title: Novel screening method for glaucomatous eyes with myopic tilted discs: the crescent moon sign.
abstract: OBJECTIVE
  To our knowledge, there is no reliable screening method for glaucomatous eyes with myopic tilted discs.
  
  
  OBJECTIVE
  To evaluate the diagnostic ability of a novel screening modality, the crescent moon (CM) sign, defined as the discontinuity between the superior or inferior optic rim margin and the temporal optic rim margin, for the detection of glaucomatous eyes with myopic tilted discs.
  
  
  METHODS
  The study was cross-sectional and conducted in a hospital setting from November 1, 2011, to November 1, 2013. Seventy eyes of 70 individuals with early open-angle glaucoma (mean deviation greater than -6 dB) and 70 eyes of 70 normal control participants who had myopic tilted discs were recruited. Another independent group consisting of 60 eyes of 60 individuals with early glaucoma and 60 eyes of 60 normal control participants was enrolled. Two masked glaucoma specialists independently assessed the optic disc on stereoscopic disc photography. The diagnostic performance of the CM sign was evaluated in comparison with violation of the ISNT rule (inferior ≥ superior ≥ nasal ≥ temporal order of configuration for disc rim thickness in normal eyes) and the modified ISNT rule (application of the ISNT rule based on the long axis of the disc).
  
  
  METHODS
  Sensitivity and specificity of the CM sign.
  
  
  RESULTS
  The CM sign was more frequently observed in the inferotemporal optic rim margin than in the superotemporal optic rim margin. In a comparative evaluation of the glaucoma diagnostic sensitivity and specificity, the CM sign showed higher sensitivities (90.0%-91.4%) than the ISNT rule (73.3%-75.7%) or the modified ISNT rule (68.6%-70.0%). The CM sign also showed higher specificities (82.9%-83.3%) than the ISNT rule (68.3%-71.4%) or the modified ISNT rule (76.6%-80.0%). Furthermore, the CM sign was shown to be associated with the occurrence of visual field defects in the corresponding hemifield (P < .001).
  
  
  CONCLUSIONS
  The CM sign can be a useful screening tool for the detection of early glaucoma with myopic tilted discs.
authors.affiliation: Department of Ophthalmology, Hangil Eye Hospital, Incheon, Korea2Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Mi Jeung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea3Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea.
authors.forename: Seok Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea5Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea6Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Tae-Woo
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea5Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Myung
authors.initials: DM
authors.lastname: Kim
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D005124:Eye Abnormalities / Q000175:diagnosis*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000175:diagnosis*; D009412:Nerve Fibers / Q000473:pathology; D015588:Observer Variation; D009898:Optic Disk / Q000002:abnormalities* / Q000473:pathology; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult