Change of ocular parameters in children with large cup-to-disc ratio and interocular cup-to-disc ratio asymmetry

Enlarged optic disc cupping and interocular cup-to-disc ratio (CDR) asymmetry are often important indicators of glaucoma. Clinically, we occasionally encounter children with large CDR and interocular CDR asymmetry during vision screening. This study aimed to report longitudinal change of ocular parameters in children with large cup-to-disc ratio (CDR) and interocular CDR asymmetry.

This was a retrospective, observational case series of 160 eyes of 160 children with large CDR who visited a tertiary eye center from January 2010 to June 2016. Average CDR ≥ 0.6 were considered large CDR values, and CDR asymmetry was defined as an interocular difference ratio value greater than 0.2. All included patients showed interocular pressure (IOP) < 21 mmHg at least three ophthalmic examinations conducted at total intervals of at least 30 months.

The mean age of children included in the study was 7.14 ± 2.42 years, with a follow-up period of 54.46 ± 19.82 months. Changes in refractive error and axial length were significantly different between initial and final examination (p < 0.001). However, optic nerve head (ONH) analysis and retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses were not significantly different between initial and final examination. In interocular comparisons of patients with CDR asymmetry, changes of refractive error, axial length, ONH analysis, and RNFL and mGCIPL thickness were not significantly different between the two eyes.

There were no significant differences in the changes of ONH analysis, and RNFL and mGCIPL thicknesses in children with large CDR, or those with interocular CDR asymmetry over the study period. Our results provide helpful information for the establishment of guidelines for managing children with large CDR and interocular CDR asymmetry.