Asymmetry in optic disc parameters: The blue mountains eye study

PURPOSE. To examine asymmetry in vertical optic disc parameters among subjects classified as normal, as having ocular hypertension (OH), and as having open-angle glaucoma (OAG) in a population-based sample. METHODS. The Blue Mountains Eye Study examined 3654 people aged 49 to 97 years, including 2929 normal subjects, 118 with OH, and 79 with OAG in the groups of interest for the asymmetry study. Optic disc parameters were measured in a masked manner from stereo optic disc photographs. RESULTS. Vertical disc diameter asymmetry (the absolute value of left minus right disc diameters) was similar among normal, OH, and OAG groups (median, 0.07-0.08 mm). Vertical cup-disc ratio asymmetry was higher in patients with OAG (median, 0.11) than in normal subjects (median, 0.06; P < 0.0001) and in those with OH (median, 0.05; P < 0.0001) but was similar between normal subjects and patients with OH (P = 0.17). A cup-disc ratio asymmetry of 0.2 or more was found in 24% of patients with OAG, compared with 1% of patients with OH and 6% of normal subjects. Corresponding rates for cup-disc ratio asymmetry of 0.3 or more in these three groups were 10%, 0%, and 1%, respectively. Using multiple linear regression, cup-disc ratio asymmetry was associated with disc diameter asymmetry and intraocular pressure asymmetry. However, these two factors explained only 3% of the variability of cup-disc ratio asymmetry and 20% of cup diameter asymmetry. CONCLUSIONS. Despite differences between the OAG group and either the OH or normal groups, asymmetry alone was not useful in identifying patients with OAG. At all levels of asymmetry, subjects were more likely to be classified as normal than with OH or OAG.