Pharmacological mydriasis and optic disc examination

J F Kirwan, P Gouws, A E Linnell, J Crowston, C Bunce

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

AIM: To determine whether pharmacological mydriasis leads to a significant difference in interobserver agreement of optic disc measurement compared with examination without mydriasis.

METHOD: A cross sectional study was performed with a pair of observers examining the optic disc of two randomised groups of patients, one group before diagnostic mydriasis, and the other afterwards. Horizontal and vertical disc diameters and cup/disc ratios were measured with a 78 dioptre lens. The study was repeated with another observer pair and two further groups of patients.

RESULTS: In study A 86 subjects were examined in total (52 without and 34 with mydriasis). In study B 87 subjects were examined (45 without and 42 with mydriasis). The 95% limits of agreement of the cup/disc ratio measurement differences were significantly larger without mydriasis (p<0.001 for all studies (F test)). For both studies examination after mydriasis gave significantly greater agreement for vertical and horizontal cup/disc ratios. The cases with good agreement (0.1 difference or better) for vertical cup/disc ratios were 37/52 (72%) and 34 /45 (76%) without mydriasis and 33/34 (97%) and 40/42 (95%) respectively with mydriasis. Similar differences were recorded for horizontal cup/disc ratios. Disc diameter measurement results showed similar differences in study A but were not affected by mydriasis in study B.

CONCLUSIONS: Examination of the optic disc without pharmacological mydriasis gives significantly poorer interobserver agreement. In this study, the mean 95% limits of agreement values for all cup/disc ratio values were 0.27 for examination without mydriasis and 0.13 for examination with mydriasis. A measure outside these limits would suggest a real difference. This study indicates that mydriasis is important for reproducible clinical examination in glaucoma.

Original languageEnglish
Pages (from-to)894-8
Number of pages5
JournalThe British journal of ophthalmology
Volume84
Issue number8
DOIs
Publication statusPublished - 1 Aug 2000

Keywords

  • Cross-Sectional Studies
  • Glaucoma
  • Humans
  • Mydriatics
  • Observer Variation
  • Optic Disk
  • Prospective Studies
  • Pupil
  • Clinical Trial
  • Journal Article
  • Randomized Controlled Trial

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