Assessment of change of optic nerve head cupping in pediatric glaucoma using the RetCam 120
Assessment of change of optic nerve head cupping in pediatric glaucoma using the RetCam 120
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DOI：
10.1016/j.jaapos.2006.07.011
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发表时间：
2006-12-01
期刊：
影响因子：
1.6
通讯作者：
Levin, Alex V.
中科院分区：
文献类型：
--
作者：
Erraguntla, Vasudha;MacKeen, Leslie D.;Levin, Alex V.
为了确定当分析用RetCam 120（Clarity Medical Systems，Inc.，普莱森顿，CA）用于评估儿童青光眼视盘杯状的进展。方法5名观察者比较了64只眼睛的RetCam 120二维照片，以确定视盘是否发生了变化。观察员包括儿科青光眼专家、儿科神经眼科专家、斜视专家、儿科眼科成像专家和儿科眼科研究员。每例患者均对患者身份和临床病程设盲。对于每例患者，观察员审查了治疗前和治疗开始后至少6个月拍摄的照片。计算观察者间的变异性，并进行分析，以确定有影响力的变量。一致性水平和影响摄影质量的变量之间没有显著相关性：对比度和照明的可变性，曝光和放大率，图像清晰度，角膜上荧光素的存在，以及分辨率差的图像像素化。评分员注意到75.6%的观察结果中存在这些图像变量的问题。获得的Kappa统计量为Kappa = 0.29，总体比例的协议p = 0.69，这表明一个公平的协议，但不是一个温和agreement.Conclusions RetCam 120小儿视神经乳头照片比较，主观上由观察者进行不同的观点，并从临床信息中隔离，可能不是一个可靠的指标杯状变化。此外，图像对比度、亮度、颜色和像素化的变化对观察者之间的一致性构成了重大挑战。RetCam 120图像的比较不应被视为监测小儿青光眼的唯一标准。
PURPOSE To ascertain the interobserver agreement among various specialists when analyzing images of the optic nerve head taken with the RetCam 120 (Clarity Medical Systems, Inc., Pleasanton, CA) for assessing the progression of optic disk cupping in pediatric glaucoma.METHODS Five observers compared pairs of RetCam 120 two-dimensional photographs from 64 eyes to identify whether or not changes in the optic disk had occurred. Observers included a pediatric glaucoma specialist, pediatric neurophthalmologist, strabismologist, pediatric ophthalmic imaging specialist, and pediatric ophthalmology fellow. Each was masked to the patient identity and clinical course. For each patient, the observers reviewed the photographs taken prior to therapy and at a minimum of 6 months following initiation of therapy. Interobserver variability was calculated and analysis conducted to identify influential variables.RESULTS Poor agreement was noted between the observers. No significant association was obtained between agreement level and variables affecting photographic quality: variability of contrast and illumination, exposure and magnification, image clarity, presence of fluorescein on the cornea, and pixelation of the image with poor resolution. Raters noted problems with these image variables in 75.6% of the observations. The Kappa statistic obtained was kappa = 0.29 with overall proportion of agreement of p = 0.69, suggesting a fair agreement but not a moderate agreement.CONCLUSIONS Comparison of RetCam 120 pediatric optic nerve head photographs, when performed subjectively by observers with different perspectives, and in isolation from clinical information, may not be a reliable indicator of cupping change. In addition, variations in image contrast, luminance, color, and pixelation pose significant challenges to agreement between observers. Comparison of RetCam 120 images should not be considered the sole criterion for monitoring pediatric glaucoma.