title: Eyes with Suspicious Appearance of the Optic Disc and Normal Intraocular Pressure: Using Clinical and Epidemiological Characteristics to Differentiate Those with and without Glaucoma.
abstract: Among all glaucoma suspects, eyes with optic nerve head features suspicious or suggestive of early glaucoma are probably those that offer the greatest challenge for clinicians. In contrast with the robust longitudinal data published on ocular hypertension, there is no specific management guideline for these patients. Therefore, evaluating eyes with suspicious optic disc appearance and normal intraocular pressure (IOP), we sought to investigate potential differences in clinical and epidemiological characteristics to differentiate those with normal-tension glaucoma (NTG) from those with presumed large physiological optic disc cups (pLPC). In this observational case-control study, we consecutively enrolled individuals with pLPC and NTG. All eyes had vertical cup-to-disc ratio (VCDR)≥0.6 and untreated IOP<21 mmHg. Glaucomatous eyes had reproducible visual field defects. Eyes with pLPC required normal visual fields and ≥30 months of follow-up with no evidence of glaucomatous neuropathy. Clinical and epidemiological parameters were compared between groups. Eighty-four individuals with pLPC and 40 NTG patients were included. Regarding our main results, NTG patients were significantly older and with a higher prevalence of Japanese descendants (p<0.01). Not only did pLPC eyes have smaller mean VCDR, but also larger optic discs (p≤0.04). There were no significant differences for gender, central corneal thickness, and spherical equivalent (p≥0.38). Significant odds ratios (OR) were found for race (OR = 2.42; for Japanese ancestry), age (OR = 1.05), VCDR (OR = 5.03), and disc size (OR = 0.04; p≤0.04). In conclusion, in patients with suspicious optic disc and normal IOP, those with older age, Japanese ancestry, smaller optic discs, and larger VCDR are more likely to have NTG, and therefore, deserve deeper investigation and closer monitoring.
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.|Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil.
authors.forename: Diego T
authors.initials: DT
authors.lastname: Dias
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.|Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil.
authors.forename: Michele
authors.initials: M
authors.lastname: Ushida
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Marina C
authors.initials: MC
authors.lastname: Sousa
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America.
authors.forename: Syril
authors.initials: S
authors.lastname: Dorairaj
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.|Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Biteli
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Mauro T
authors.initials: MT
authors.lastname: Leite
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Paranhos
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil.|Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil.
authors.forename: Tiago S
authors.initials: TS
authors.lastname: Prata
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005123:Eye / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D057066:Low Tension Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000000981:diagnostic imaging* / Q000503:physiopathology; D058609:Visual Field Tests