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Abstract #6354 Published in IGR 3-2
What optic disc parameters are most accurately assessed using the direct ophthalmoloscope?
Theodossiades J; Murdoch IEye 2001; 15: 283-287
PURPOSE: It has been suggested that over-reliance on the cup-to-disc ratio is a major factor in the misinterpretation of the optic disc. In spite of this, optometrist assessment of the optic disc tends to be restricted to measurement of the cup-to-disc ratio and cup depth only. Would interpretation of the disc improve if optometrists were to evaluate other parameters? The aim of this study was to evaluate the accuracy of optometrist assessment of nine parameters of the optic nerve head using direct ophthalmoscopy. METHODS: Eight optometrists evaluated nine parameters of the optic nerve head (vertical disc diameter, vertical cup-to-disc ratio, neuroretinal rim configuration, cup shape, neuroretinal rim color, vessel path, presence/absence of hemorrhage, extent and location of peripapillary atrophy, and classification of health status of the disc) in 50 eyes of 50 patients, using direct ophthalmoloscopy. Intensive training in optic nerve head assessment was given prior to assessing the patients. Criteria for evaluation were discussed. The 'gold standard' reference was the classification of the parameters by a consultant ophthalmologist with a special interest in glaucoma. RESULTS: Interobserver agreement for vertical cup-to-disc ratio was almost perfect (mean weighted kappa 0.84). Agreement for neuroretinal rim configuration, cup shape, hemorrhage, and final classification of the disc was good (mean kappa 0.62-0.67). There was moderate agreement for vessel configuration (mean kappa 0.53). For assessment of peripapillary atrophy, disc size, and neuroretinal rim color, agreement was fair (mean kappa 0.22-0.34). CONCLUSIONS: Accuracy of assessment was greatest for vertical cup-to-disc ratio, neuroretinal rim configuration and cup shape. Improved agreement has been demonstrated for the final classification of the disc compared to previous reports. The combination of training and assessment of additional disc parameters appears to improve interpretation of the optic nerve head by optometrists.
Dr I. Murdoch, Department of Preventive Ophthalmology, Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK. i.murdoch@ucl.ac.uk
Classification:
2.14 Optic disc (Part of: 2 Anatomical structures in glaucoma)
6.5 Ophthalmoscopy (Part of: 6 Clinical examination methods)
