Vertical Cup-to-Disc Ratio: Agreement between Direct Ophthalmoscopic Estimation, Fundus Biomicroscopic Estimation, and Scanning Laser Ophthalmoscopic Measurement

Watkins, Russell; Panchal, Leena; Uddin, Jimmy; Gunvant, Pinakin

doi:10.1097/00006324-200306000-00012

Cited by 21 publications

(17 citation statements)

References 19 publications

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“…24 Previous studies have compared other methods of quantitative measurements with qualitative measures. Watkins et al 22 reported that direct ophthalmoscopy and fundus biomicroscopy were biased toward underestimation when compared with Heidelberg Retina Tomography (HRT), although the differences with biomicroscopy were smaller than those we found. Ikram et al 25 compared ophthalmoscopy with other semiautomated systems of optic disc analysis and also found that there was ophthalmoscopic underestimation of the VCDR when compared with HRT and that the difference was even greater when compared with the ImageNet System.…”

Section: Discussioncontrasting

confidence: 81%

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Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Arnalich‐Montiel¹,

Muñoz-Negrete²,

Rebolleda³

et al. 2006

Eye

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Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement AbstractPurpose 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 openangle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cupto-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 (Po0.001) 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 (Po0.001) 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.

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Section: Discussioncontrasting

confidence: 81%

“…22 Although previous studies have reported weak interobserver agreement of ophthalmoscopic assessment based on low ICC, we found a high ICC for both the VCDR and the HCDR. 10,11 However, the agreement in the estimation of the HCDR was less strong, and one of the specialists had a value that was significantly higher.…”

Section: Discussioncontrasting

confidence: 67%

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Arnalich‐Montiel¹,

Muñoz-Negrete²,

Rebolleda³

et al. 2006

Eye

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“…Specifically, undilated DO underestimated the cup to disc ratios and had a higher inter‐observer variability when compared with a semi‐automated image‐analysis device (Wolfs et al. 1999), bio‐microscopy and the Heidelberg Retina Tomograph (Watkins et al. 2003).…”

Section: Resultsmentioning

confidence: 99%

Objectives of teaching direct ophthalmoscopy to medical students

Benbassat

Polak

Javitt

2011

Acta Ophthalmologica

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ABSTRACT.Purpose: To propose the objectives of undergraduate training in direct ophthalmoscopy (DO). Method: Narrative review of the literature on (i) opinions about the expected proficiency from students in DO, and (ii) estimates of its diagnostic value. Results: (i) Authorities disagree on the proficiency in DO that they expect from students. Textbooks of physical diagnosis differ in their coverage of DO. Surveys have indicated that US physicians expect students to be able to detect optic nerve head abnormalities. The Association of American Medical Colleges expects students to perform ophthalmoscopic examination and describe observations. The International Council of Ophthalmology expects students to recognize also diabetic and hypertensive retinopathies. The Association of University Professors in Ophthalmology requires that students recognize papilloedema, cholesterol emboli, glaucomatous cupping and macular degeneration.(ii) There is evidence that DO, even by ophthalmologists, is inadequate for screening for glaucoma, diabetic and hypertensive retinopathies. Two studies have suggested a limited value of DO in detecting clinical emergencies. Conclusions: The evidence that DO, even by ophthalmologists, is sub-optimal in detecting common abnormalities challenges existing the notions of training medical students. On pending the results of additional studies of the value of DO in detecting emergencies, we suggest that undergraduate teaching of DO should impart the following: (i) an ability to identify the red fundus reflex and optic disc; (ii) an ability to recognize signs of clinical emergencies in patients, mannequins or fundus photographs; and (iii) knowledge about, but not an ability to detect, other retinopathies.

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“…1,2,4,5,13, 17,52,58,102,122,131,137,138,165,167,171,182 Systematic measurement error may occur depending on the instrument and technique used. The size of an optic disk image is dependent on instrument magnification and the magnification properties of the eye.…”

Section: Techniques For Measuring Disk Sizementioning

confidence: 99%

Optic Disk Size and Glaucoma

Hoffmann

Zangwill

Crowston

et al. 2007

Survey of Ophthalmology

141

110

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Assessment of optic disk size is an important, but often overlooked, component of the diagnostic evaluation for glaucoma. Measured values of optic disk size vary with the measurement technique utilized. Available methods for disk size measurement and their respective strengths and limitations will be discussed. Further, actual disk size varies with race and possibly other demographic characteristics. Disk size is also associated with variation of specific anatomical structures of the optic nerve head and the retinal nerve fiber layer. These disk size-dependent variations may influence the susceptibility to glaucoma or the likelihood of glaucoma diagnosis. This manuscript reviews the published evidence relating to disk size and glaucoma.

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Vertical Cup-to-Disc Ratio: Agreement between Direct Ophthalmoscopic Estimation, Fundus Biomicroscopic Estimation, and Scanning Laser Ophthalmoscopic Measurement

Abstract: Fundus biomicroscopy enables more accurate, less variable VCDR estimation than direct ophthalmoscopy. The clinician should record which method they used to examine the optic nerve head so that subsequent clinical decisions are not influenced by apparent VCDR changes.

Cited by 21 publications

References 19 publications

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Cup-to-disc ratio: agreement between slit-lamp indirect ophthalmoscopic estimation and stratus optical coherence tomography measurement

Objectives of teaching direct ophthalmoscopy to medical students

Optic Disk Size and Glaucoma

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