Comparison of Quantitative Imaging Devices and Subjective Optic Nerve Head Assessment by General Ophthalmologists to Differentiate Normal From Glaucomatous Eyes
Comparison of Quantitative Imaging Devices and Subjective Optic Nerve Head Assessment by General Ophthalmologists to Differentiate Normal From Glaucomatous Eyes
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DOI：
10.1097/ijg.0b013e31818153da
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发表时间：
2009-03-01
影响因子：
2
通讯作者：
Susanna, Remo
中科院分区：
文献类型：
--
作者：
Vessani, Roberto M.;Moritz, Rodrigo;Susanna, Remo
目的：比较普通眼科医生和青光眼专家对视神经头(ONH)和视网膜神经纤维层(RNFL)的主观评估能力与光学相干断层扫描仪(Stratus OCT，Carl Zeiss Meditec Inc.)、共焦扫描激光眼底镜(HRT III)、海德堡海德堡工程公司(Heidelberg Engineering，Heidelberg Engineering，Heidelberg Engineering)的客观测量结果。和扫描激光偏振仪(GDX增强角膜补偿；Carl Zeiss Meditec Inc.，加利福尼亚州都柏林)鉴别青光眼和正常眼。方法：选择青光眼患者61例，正常眼57例，共118例。三位独立的普通眼科医生和我的青光眼专家对ONH立体照片进行了评估。为每种成像技术构建受试者工作特征曲线，并评估在固定特异度下的灵敏度。结果：与普通眼科医生对青光眼和正常眼的立体视觉分级(0.80)相比，每种技术的最佳参数均可显示更大的Aroc(层状OCT RNFL 0.92；层状OCT ONH垂直积分面积=0.86；层状OCT黄斑厚度=0.82；GDX增强角膜补偿=0.91，HRT3全局杯盘比=0.83；HRT3青光眼概率评分数值面积分数0.83)。青光眼专家立体摄影分级提供的AROC(0.92)等于或大于每个计算机成像设备的最佳参数。与普通眼科医生对视盘的主观评价相比，普通眼科医生对视盘的主观评价与青光眼专家对视盘的主观评价相结合对青光眼患者的识别率更高(29.5%对19.7%)。结论：所有影像技术对ONH的诊断能力均优于普通眼科医生对ONH的主观评价，但青光眼专家对视盘的主观评价不如普通眼科医生的主观评价。目的RNFL测量与普通眼科医生或青光眼专家对视盘的主观评估相结合，可改善青光眼的检测。
Purpose: To compare the ability of Subjective assessment of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) by general ophthalmologists and by a glaucoma expert with objective measurements by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Inc), confocal scanning laser ophthalmoscope (HRT III; Heidelberg Engineering, Heidelberg. Germany), and scanning laser polarimetry (GDx enhanced corneal compensation; Carl Zeiss Meditec Inc, Dublin, CA) in discriminating glaucomatous and normal eyes.Methods: Sixty-one glaucomatous and 57 normal eyes or 118 subjects Were included in the study. Three independent general ophthalmologists and I glaucoma expert evaluated ONH stereo-photographs. Receiver operating characteristic curves were constructed for each imaging technique and sensitivity at fixed specificity was estimated. Comparisons or areas under these curves (aROCs) and agreement (k) were determined between stereophoto grading and best parameter from each technique.Results: Best parameter from each technique showed larger aROC (Stratus OCT RNFL 0.92; Stratus OCT ONH vertical integrated area = 0.86; Stratus OCT macular thickness = 0.82; GDx enhanced corneal compensation = 0.91, HRT3 global cup-to-disc ratio = 0.83; HRT3 glaucoma probability score numeric area score 0.83) compared with stereophotograph grading by general ophthalmologists (0.80) in separating glaucomatous and normal eyes. Glaucoma expert stereophoto grading provided equal or larger aROC (0.92) than best parameter of each computerized imaging device. Stereophoto evaluated by a glaucoma expert showed better agreement with best parameter of each quantitative imaging technique in classifying eyes either as glaucomatous or normal compared with stereophoto grading by general ophthalmologists, The combination Of Subjective assessment of the optic disc by general ophthalmologists with RNFL objective parameters improved identification of glaucoma patients in a larger proportion than the combination of these objective parameters with Subjective assessment of the optic disc by a glaucoma expert (29.5% vs. 19.7%, respectively).Conclusions: Diagnostic ability of all imaging techniques showed better performance than subjective assessment of the ONH by general ophthalmologists, but not by It glaucoma expert, Objective RNFL measurements may provide improvement in glaucoma detection when combined with subjective assessment of the optic disc by general ophthalmologists or by a glaucoma expert.