Improving glaucoma staging in clinical practice by combining the ICD-10 glaucoma severity classification system and optical coherence tomography

• Published in: Eye (London) Vol. 38; no. 1; pp. 153 - 160
• Main Authors: Leshno, Ari, Tsamis, Emmanouil, Harizman, Noga, De Moraes, Carlos Gustavo, La Bruna, Sol, Rai, Anvit, Garg-Shukla, Aakriti, Cioffi, George A., Wang, Qing, Liebmann, Jeffrey M., Hood, Donald C.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2024; Nature Publishing Group
• Subjects: 692/699/3161/3169/3170; 692/699/3161/3172; Classification; Clinical medicine; Eye; Glaucoma; Glaucoma - diagnosis; Humans; International Classification of Diseases; Intraocular Pressure; Laboratory Medicine; Medicine; Medicine & Public Health; Nerve Fibers; Ophthalmology; Pharmaceutical Sciences/Technology; Retinal Ganglion Cells; Structure-function relationships; Surgery; Surgical Oncology; Tomography; Tomography, Optical Coherence - methods; Visual Field Tests - methods; Visual Fields
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-023-02650-5

Objective
The International Classification of Disease, 10th revision (ICD-10) codes used for glaucoma severity classification are based on the 24-2 visual-field (VF) test. This study aim was to assess the added value of providing clinicians with optical coherence tomography (OCT) data, in addition to functional data, for glaucoma staging in clinical practice.
Exposure
Disease classification was determined for 54 glaucoma eyes, according to the principles of the ICD-10 guidelines. Eyes were independently graded in a masked fashion using the 24-2 VF test and 10-2 VF test, with and without OCT information. The reference standard (RS) for severity was determined using a previously published automated structure-function topographic agreement for glaucomatous damage using all available information.
Results
The RS classified eyes as mild, moderate and advanced in 3, 16 and 35 cases, respectively. Individual and combined 24-2 and 10-2 based gradings were significantly different from the RS (all
P
 < 0.005), with Kappa agreements of 0.26, 0.45 and 0.42 respectively (
P
 < 0.001). Classifications using OCT combined with either of the VF were not-significantly different from the RS (
P
 > 0.3) with Kappa agreements of 0.56 and 0.57 respectively (
P
 < 0.001). Combining 24-2 with OCT had less severity overestimations while 10-2 with OCT had fewer underestimations.
Conclusion
Combining OCT and VF data provides better staging of glaucoma severity than VF data alone. The 24-2 and OCT combination seems most appropriate given the high concordance with the RS and less overestimation of severity. Incorporating structural information into disease stages allows clinicians to set more appropriate severity-based treatment targets for individual patients.