To report the reliability of the glaucoma disk damage likelihood scale (DDLS) in comparison to the Armaly cup/disk ratio by determining the interobserver and intraobserver agreement for optic disk stereo photographs and the interobserver agreement for in vivo patient measurements of the optic disk.
Design
Observational case series.
Methods
Optic disk photographs: 48 stereo pairs of optic nerve photographs were selected from patients with a spectrum of glaucomatous visual field loss. Two masked observers graded the optic disk photographs three times according to the DDLS and Armaly cup/disk ratio. Interobserver and intraobserver agreements were calculated using the test–retest method. Patient measurements: three observers performed in vivo patient measurements on 34 eyes of glaucoma clinic patients and made a single determination of the DDLS stage and Armaly cup/disk ratio, based on the indirect biomicroscopic examination. Level of interobserver agreement was tabulated.
Results
Optic disk photographs: interobserver and intraobserver agreement for the vertical DDLS measurement was greater than for two determinations (clinical impression and measured) of the vertical Armaly cup/disk ratio (interobserver: 85% vs 68% and 74%, respectively; intraobserver grader 1: 97% vs 89% and 80%, grader 2: 99% vs 95% and 89%, respectively). In vivo patient measurements: the interobserver agreement for the DDLS and Armaly cup/disk ratio was similar (70.1% vs 67.6%, respectively).
Conclusions
For the stereo optic disk photographs, the inter- and intra-observer agreement for the DDLS is greater than the Armaly cup/disk ratio. For the in vivo patient measurements, the level of agreement for the DDLS and the Armaly cup/disk ratio is similar.
aWilliam and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University School of Medicine (J.D.H., M.K., U.A., A.B., W.C.S., G.L.S.), Philadelphia, Pennsylvania, USA
bTemple University School of Medicine (C.L.), Philadelphia, Pennsylvania, USA
cThe Tulane Center for Clinical Effectiveness and Prevention, Tulane University Health Sciences Center, Tulane University (W.C.S.), New Orleans, Louisiana, USA
Inquiries to Jeffrey D. Henderer, MD, Wills Eye Hospital, Glaucoma Service, 840 Walnut Street, Suite 1120, Philadelphia, PA 19107, USA; fax: (215) 928-3903
☆ This work is supported in part by the Glaucoma Service Foundation, Philadelphia, Pennsylvania.
ABSTRACT