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Leshno A, Tsamis E, Harizman N, De Moraes CG, La Bruna S, Rai A, Garg-Shukla A, Cioffi GA, Wang Q, Liebmann JM, Hood DC. Improving glaucoma staging in clinical practice by combining the ICD-10 glaucoma severity classification system and optical coherence tomography. Eye (Lond) 2024; 38:153-160. [PMID: 37391515 PMCID: PMC10764715 DOI: 10.1038/s41433-023-02650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE The International Classification of Disease, 10th revision (ICD-10) codes used for glaucoma severity classification are based on the 24-2 visual-field (VF) test. This study aim was to assess the added value of providing clinicians with optical coherence tomography (OCT) data, in addition to functional data, for glaucoma staging in clinical practice. EXPOSURE Disease classification was determined for 54 glaucoma eyes, according to the principles of the ICD-10 guidelines. Eyes were independently graded in a masked fashion using the 24-2 VF test and 10-2 VF test, with and without OCT information. The reference standard (RS) for severity was determined using a previously published automated structure-function topographic agreement for glaucomatous damage using all available information. RESULTS The RS classified eyes as mild, moderate and advanced in 3, 16 and 35 cases, respectively. Individual and combined 24-2 and 10-2 based gradings were significantly different from the RS (all P < 0.005), with Kappa agreements of 0.26, 0.45 and 0.42 respectively (P < 0.001). Classifications using OCT combined with either of the VF were not-significantly different from the RS (P > 0.3) with Kappa agreements of 0.56 and 0.57 respectively (P < 0.001). Combining 24-2 with OCT had less severity overestimations while 10-2 with OCT had fewer underestimations. CONCLUSION Combining OCT and VF data provides better staging of glaucoma severity than VF data alone. The 24-2 and OCT combination seems most appropriate given the high concordance with the RS and less overestimation of severity. Incorporating structural information into disease stages allows clinicians to set more appropriate severity-based treatment targets for individual patients.
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Affiliation(s)
- Ari Leshno
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmanouil Tsamis
- Department of Psychology, Columbia University Schermerhorn Hall, 1190 Amsterdam Ave #406, New York, NY, 10027, USA
| | - Noga Harizman
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - Sol La Bruna
- Department of Psychology, Columbia University Schermerhorn Hall, 1190 Amsterdam Ave #406, New York, NY, 10027, USA
| | - Anvit Rai
- Albert Einstein College of Medicine, New York, NY, 10461, USA
| | - Aakriti Garg-Shukla
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - Qing Wang
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA
| | - Donald C Hood
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, 635 W 165th St, New York, NY, 10032, USA.
- Department of Psychology, Columbia University Schermerhorn Hall, 1190 Amsterdam Ave #406, New York, NY, 10027, USA.
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Chang AY, Tsamis E, Blumberg DM, Al-Aswad LA, Cioffi GA, Hood DC, Liebmann JM, De Moraes CG. The Role of Intraocular Pressure and Systemic Hypertension in the Progression of Glaucomatous Damage to the Macula. J Glaucoma 2022; 31:317-321. [PMID: 35320139 PMCID: PMC9050853 DOI: 10.1097/ijg.0000000000002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Macular structural and functional parameters were better correlated with pressure-dependent glaucomatous damage than conventional parameters. Self-reported systemic hypertension (HTN) was not associated with structural or functional progression in this cohort. PURPOSE The aim was to examine the relationships between intraocular pressure (IOP), systemic HTN, and glaucoma progression using structural testing with optical coherence tomography (OCT) and functional testing with visual field (VF). PATIENTS AND METHODS A total of 191 eyes of 119 patients enrolled in a prospective, longitudinal study (Structural and Functional Progression of Glaucomatous Damage to the Macula study) with a diagnosis of glaucoma were analyzed. Patients were tested with 10-2 and 24-2 VF and spectral-domain OCT obtained at 4 to 6 month intervals. IOP from each visit was collected. Self-reported diagnoses of HTN were reported in 72 eyes (37%) in the patients included. Linear mixed effects regression was used to test the relationship between summary statistics from VF and OCT and HTN diagnosis. The goodness-of-fit of relationships was assessed with Bayesian information criterion. RESULTS Mean follow-up IOP was most associated with the following OCT parameters: global macula ganglion cell layer (GCL), inferior macula GCL, mean macular vulnerability zone GCL, and mean less vulnerable zone macula GCL, and with the following VF parameters: 10-2 PSD and 10-2 MD. There was no significant difference in rates of progression between HTN and non-HTN patients for any OCT or VF parameter. Models with the best goodness-of-fit for the relationship between HTN and progression were the same as those observed for IOP. CONCLUSION Macular structural and functional parameters are more sensitive to IOP in terms of glaucomatous progression when compared with more conventional parameters. While HTN was not significantly associated with progression using any parameter, macular structural and functional parameters had a better goodness-of-fit to model progression and may be useful as endpoints.
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Affiliation(s)
- Angela Y Chang
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Emmanouil Tsamis
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Dana M Blumberg
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | | | - George A Cioffi
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Donald C Hood
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
- Department of Psychology, Columbia University, New York, NY
| | - Jeffrey M Liebmann
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - C G De Moraes
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
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