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Morphological Diagnostics in Paediatric Glaucoma-Analysis of the Disc Damage Likelihood Scale by KOWA Non Mydriatic Fundus Camera and its Correlation to HRT and OCT

Title: Morphological diagnostics in paediatric glaucoma

Background: Morphological parameters vary in paediatric glaucoma with a minor knowledge on standard values available compared to an adult cohort. Accordingly, we designed a study to assess the objectively measured disc damage likelihood scale (DDLS) by KOWA stereophotography as a novel parameter in comparison to standard glaucoma diagnostics, HRT 3 and OCT.

Methods and Findings: Prospective study of 47 eyes (n=47) categorized into three groups; 14 normal optic discs (11 female f, 3 male m, 12.7 ± 6.1years), 15 glaucoma suspects (3f, 12m, 11.7 ± 3.1years) and 18 paediatric glaucoma (10f, 8m, 11.2 ± 2.5years). Stereometric measurements of the optic disc by KOWA camera, Moorfields regression analysis (MRA) and glaucoma probability score (GPS) of the HRT3 and retinal nerve fibre layer (RNFL) of the OCT were analysed. Results were split in 2 groups: Diagnosis 1 was defined as “outside normal limits”, Diagnosis 2 as “borderline or outside normal limits”.

Referring to Diagnosis 1 and 2, DDLS did not show a significant correlation with MRA, GPS and RNFL in glaucoma suspects, healthy children and paediatric glaucoma. In paediatric glaucoma the correlation of the GPS compared to KOWA rim/disc ratio was significant in all six quadrants; supernasal (r=-0.794 p=0.006), nasal (r=-0.845 p=0.002), inferonasal (r=-0.659 p=0.038), infertemporal (r=-0.636 p=0.048), temporal (r=-0.656 p=0.039) and superotemporal segment (r=-0.755 p=0.012). Regarding the area under the curve (Receiving operating characteristics ROC) the highest predictive power was demonstrated by DDLS (0.669-0.833) compared to R.Burk (0.142-0.595) and F.S.Mikelberg (0.050-0.619) coefficients considering all devices.

Conclusions: The DDLS showed the highest predictive power for glaucomatous damage compared to glaucoma coefficients of the established devices. Additionally, the gold standard of optic nerve head assessment still includes the examination of the fundus photography. As stereo photography is an easy and timesaving instrument, it might be an additive tool in paediatric glaucoma.


Milena Pahlitzsch*, Sibylle Winterhalter, Necip Torun, Carl Erb, Anna-Karina B Maier1, Eckart Bertelmann and Matthias K J Klamann

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