Interobserver and Intraobserver Variability in the Detection of Glaucomatous Progression of the Optic Disc
Interobserver and Intraobserver Variability in the Detection of Glaucomatous Progression of the Optic Disc
复制标题
视盘青光眼进展检测中观察者间和观察者内的变异性
DOI：
10.1097/00061198-199612000-00005
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发表时间：
1996
影响因子：
2
通讯作者：
D. Minckler
中科院分区：
文献类型：
--
作者：
A. Coleman;A. Sommer;C. Enger;H. L. Knopf;R. Stamper;D. Minckler
目的评价获得青光眼疑似患者的随访立体照片在识别进行性视神经损伤中的潜在价值。方法从参加青光眼筛查研究的受试者的记录中选择19组立体视盘照片，反映了19例患者在两个时间点各一只眼的情况。三位专家一致认为，其中13只眼睛患有进行性青光眼视神经损伤。另外四名眼科医生戴着面具参加了专家小组的评估，然后评估了同一只眼睛的青光眼进展。他们被要求以三种方式评估青光眼的进展：第一，通过从最初的立体照片中绘制视神经头外观，然后将他们自己的图纸与后续的立体照片进行比较；第二，通过直接比较连续的立体照片；以及第三，通过将另一位检查人员绘制的视神经头图纸与后续照片进行比较。结果无论是敏感度还是特异度，序列立体照片的灵敏度和特异度都不比图纸好。当检查者将自己的图纸与后续照片进行比较时，个别眼科医生与专家小组确定的进展的符合率为23%-62%，当检查者将自己的图纸与后续照片进行比较时，个人眼科医生与专家小组确定的进展的符合率为54%-71%，而当将另一位眼科医生的图纸与后续照片进行比较时，个体眼科医生与专家小组确定的进展的符合率为38%-85%。结论与在此期间视力丧失的受试者使用由照片制作的视神经头部基线图相比，视神经头的基线立体照片并不能显著提高对进行性青光眼视神经损伤的识别能力。
PurposeTo evaluate the potential value of obtaining follow-up stereoscopic photographs on glaucoma suspects in identifying progressive optic nerve damage. MethodsNineteen sets of stereoscopic optic disc photographs, reflecting one eye from each of 19 patients at two time points, were selected from the records of subjects enrolled in the Glaucoma Screening Study. By consensus, three experts judged 13 of these eyes to have progressive glaucomatous optic nerve damage. Four other ophthalmologists who were masked to the expert panel evaluation then assessed glaucomatous progression in the same eyes. They were asked to evaluate glaucomatous progression in three ways: first, by drawing the optic nerve head appearance from initial stereoscopic photographs and later comparing their own drawings to follow-up stereoscopic photographs; second, by comparing serial stereoscopic photographs directly; and third, by comparing drawings of the optic nerve head made by another examiner to the follow-up photographs. ResultsNeither sensitivity nor specificity was consistently better for serial stereoscopic photographs than for drawings. Individual ophthalmologist agreement rates with the expert panel's determinations of progression were 23–62% when examiners compared their own drawings to follow-up photographs, 54–71% when examiners compared serial stereoscopic photographs, and 38–85% when comparing another ophthalmologist's drawings to follow-up photographs. ConclusionBaseline stereoscopic photographs of the optic nerve head did not substantially improve recognition of progressive glaucomatous optic nerve damage when compared with the use of baseline drawings of the optic nerve head made from photographs in subjects who developed visual loss in the interim.