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Prevalence of Different Types of Glaucomatous Optic Disc Appearance and Their Clinical Correlations: The Blue Moutains Eye Study
1. Chih-Hung Kuo1,2
2. Marcelo Nicolela³
3. Paul Mitchell1,2
4. Ivan Goldberg²
5. Paul R Healey1,2
¹Centre for Vision Research, Sydney, Australia
²Sydney Medical School, Sydney, Australia
³Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
Purpose: Four distinct glaucomatous optic discs appearances with differing associations and outcomes have been described1. This study aimed to determine the applicability of this classification system to a general population.
Methods: The Blue Mountain Eye Study examined 3654 older Australians. 108 participants were diagnosed with open-angle glaucoma by expert panel. Their stereoscopic optic disc photographs were graded by one author (MTN) in a masked fashion.
Results: Of 201 classifiable eyes (103 patients), 26 eyes graded with low confidence were excluded. Of 175 remaining eyes, 119 (68%) could be classified as: focal ischemic (43), myopic glaucomatous (8), senile sclerotic (37), or generalized enlargement (31). The other 76 eyes were classified as mixed (20), advanced (19), atypical (3) or normal (14). The senile sclerotic and myopic glaucomatous groups were older than the focal ischemic group (p < 0.05#). The myopic glaucomatous group had the most negative refraction (p < 0.05#). Most (83%) of the myopic glaucomatous group was previously undiagnosed (p < 0.05##). Scotomata in the focal ischemic group frequently involved the most central points (p < 0.05##). There were no differences in either intraocular pressure or cup-to-disc ratio between groups.
Conclusion: Most eyes with open-angle glaucoma in an older population could be classified into one of the four pre-defined disc appearances. Eyes classified as 'myopic glaucomatous' were substantially under-diagnosed, whereas eyes classified as 'focal ischemic' had more fixation-threatening scotomata.
Reference
1. Nicolela M, Drance S. Various glaucomatous optic nerve appearances: clinical correlations. Ophthalmology 1996;103:640-9.
#Mann-Whitney U Test
##Pearson Chi-Square Test
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