ArticleAmerican journal of ophthalmology2025
Inefficacy of Longitudinal Cup-to-Disc Ratio Measurements in Identifying Glaucoma Progression.
Article in American journal of ophthalmology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo assess whether longitudinal change in cup-to-disc ratio (ΔCDR) is predictive of glaucoma progression on optical coherence tomography (OCT) or standard automated perimetry (SAP).
designRetrospective cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Subjects in the Bascom Palmer Glaucoma Repository. METHODS, INTERVENTION, OR TESTING: We extracted CDRs from the electronic health record. We identified OCT and SAP tests performed within ±6 months of CDRs. Baseline and final CDRs were defined as CDRs closest to the baseline and final tests, respectively. Eyes were required to have ≥5 tests spanning ≥2 years. ΔCDR was calculated as CDR
main outcome measuresArea under receiver operating characteristic curve (AUC) predicting OCT or SAP progression using ΔCDR.
resultsIn the OCT analysis (N = 3313 eyes), ΔCDR ≥0.20 was observed in only 7.1% of OCT progressors and 4.8% of non-progressors (P = .04). Only 2% of the variation in OCT RNFL slopes was explained by ΔCDR. AUC was 0.55. At 90% specificity, ΔCDR had a sensitivity of 15% in detecting OCT progressors. In the SAP analysis (N=2,174 eyes), ΔCDR ≥0.20 was observed in only 7.7% of SAP progressors and 5.7% of non-progressors (P = .23). Only 1% of the variation in SAP MD slopes was explained by ΔCDR. AUC was 0.53. At 90% specificity, ΔCDR had a sensitivity of 16% in detecting SAP progressors.
conclusionsLongitudinal CDR data performs similar to random selection in identifying glaucoma progression on both structural and functional testing. Given this weak association, clinicians should gauge glaucomatous progression using both a comprehensive optic nerve head examination and ancillary testing.
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