Abstract
Purpose
To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs).
Methods
Twenty-five ocular hypertensive subjects and 56 patients with primary open-angle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cup-to-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference.
Results
The mean VCDR and HCDR was significantly higher (P<0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher (P<0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland–Altman method, as the cupping increased, the agreement also increased.
Conclusions
There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Sommer A, Katz J, Quigley HA, Millar NR, Robin AL, Richter RC et al. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol 1991; 109: 77–83.
Zeyen TG, Caprioli J . Progression of disc and field damage in early glaucoma. Arch Ophthalmol 1993; 111: 62–65.
Harweth RS, Carter-Dawson L, Shen F, Smith III EL, Crawford ML . Ganglion cell losses underlying visual field defects from experimental glaucoma. Invest Ophthalmol Vis Sci 1999; 40: 2242–2250.
Mistlberger A, Liebmann JM, Greenfield DS, Hoh ST, Ishikawa H, Marmor M et al. Assessment of optic disc anatomy and nerve fiber layer thickness in ocular hypertensive subjects with normal short wavelength automated perimetry. Ophthalmology 2002; 109: 1362–1366.
Greaney MJ, Hoffman DC, Garway-Heath DF, Nakla M, Coleman AL, Caprioli J . Comparison of optic nerve imaging methods to distinguish normal eyes from those with glaucoma. Invest Ophthalmol Vis Sci 2002; 43: 140–145.
Nouri-Mahdavi K, Hoffman BA, Tannenbaum DP, Law SK, Caprioli J . Identifying early glaucoma with optical coherence tomography. Am J Ophthalmol 2004; 137: 228–235.
Wollstein G, Ishikawa H, Wang J, Beaton SA, Schuman JS . Comparison of three optical coherence tomography scanning areas for detection of glaucomatous damage. Am J Ophthalmol 2005; 139: 39–43.
Medeiros FA, Zangwill LM, Bowd C . Evaluation of retinal nerve fiber layer, optic nerve head, and macular thickness measurements for glaucoma detection using optical coherence tomography. Am J Ophthalmol 2005; 139: 44–55.
Airaksinen PG, Drance SM, Douglas GR, Schulzer M . Neuroretinal rim areas and visual field indices in glaucoma. Am J Ophthalmol 1985; 99: 107–110.
Lichter PR . Variability of expert observers in evaluating the optic disc. Trans Am Ophthalmol Soc 1976; 74: 532–572.
Tielsch JM, Katz J, Quigley HA, Miller NR, Sommer A . Intraobserver and interobserver agreement in measurements of optic disc characteristics. Ophthalmology 1988; 95: 350–356.
Schuman JS, Hee MR, Arya AV, Pedut-Kloizman T, Puliafito CA, Fujimoto JG et al. Optical coherence tomography: a new tool for glaucoma diagnosis. Curr Opin Ophthalmol 1995; 6: 89–95.
Schuman JS, Pedut-Kloizman T, Hertzmark E, Hee MR, Wilkins JR, Coker JG et al. Reproducibility of nerve fiber layer thickness measurements using optical coherence tomography. Ophthalmology 1996; 103: 1889–1898.
Schuman JS, Wollstein G, Farra T, Hertzmark E, Aydin A, Fujimoto JG et al. Comparison of optic nerve head measurements obtained by optical coherence tomography and confocal scanning laser ophthalmoscopy. Am J Ophthalmol 2003; 135: 504–512.
Paunescu LA, Schuman JS, Price LL, Stark PC, Beaton S, Ishikawa H et al. Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT. Invest Ophthalmol Vis Sci 2004; 45: 1716–1724.
Park CY, Kim YT, Kee C . Evaluation of the influence of tilt optic disc on the measurement of optic disc variables obtained by optical coherence tomography and confocal scanning laser ophthalmoscopy. J Glaucoma 2005; 14: 210–214.
Hodapp E, Parrish II RK, Anderson DR . Clinical Decisions in Glaucoma. CV Mosby: St Louis, 1993, pp 46–47.
Katz J, Quigley HA, Sommer A . Detection of incident field loss using the glaucoma hemifield test. Ophthalmology 1996; 103: 657–663.
Shrout PE, Fleiss JL . Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420–428.
Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
Leung CK, Chan WM, Hui YL, Yung WH, Woo J, Tsang MK et al. Analysis of retinal nerve fiber layer and optic nerve head in glaucoma with different reference plane offsets, using optical coherence tomography. Invest Ophthalmol Vis Sci 2005; 46: 891–899.
Watkins R, Panchal L, Uddin J, Gunvant P . Vertical cup-to-disc ratio: agreement between direct ophthalmoscopic estimation, fundus biomicroscopic estimation, and scanning laser ophthalmoscopic measurement. Ophthalmol Vis Sci 2003; 80: 454–459.
Cesana BM . Comparison of measurement methods requires appropriate statistical methodology. Am J Ophthalmol 2004; 137: 787–788.
Hanson S, Krishnan SK, Phillips J . Observer experience and cup:disc ratio assessment. Ophthalmol Vis Sci 2001; 78: 701–705.
Ikram MK, Borger PH, Assink JJ, Jonas JB, Hofman A, de Jong PT . Comparing ophthalmoscopy, slide viewing, and semiautomated systems in optic disc morphometry. Ophthalmology 2002; 109: 486–493.
Correnti AJ, Wollstein G, Price LL, Schuman JS . Comparison of optic nerve head assessment with digital stereoscopic camera (discam), scanning laser ophthalmoscopy and stereophotography. Ophthalmology 2003; 110: 1499–1505.
Hrynchak P, Hutchings N, Jones D, Simpson T . A comparison of cup to disc ratio measurement in normal subjects using optical coherence tomography image analysis of the optic nerve head and stereo fundus biomicroscopy. Ophthalmol Physiol Opt 2004; 24: 543–550.
Wolfs RC, Borger PH, Ramrattan RS, Klaver CC, Hulsman CA, Hofman A et al. Changing views on open angle glaucoma: definitions and prevalences—The Rotterdam Study. Invest Ophthalmol Vis Sci 2000; 41: 3309–3321.
Zangwill L, Shakiba S, Caprioli J, Weinreb . Agreement between clinicians and a confocal scanning laser ophthalmoscope in estimating cup/disk ratios. Am J Ophthalmol 1995; 119: 415–421.
Briton RJ, Drance SM, Schulzer M, Douglas GR, Mawson DK . The area of the neuroretinal rim of the optic nerve in normal eyes. Am J Ophthalmol 1987; 103: 497–504.
Garway-Heath DF, Ruben ST, Viswanathan A, Hitchings RA . Vertical cup/disc ratio in relation to optic disc size: its value in the assessment of the glaucoma suspect. Br J Ophthalmol 1998; 82: 1118–1124.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no financial interest in the materials mentioned in this article
Rights and permissions
About this article
Cite this article
Arnalich-Montiel, F., Muñoz-Negrete, F., Rebolleda, G. et al. Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement. Eye 21, 1041–1049 (2007). https://doi.org/10.1038/sj.eye.6702391
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6702391
This article is cited by
-
Intraobserver and interobserver agreement of computer software-assisted optic nerve head photoplanimetry
Japanese Journal of Ophthalmology (2014)
-
Stellenwert einer perimetrischen Differenzialdiagnostik beim primären Offenwinkelglaukom
Der Ophthalmologe (2013)
-
Optic disc cupping after optic neuritis evaluated with optic coherence tomography
Eye (2009)
