Morphologic assessment for glaucoma in the multicenter uveitis steroid treatment (MUST) trial

Sapna S. Gangaputra, Michael M. Altaweel, Qian Peng, David S. Friedman, P. Kumar Rao, C. Stephen Foster, Rosa Y. Kim, Susan B. Reed, Sunil K. Srivastava, Ira G. Wong, John H. Kempen

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose: To compare Reading Center (RC) cup-to-disc ratio (CDR) assessment from stereoscopic photographs with clinician estimation in a uveitis clinical trial. Methods: Clinical estimation of CDR was performed by ophthalmologists via dilated biomicroscopy. Photographic evaluation was performed at an independent RC by masked, certified evaluators. Quality control was performed by repeat grading of 77 randomly selected images. Results: Among 479 eyes with uveitis, 353 eyes had clinical and photographic grades for CDR. Agreement between clinical and RC grading was fair, with exact agreement of 29%. Agreement within 0.1 and 0.2 CDR was 70 and 93%, respectively (weighted κ=.34). Intergrader reproducibility at the RC was better (weighted κ=.59, ICC 0.74). Conclusion: Morphologic assessment of cup to disc ratio is an important outcome and safety measure for determining glaucomatous damage in clinical trials. Masked RC measurements are more likely to be accurate than biomicroscopic grading in identifying meaningful anatomical change associated with glaucoma.

Original languageEnglish
Pages (from-to)267-274
Number of pages8
JournalOcular Immunology and Inflammation
Issue number4
StatePublished - Aug 2011


  • clinical trial
  • glaucoma
  • optic nerve head
  • uveitis


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