The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage.
The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage.
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ICD-10 青光眼严重程度评分低估了青光眼视神经损伤的程度。
DOI：
10.1016/j.ajo.2022.08.009
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发表时间：
2022
影响因子：
4.2
通讯作者：
Hood,DonaldC
中科院分区：
文献类型：
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作者：
Leshno,Ari;Tsamis,Emmanouil;Harizman,Noga;Cioffi,GeorgeA;Wang,Qing;LaBruna,Sol;Rai,Anvit;DeMoraes,CarlosGustavo;Liebmann,JeffreyM;Hood,DonaldC
目的评价国际疾病分类第十版（ICD-10）中基于视野缺损位置的青光眼严重程度分级方法；鉴于已知24-2视野测试对早期疾病和黄斑损害的敏感性较差，我们假设icd -10编码不能准确反映青光眼损害的程度。设计回顾性效度和信度分析。方法对80只青光眼视神经病变（GON）进行临床观察。蒙面审查员根据24-2 VF分配了一个icd -10严重性等级。另外两名蒙面检查人员确定在每个半场和/或中心5度存在光学相干断层扫描（OCT）结构损伤，以定义基于OCT的等效分类。结果80只眼根据24-2 VF分为轻度、中度、重度，分别为15、23、42例；根据OCT分为轻度、中度、重度，分别为6、7、67例，其中29例（36%）为重度。33例（41.3%）黄斑病变OCT漏诊率为24-2。在80例中有4例（5%），VF高估了严重程度，可能是由于24-2测试的可变性。icd -10系统仅依赖于24-2的损伤，它提供了24-2的功能评分，而不是“青光眼”严重程度评分。OCT显示不同等级的损伤差异很大，24-2 VF的眼睛中有很大一部分显示黄斑结构损伤。将OCT信息添加到icd -10系统将有助于更准确地反映青光眼损害的程度。
PurposeTo evaluate theInternational 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 theICD-10codes would not accurately reflect the extent of glaucomatous damage.DesignRetrospective validity and reliability analysis.MethodsWe evaluated 80 eyes with glaucomatous optic neuropathy (GON). Masked reviewers assigned anICD-10severity 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 equivalentICD-10classification.ResultsA 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.ConclusionsTheICD-10system 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 theICD-10system would help it to more accurately reflect the extent of glaucomatous damage.