Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema
Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema
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DOI：
10.1089/tmj.2017.0120
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发表时间：
2018-05-01
影响因子：
4.7
通讯作者：
De Lott, Lindsey B.
中科院分区：
文献类型：
--
作者：
Bursztyn, Lulu;Woodward, Maria A.;De Lott, Lindsey B.
背景：视盘水肿是严重神经系统疾病的一个重要指标，但直接检眼镜检测效果不佳。便携式眼底照相可以克服这个difficult.Introduction：本研究的目的是确定的灵敏度和特异性的手持，nonmandriatic眼底照相机检测视盘edema.Materials and Methods：回顾性审查nonmandriatic视盘照片与便携式眼底照相机（Pictor Plus; Volk Optical，Mentor，OH）从密歇根大学神经眼科诊所。我们纳入了109例患者的103只连续的视盘水肿眼和103只连续的无视盘水肿眼。四位盲态的神经眼科医生对每个视盘的一张照片进行随机分级，并记录视盘水肿的存在。将分级者的照片判读的敏感性和特异性与临床检查进行比较。结果：检测视盘水肿的敏感性和特异性分别为71.8-92.2%和81.6- 95.2%。在0-8.3%的情况下，发现照片无法分级。综合评分器的可靠性范围为0.60 [95%置信区间（CI）：0.52-0.67]至0.72（95% CI：0.66-0.77）。分级器内可靠性范围为0.76（95%CI：0.63-0.92）至0.82（95%CI：0.69-0.95）。讨论：大多数分级器（但不是所有分级器）进行远程视盘水肿筛查时，采用便携式非散瞳技术拍摄的照片符合阈值灵敏度和特异性。分级者之间的可靠性是中等强度和强大的个人provider.Conclusions：便携式摄影有希望用于远程筛选视盘水肿。
Background: Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty.Introduction: The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema.Materials and Methods: Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics.Results: The sensitivity and specificity for detection of optic disc edema were 71.8-92.2% and 81.6-95.2%, respectively. Photos were found to be ungradable in 0-8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52-0.67] to 0.72 (95% CI: 0.66-0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63-0.92) to 0.82 (95% CI: 0.69-0.95).Discussion: Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate-strong and strong within individual providers.Conclusions: Portable photography holds promise for use in remote screening of optic disc edema.