The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage

Ari Leshno, Emmanouil Tsamis, Noga Harizman, George A. Cioffi, Qing Wang, Sol La Bruna, Anvit Rai, Carlos Gustavo De Moraes, Jeffrey M. Liebmann, Donald C. Hood*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate the International Classification of Disease, Tenth Revision (ICD-10) codes used for glaucoma severity classification, which are based on the location of visual field (VF) defects; given the known poor sensitivity of the 24-2 visual field test to early disease and macular damage, we hypothesized that the ICD-10 codes would not accurately reflect the extent of glaucomatous damage. Design: Retrospective validity and reliability analysis. Methods: We evaluated 80 eyes with glaucomatous optic neuropathy (GON). Masked reviewers assigned an ICD-10 severity grade based on 24-2 VF. Two additional masked examiners determined the presence of optical coherence tomography (OCT) structural damage in each hemifield and/or central 5 degrees to define an OCT-based equivalent ICD-10 classification. Results: A total of 80 eyes with GON were classified as mild, moderate and advanced in 15, 23, and 42 cases, respectively, based on the 24-2 VF, and in 6, 7, and 67 cases, respectively, based on OCT. The OCT classifications were more severe in 29 of 80 cases (36%). In 33 cases (41.3%), macular damage detected by OCT was missed by the 24-2. In 4 of 80 cases (5%), the VF overestimated the severity, likely due to variability of the 24-2 test. Conclusions: The ICD-10 system relies solely on damage seen on the 24-2 and as provides a 24-2 functional score rather than a “glaucoma” severity score. OCT revealed wide variation of damage across grades, with a significant proportion of the eyes showing macular structural damage missed with the 24-2 VF. Adding OCT information to the ICD-10 system would help it to more accurately reflect the extent of glaucomatous damage.

Original languageEnglish
Pages (from-to)133-142
Number of pages10
JournalAmerican Journal of Ophthalmology
StatePublished - Dec 2022


FundersFunder number
Carl Zeiss Meditech, Inc.
Columbia University Department of Ophthalmology
Jane and David Walentas Glaucoma Research Fund
Novartis Inc.
Ora Clinical, Inc.
Perfuse Therapeutics
National Eye InstituteRO1-EY-02115, R01EY025253
Research to Prevent Blindness
Heidelberg Engineering


    • Glaucoma
    • ICD-10
    • Optical coherence tomography
    • Perimetry
    • Severity


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