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Frequencies of 4 Distinct Patterns of Glaucomatous Disc Appearance and Their Clinical Associations in Japanese Population-based Studies

Iwase, Aiko, MD, PhD*; Araie, Makoto, MD, PhD; Kuwayama, Yasuaki, MD, PhD; Murata, Hiroshi, MD§; Yamamoto, Tetsuya, MD, PhD

doi: 10.1097/IJG.0000000000001240
Original Studies
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Purpose: To study the frequencies and factors associated with 4 disc patterns in primary open-angle glaucoma (POAG) identified in population-based studies: focal glaucomatous (FG type), generalized enlargement of cup (GE type), myopic glaucomatous (MG type), and senile sclerotic glaucomatous (SS type) patterns.

Subjects: In total, 270 disc photographs of acceptable quality were extracted from the records of 270 definitive POAG cases diagnosed according to the International Society of Geographical and Epidemiological Ophthalmology Criteria in 2 Japanese population-based glaucoma surveys. One randomly chosen eye from the bilateral POAG cases was included.

Results: Using a method of κ coefficient of reproducibility of classification of 0.80 according to a preliminary study, 143 discs were classified as FG, GE, MG, or SS types with respective frequencies of 57% (95% confidence interval [CI], 48-66), 33% (95% CI, 25-42), 7% (95% CI, 3-13), and 3% (95% CI, 0-7), and 127 discs as the miscellaneous type. Multinomial logistic regression analysis showed that the MG type was associated (P=0.052, 0.025, 0.019, and 0.018) with younger age, lower body mass index (BMI), and greater disc area and ovality, and the GE type was associated (P<0.001, 0.036, and 0.056) with greater disc area, corneal radius, and hyperopic refraction than the FG type.

Conclusions: The FG type occurs most frequently in Japanese POAG followed by the GE type. The MG and SS types occurred much less often than previously reported in Japanese. Associations with age, BMI, disc area and ovality, refraction, and corneal radius differed among the FG, GE, and MG types.

*Tajimi Iwase Eye Clinic, Tajimi

Kanto Central Hospital of the Mutual Aid Association of Public School Teachers

§Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo

Fukushima Eye Clinic, Osaka

Department of Ophthalmology, Gifu University Graduate School of Medicine Gifu, Japan

The Tajimi study was supported by the Japan National Society for the Prevention of Blindness, Tokyo, Japan; the Japan Ophthalmologists Association, Tokyo, Japan; and the Kumejima study by the Grant-in-Aid for Scientific Research by the Ministry of Health, Labor and Welfare, Tokyo, Japan. (H18-Sensory-General-001); and the Grant-in-Aid for Scientific Research (C) 17591845 by the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan; and the Japan National Society for the Prevention of Blindness, Tokyo, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Aiko Iwase, MD, PhD, Tajimi Iwase Eye Clinic, 3-101-1, Hon-machi, Tajimi, Gifu Prefecture 507-0033, Japan (e-mail: aiko-gif@umin.net).

Received October 28, 2018

Accepted March 2, 2019

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