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Abstract #128113 Published in IGR 25-3
Inefficacy of Longitudinal Cup-to-Disc Ratio Measurements in Identifying Glaucoma Progression
Kamdar A; Medeiros FA; Swaminathan SSAmerican Journal of Ophthalmology 2025; 279: 78-85
OBJECTIVE: To 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). DESIGN: Retrospective 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 - CDR . Using ordinary least squares regression, we calculated eye-specific rates of change in OCT retinal nerve fiber layer (RNFL) and SAP mean deviation (MD). We classified eyes as progressors if they had statistically significant negative eye-specific slopes (P < .05). We then evaluated how well ΔCDR predicted progression on OCT or SAP. MAIN OUTCOME MEASURES: Area under receiver operating characteristic curve (AUC) predicting OCT or SAP progression using ΔCDR. RESULTS: In 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. CONCLUSIONS: Longitudinal 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.
From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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