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Abstract #106586 Published in IGR 23-3
Agreement of Diagnostic Classification Between Structural Parameters in Pre-Perimetric and Early Perimetric Glaucoma
Mathews B; Le PH; Budenz DL; Mwanza JCJournal of Glaucoma 2023; 32: 301-306
PRECIS: In both pre-perimetric and early perimetric glaucoma, the diagnostic agreements between optic disc, retinal nerve fiber layer and ganglion cell inner plexiform layer parameters based on Cirrus HD-OCT normative database classification were mostly fair, suggesting that abnormal classification in one anatomic area may suffice for the diagnosis of glaucoma in early stages. PURPOSE: To evaluate the agreement of normative database diagnostic classification between optic disc, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) in patients with early glaucoma. METHODS: Retrospective cross-sectional study involving 66 eyes (66 patients) with pre-perimetric and 97 eyes (97 patients) with early perimetric glaucoma. Normative database diagnostic classifications were retrieved from Cirrus HD-OCT scans of one eye per participant. An eye was considered abnormal if any of the optic disc, RNFL, or GCIPL was abnormal (yellow or red color-coded classification). For combined parameters, the eye had to be flagged as abnormal by both classifications, regardless of the parameters that were abnormal (global or sectorial). Agreement was assessed with Cohen's Kappa statistics. RESULTS: The agreement between RNFL and GCIPL was fair in both pre-perimetric (κ=0.25) and perimetric glaucoma (κ=0.21). Agreements between RNFL or GCIPL and ONH parameters (rim area and vertical cup-to-disc ratio; VCDR) were inconclusive due to insufficient date (P>0.05). Combining GCIPL and rim area agreed fairly with RNFL both in pre-perimetric (κ=0.21) and perimetric glaucoma (κ=0.33). The best classification agreement (moderate) was achieved with the comparison RNFL-rim area versus VCDR (κ=0.48 in pre-perimetric, 0.45 in perimetric glaucoma). There were no significant differences between pre-perimetric and perimetric glaucoma coefficients of classification agreement. CONCLUSIONS: The normative database diagnostic agreements between optic disc, RNFL, and GCIPL were mostly fair in both pre-perimetric and early perimetric glaucoma. Clinicians should not wait for multiple structures to show abnormality on OCT to diagnose early glaucoma.
Department of Ophthalmology, Kittner Eye Center, University of North Carolina, 2226 Nelson Highway, Chapel Hill, NC, U.S.A.
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