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. 2000 Aug;84(8):894–898. doi: 10.1136/bjo.84.8.894

Pharmacological mydriasis and optic disc examination

J Kirwan 1, P Gouws 1, A Linnell 1, J Crowston 1, C Bunce 1
PMCID: PMC1723608  PMID: 10906099

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.



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Figure 1  .

Figure 1  

Figure 1  

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(A) Bland-Altman plot of interobserver agreement for VCD without mydriasis (study A data). (B) Bland-Altman plot of interobserver agreement for VCD with mydriasis (study A data).

Figure 2  .

Figure 2  

Figure 2  

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(A) Bland-Altman plot of interobserver agreement for VDD without mydriasis (study A data). (B) Bland-Altman plot of interobserver agreement for VDD with mydriasis (study A data).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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