because of the inconsistency in CDR estimates between photo reading and evaluation at the slit-lamp, it may be preferable to compare prior photos of the optic disc to current photos rather than comparing prior photos with current clinical examination.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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