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Pingping Zhao, Yangjiani Li, Mohammad Eslami, Saber Kazeminasab, Mojtaba Fazli, Vishal Sharma, Omar Halawa, Nazlee Zebardast, Mengyu Wang, Tobias Elze; The Impact of Race on the Relationship Between Cup-To-Disc Ratio and Glaucomatous Visual Field Loss. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1660 – A0155.
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To investigate the impact of patient race on the association between cup-to-disc ratio (CDR) and glaucomatous visual field (VF) loss.
From all patients from Mass. Eye and Ear glaucoma service, the most recent pairs of reliable Humphrey 24-2 VFs (false positives/negatives ≤ 15%, fixation losses ≤ 20%) and vertical CDR measurements obtained from peripapillary optical coherence tomography volume scans (Cirrus HD-OCT, signal strength ≥ 6) were selected if the patient self-identified as either Asian, Black or White on an electronic medical record questionnaire. Model selection by Bayes Factors (BF), estimated by Bayesian Information Criterion, was performed to identify the association between VF mean deviation (MD) and CDR with age and race as covariates. Additionally, the MD vs. CDR relationship was compared between the separate race groups.
16,198 eyes of 9,597 patients (56.1% female) were selected. 909 patients identified as Asian, 1,561 as Black and 7,127 as White. There was a significant main effect of race (ANOVA, p<0.001) vs. age, MD and CDR. Although White patients where the oldest group, their MD was highest and their CDR lowest among all races (Fig. 1A-C). The Bayesian model comparison identified CDR as the best single parameter model and the model consisting of age, race and CDR as the best overall model for MD (Fig. 1D), with higher age, higher CDR, and Asian and Black race significantly associated with lower MD (each p<0.001). CDR and MD are negatively correlated; the correlation strength substantially differs by race (Pearson’s r in the entire population: -0.28, Asians: -0.23, Blacks: -0.32, Whites: -0.27, each p<0.001). Fig. 2 shows a scatterplot of MD vs. CDR colored by patient race, together with the respective three linear regression fits, which considerably differ between the race groups, with the largest negative slope for Black patients.
Based on the most recent measurements of all patients of a large glaucoma clinic, our results confirm larger CDR to be related to more severe glaucomatous VF loss. The strength of this association considerably varies by patient race, with the strongest relationship observed for Black patients. As CDR is an important clinical parameter to diagnose glaucoma, our results suggest to include patient race when interpreting CDR in the context of glaucoma severity.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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