Kamdar Amey, Medeiros Felipe A, Swaminathan Swarup S
From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Ophthalmol. 2025 Nov;279:78-85. doi: 10.1016/j.ajo.2025.07.005. Epub 2025 Jul 11.
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).
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.
Area under receiver operating characteristic curve (AUC) predicting OCT or SAP progression using ΔCDR.
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.
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.
评估杯盘比纵向变化（ΔCDR）是否可通过光学相干断层扫描（OCT）或标准自动视野计（SAP）预测青光眼进展。
回顾性队列研究。
研究对象、参与者和/或对照：巴斯科姆·帕尔默青光眼资料库中的研究对象。
方法、干预措施或检测方法：我们从电子健康记录中提取杯盘比。我们确定在杯盘比测量前后6个月内进行的OCT和SAP检测。基线和最终杯盘比分别定义为最接近基线和最终检测的杯盘比。眼睛需要有跨越至少2年的≥5次检测。ΔCDR计算为最终杯盘比减去基线杯盘比。使用普通最小二乘法回归，我们计算了OCT视网膜神经纤维层（RNFL）和SAP平均偏差（MD）的眼特异性变化率。如果眼睛具有统计学上显著的负眼特异性斜率（P < 0.05），则将其分类为进展者。然后，我们评估了ΔCDR在预测OCT或SAP进展方面的效果。
使用ΔCDR预测OCT或SAP进展的受试者工作特征曲线下面积（AUC）。
在OCT分析中（N = 3313只眼），仅7.1%的OCT进展者和4.8%的非进展者观察到ΔCDR≥0.20（P = 0.04）。ΔCDR仅解释了OCT RNFL斜率中2%的变异。AUC为0.55。在90%特异性时，ΔCDR检测OCT进展者的灵敏度为15%。在SAP分析中（N = 2174只眼），仅7.7%的SAP进展者和5.7%的非进展者观察到ΔCDR≥0.20（P = 0.23）。ΔCDR仅解释了SAP MD斜率中1%的变异。AUC为0.53。在90%特异性时，ΔCDR检测SAP进展者的灵敏度为16%。
在结构和功能检测中，纵向杯盘比数据在识别青光眼进展方面的表现与随机选择相似。鉴于这种弱相关性，临床医生应使用全面的视神经乳头检查和辅助检测来评估青光眼进展。
