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Evaluation of Focal Vasoconstriction of Retinal Arterioles in Glaucoma
1Böhm A. G., 2Bowd C., 2El-Beltagi T., 1Pillunat L. E., 2Weinreb R. N.,
1Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Augenheilkunde (Dresden)
2Glaucoma Center, UCSD (La Jolla)
Purpose: Focal arteriolar narrowing has been reported to be more common in glaucoma eyes compared to normal eyes. This study was performed to compare two methods for grading focal arteriolar narrowing.
Material and methods: Stereoscopic optic disc photographs of 48 normal subjects, 20 ocular hypertensive patients (OHT) and 29 primary open angle glaucoma patients (from one randomly selected eye per subject) were reviewed independently in a masked fashion by two graders: Focal arteriolar narrowing within one disc diameter from the rim edge was evaluated based on two different definitions: 1. narrowing present if the arteriole was wider distal to the narrowing and 2. narrowing present if the arteriole was wider both distal and proximal to the narrowing.
Results: Focal arteriolar narrowing was observed with definition 1 in 37,5% (18/48), 35% (7/20), and 65.5% (19/29) of normals, OHTs and POAG patients, respectively. It was observed with definition 2 in 18,8% (9/48), 0% (0/20), and 48,3% (14/29) of normals, OHTs and POAG patients, respectively. With both definitions, focal arteriolar narrowing was significantly higher in glaucoma versus normal eyes (Chi square test: definition 1 p<0.03; definition 2 p<0.0001). The number of eyes with focal arteriolar narrowing was significantlly higher with method 1 than in method 2 across all photographs and subgroups (Chi square test: p < 0.0001). The overall agreement between the two graders was kappa 0.77±0.06 for definition 1 and 0.43±0.11 for definition 2.
Conclusions: The prevalence of focal arteriolar narrowing is highly dependent upon the defined criterion. A standardized definition of focal arteriolar narrowing is needed to archieve comparable and reproducible results among various studies.