Spotlight on the Disc-Damage Likelihood Scale (DDLS)

Figures & data

Table 1 Summary of Studies Examining the DDLS Identified in the Literature Search

Authors	Year	Summary of Findings
Buller, et al^Citation75	2021	Evaluation of DDLS used by optometrists for monitoring patients in community shared care scheme.
Bouacheria, et al^Citation76	2020	Evaluation of computer image analysis algorithm enabling automatic measurement of DDLS.
Formichella, et al^Citation74	2020	Significant correlation was reported between thinner OCT RNFL thickness and higher DDLS. Higher first visit discharge rate found in patients with lower DDLS referred by community optometrists to glaucoma clinic.
Kumar et al^Citation42	2019	Evaluation of computer image analysis algorithm enabling automatic measurement of DDLS.
Kara-José, et al^Citation37	2017	DDLS had good ability to differentiate between glaucomatous and healthy eyes, performing better than OCT RNFL thickness and SAP MD.
Lutaka, et al^Citation77	2017	DDLS was significantly correlated with visual field index but less so with MD and PSD.
Dervisevic et al^Citation78	2017	DDLS was correlated with visual field loss. Tilted discs had significantly higher DDLS scores.
Waisbourd et al^Citation69	2016	Evaluation of reproducibility of optic disc grading using photographs obtained by a hand-held fundus camera using DDLS and CDR.
Kitaoka et al^Citation71	2016	Evaluation of associations between the DDLS and various morphological parameters of the optic nerve head using a stereo fundus camera.
Zhang et al^Citation44	2016	DDLS had the highest specificity for predicting a relative afferent pupillary defect (RAPD).
Ekici et al^Citation45	2015	Structural measures including DDLS were not informative with regards to visual related performance or visual related quality of life.
Pahlitzsch et al^Citation41	2015	DDLS was significantly correlated with HRT Moorfields Regression Analysis in preperimetric primary open angle glaucoma.
Han et al^Citation72	2014	DDLS obtained using 3D optic disc photography showed moderate agreement with that obtained by glaucoma specialists.
Chandra et al^Citation79	2013	Evaluation of correlation between CDR and DDLS with RNFL and global visual field indices.
Ungar et al^Citation40	2012	Evaluation of the ability of structural assessment of the disc including DDLS to predict glaucomatous visual field progression.
Zangalli et al^Citation80	2011	Review article of DDLS.
Ichhpujani et al^Citation43	2011	Magnifier-assisted swinging flashlight method demonstrated as the most sensitive method of determining RAPD in terms of differences in DDLS and visual field mean deviation.
Majid et al^Citation39	2010	Evaluation of the relationship between DDLS, visual field and OCT parameters for the diagnosis of glaucoma.
Henderer et al^Citation38	2009	When using stereophotographs, DDLS had a higher sensitivity and specificity for detecting glaucomatous change compared to vertical, horizontal, and maximal CDR.
Bochmann et al^Citation29	2009	Evaluation of the interobserver agreement for DDLS showing better agreement than for CDR.
Hornova et al^Citation81	2008	DDLS correlated well with visual field loss and topographical damage data obtained from HRT.
Spaeth et al^Citation26	2006	Review of known methods of grading optic disc glaucomatous changes including the DDLS.
Danesh-Meyer et al^Citation36	2006	Evaluation of the relationship between the DDLS score and the global and sectoral optic disc (HRT) and VF parameters.
Danesh-Meyer et al^Citation16	2006	Evaluation of the diagnostic strength of CDR, DDLS and HRT in patients with glaucoma, glaucoma suspects and normal controls.
Henderer et al^Citation82	2006	DDLS editorial.
Henderer et al^Citation28	2003	Evaluation of the reliability of DDLS versus CDR by determining inter- and intra-observer agreement of optic disc stereophotographs and in vivo interobserver agreement of patient optic discs.
Bayer et al^Citation30	2002	DDLS strongly correlated with glaucomatous visual field damage.
Spaeth et al^Citation25	2002	Evaluation of the reproducibility of DDLS grading by comparing intra- and inter-observer reliability of DDLS versus CDR.

Abbreviations: DDLS, disc damage likelihood scale; CDR, cup-to-disc ratio; OCT, optical coherence tomography; RNFL, retinal nerve fiber layer; SD-OCT, spectral-domain OCT; MD, mean deviation; PSD, pattern standard deviation; SAP, standard automated perimetry; RAPD, relative afferent pupillary defect; HRT, Heidelberg retinal tomograph.

Figure 1 (A) Spaeth’s DDLS staging system stratified according to the optic disc sizes. Table reproduced from the Scottish Intercollegiate Guidelines Network (SIGN). Edinburgh: SIGN; 2015. (SIGN publication no. 144). [cited March 2015]. Available from URL: http://www.sign.ac.uk. These guidelines are licensed under the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International Licence.²⁷ (B) Table of magnification correction factors to accurately calculate disc size.

Figure 2 Examples of DDLS gradings for 3 eyes, with small (A) and large (B and C) optic disc diameters. For example (A), the thinnest width of the rim is approximately 1/7th (0.14), the diameter of the optic disc in the same Meridian, which for a small optic disc, is equivalent to a DDLS of 3. For example (B), there is no rim over approximately 130 degrees, which for a large optic disc, is equivalent to a DDLS of 6. Care however must be taken in myopic eyes, to differentiate temporal sloping of the rim from absence of rim tissue. For example, (C), the thinnest width of the rim is approximately ¼ the diameter of the optic disc, which for a large disc is equivalent to a DDLS of 0b.

Buller AJ. Results of a glaucoma shared care model using the enhanced glaucoma staging system and disc damage likelihood scale with a novel scoring scheme in New Zealand. Clin Ophthalmol. 2021;15:57–63. doi:10.2147/OPTH.S285966

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