Purpose: Little data exist detailing the normal cup-to-disc (CD) ratios and arteriole-to-venule (A/V) ratios of school age children. In addition, controversy exists in the literature regarding associations between CD and A/V ratios and visual and biometric parameters. The present study investigates the success rates of obtaining useable optic disc images from the portable Nidek Handheld Non-Mydriatic Fundus Camera (NM-200D) from school-age children. This study also describes the distribution of cup-to-disc (CD) ratios and arteriole to venule (A/V) ratios in children aged 6-7 years of age and 12-13 years of age. In addition, the present study explores associations between CD and A/V ratios and a range of visual function and biometric parameters in children aged 6-7 years and 12-13 years. Methods: Fundus images were obtained from 195 6-7 year old children and 227 12-13 year old children participating in a wider study of visual function in childhood (Northern Ireland Childhood Errors of Refraction Study [NICER]). ImageJ software was used to obtain CD and A/V ratios from the digital images. Visual function measures and biometric parameters were also available for all participants including; cycloplegic refractive error, LogMAR vision, corneal curvature, axial length, height and weight.
Bibliographical noteReference text: 1. Biglan AW. Glaucoma in children: are we making progress? J AAPOS 2006; 10: 7-21.
2. Törnquist AL, Olsson M, Martin L, Winiarski J & Fahnehjelm KT. Visual field results and optic disc morphology in patients treated with allogeneic stem-cell transplantation in childhood. Acta Ophthalmol 2011; 89: 62-69.
3. Wikstrand MH, Hård AL, Niklasson A & Hellström A. Birth weight deviation and early postnatal growth are related to optic nerve morphology at school age in children born preterm. Pediatr Res 2010; 67: 325-329.
4. Zheng Y, Cheung CY, Wong TY, Mitchell P & Aung T. Influence of Height, Weight and Body Mass Index on Optic Disc Parameters. Invest Ophthalmol Vis Sci 2010; 51: 2998-3002.
5. Marsh BC, Cantor LB, Wudunn D et al. Optic Nerve Head (ONH) Topographic Analysis by Stratus OCT in Normal Subjects: Correlation to Disc Size, Age, and Ethnicity. J Glaucoma 2010; 19: 310-318.
6. Huynh SC, Wang XY, Rochtchina E, Crowston JG & Mitchell P. Distribution of optic disc parameters measured by OCT: findings from a population-based study of 6-year-old Australian children. Invest Ophthalmol Vis Sci 2006; 47: 3276-3285.
7. Larsson E, Nuija E & Alm A. The optic nerve head assessed with HRT in 5-16-year-old normal children: normal values, repeatability and interocular difference. Acta Ophthalmol 2009 Dec 21. [Epub ahead of print].
8. Erkkila H & Laatikainen L. Characteristics of optic disc in healthy school children. Acta Ophthalmol 1979; 57: 914-921.
9. Ramrattan RS, Wolfs RC, Jonas JB, Hofman A & de Jong PT. Determinants of optic disc characteristics in a general population: The Rotterdam Study. Ophthalmology 1999; 106: 1588-1596.
10. Tong L, Saw SM, Chua WH et al. Optic disk and retinal characteristics in myopic children. Am J Ophthalmol 2004; 138: 160-162.
11. Taylor B, Rochtchina E, Wang JJ et al. Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obes 2007; 31: 1527-1533.
12. Cheung N, Tong L, Tikellis G et al. Relationship of retinal vascular caliber with optic disc diameter in children. Invest Ophthalmol Vis Sci 2007; 48: 4945-4948.
13. Yogesan K, Constable IJ, Barry CJ et al. Telemedicine screening of diabetic retinopathy using hand-held fundus camera. J Telemed Telecare 2000; 6: 219–23.
14. Yogesan K, Constable IJ, Barry CJ et al. Evaluation of a portable fundus camera for use in teleophthalmologic diagnosis of glaucoma. J Glaucoma 1999; 8: 297–301.
15. O'Donoghue L, McClelland JF, Logan NS et al. Refractive error and visual impairment in school children in Northern Ireland. Br J Ophthalmol. 2010b; 94: 1155-1159.
16. O'Donoghue L, Saunders KJ, McClelland JF et al. Sampling and measurement methods for a study of childhood refractive error in a UK population. Br J Ophthalmol. 2010a; 94: 1150-1154.
17. Kobayashi K, Ohno-Matsui K, Kojima A, et al. Fundus characteristics of high myopia in children. Jpn J Ophthalmol 2005; 49: 306-311.
18. Yasuzumi K, Ohno-Matsui K, Yoshida T, et al. Peripapillary crescent enlargement in highly myopic eyes evaluated by fluorescein and indocyanine green angiography. Br J Ophthalmol 2003; 87: 1088-1090.
19. Klais CMC, Grupchev ID, McGhee CNJ & Donaldson ML. Photoscreening for diabetic retinopathy: a comparison of image quality between film photography and digital imaging. Clin Experiment Ophthalmol 2004; 32: 393–396.
20. Leung H, Wang JJ, Rochtchina E et al. Relationships between Age, Blood Pressure, and Retinal Vessel Diameters in an Older Population. Inves Ophthalmol Vis Sci 2003; 44: 2900-2904.
21. Swanson MW. The 97.5th and 99.5th Percentile of Vertical Cup Disc Ratio in the United States. Optom Vis Sci 2011; 88: 86-92.
22. Bland JM & Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
23. McAlinden C, Khadka J, Pesudovs K. Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology. Ophthalmic Physiol Opt 2011; 31: 330–338.
24. Park HJ, Hampp C & Demer JL. Longitudinal Study of Optic Cup Progression in Children. J Pediatr Ophthalmol Strabismus 2010; 28: 1-6.
25. Sing NM, Anderson SF & Townsend JC. The normal optic nerve head. Optom Vis Sci 2000; 77: 293-301.
26. Ritch R & Caronia RM. Classic papers in glaucoma. Kugler Publications 2000. The Hague. The Netherlands.
27. Ip JM, Huynh SC, Kifley A et al. Variation of the contribution from axial length and other oculometric parameters to refraction by age and ethnicity. Invest Ophthalmol Vis Sci 2007; 48: 4846-4853.
28. Wolffsohn JS, Napper GA, Ho SM, Jaworski A & Pollard TL. Improving the description of the retinal vasculature and patient history taking for monitoring systemic hypertension. Ophthalmic Physiol Opt 2001; 21: 441-449.
29. Alibrahim E, Donaghue KC, Rogers S et al. Retinal Vascular Caliber and Risk of Retinopathy in Young Patients with Type 1 Diabetes. Ophthalmology 2006; 113: 1499-1503.
30. Wang JJ, Taylor B, Wong TY et al. Retinal Vessel Diameters and Obesity: A Population-Based Study in Older Persons. Obesity 2006; 14: 206–214.
31. Wang JJ, Mitchell P, Leung H et al. Hypertensive Retinal Vessel Wall Signs in a General Older Population. The Blue Mountains Eye Study. Hypertension 2003; 42: 534-541.
- arteriole to venule ratio
- cup-to-disc ratio
- digital images