Optic disk appearance in advanced age-related macular degeneration.
OBJECTIVE
To describe and quantify the appearance of the optic disk in patients with advanced age-related macular degeneration (ARMD).


METHODS
Retrospective comparative study.


METHODS
A total of 316 charts were reviewed. From these, 45 subjects with advanced ARMD (defined as geographic atrophy or disciform scar) in at least one eye were enrolled. Patients with glaucoma or glaucoma visual field defects were excluded. The probability of glaucomatous optic nerve damage was scored by evaluation of stereoscopic optic disk photographs in a masked fashion, according to a predefined evaluation scale and measured with confocal ophthalmoscopy (Heidelberg Retinal Tomograph; HRT). The area of macular involvement was measured in units of disk area. The optic disk evaluation scores and HRT measurements of a group of eyes with a large area of ARMD were compared with their fellow eyes with smaller areas of ARMD. The correlations between the area of macular involvement with the optic disk evaluation scores and HRT measurements were analyzed.


METHODS
The optic disk evaluation scores and the HRT measurements between study groups.


RESULTS
Eyes with larger areas of ARMD had optic disks that were more likely to be classified as glaucomatous by clinical evaluation (3.45 +/- 0.23 vs 3.05 +/- 0.18, P =.015) and by HRT imaging analysis (-0.995 +/- 0.423 vs -0.376 +/- 0.249, P =.030) than the fellow eyes with smaller areas of ARMD. For eyes with six or more disk areas of ARMD, larger areas of ARMD correlated with a higher cup/disk ratio (P =.022), smaller neuroretinal rim area (P =.022), and glaucomatous classification (P =.040) with HRT discriminant function analysis.


CONCLUSIONS
Eyes with large areas of geographic or diskiform ARMD have optic disk structural alterations that resemble glaucomatous optic neuropathy. This should be taken into consideration when evaluating patients with ARMD for glaucomatous damage.
Law
Simon K
SK
Jules Stein Eye Institute, 100 Stein Plaza 2-235, Los Angeles, CA 90095, USA. law@jsei.ucla.edu
Sohn
Yong Ho
YH
Hoffman
Douglas
D
Small
Kent
K
Coleman
Anne L
AL
Caprioli
Joseph
J
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008268:Macular Degeneration / Q000473:pathology*; D008297:Male; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D012189:Retrospective Studies; D014054:Tomography