Comparability of ophthalmic diagnoses by clinical and Reading Center examiners in the Visual Acuity Impairment Survey Pilot Study.
Comparability of ophthalmic diagnoses by clinical and Reading Center examiners in the Visual Acuity Impairment Survey Pilot Study.
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视力障碍调查试点研究中临床和阅读中心检查员眼科诊断的可比性。
DOI：
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发表时间：
1986
影响因子：
5
通讯作者：
D. Wentworth
中科院分区：
文献类型：
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作者：
R. Sperduto;R. Hiller;M. Podgor;P. Palmberg;F. Ferris;D. Wentworth
眼科设备的技术进步提供了用阅读中心对流行病学研究中记录的数据进行评估来取代直接临床检查的可能性。1981年8月至1982年12月，在美国波士顿、底特律和明尼阿波利斯三个城市进行的视力损害调查试点研究中，临床和阅读中心检查员对138名成人的133只右眼和132只左眼进行了独立的眼科诊断。阅读中心仅使用临床检查时收集的摄影和视野数据诊断眼部疾病。在本文报告的临床和阅读中心评价的比较中，只有检查者判断为病理严重程度足以将视力降低至6/9或更差的眼睛被归类为有病理。(No青光眼或糖尿病视网膜病变的诊断需要视力标准。在约80%的眼睛中，临床和阅读中心检查员之间的诊断评估一致。kappa统计量（根据机会一致性进行调整）在一般至良好范围内：133只右眼为0.60，132只左眼为0.62。当向阅读中心检查员提供关于病史、屈光不正和最佳矫正视力的额外信息时，视力为6/9或更差的眼睛子集中临床和阅读中心评估之间的一致性再次处于一般至良好范围内，45只右眼的kappas为0.61，48只左眼为0.68。阅读中心检查员在诊断病理学方面的观察者间一致性处于良好至极佳范围内。应考虑在未来的流行病学研究中使用阅读中心，但不建议取消临床检查，直到对本文所述的方案进行修改，并显示临床和阅读中心检查者之间的一致性水平有所提高。
Technologic advances in ophthalmic equipment offer the possibility of replacing direct clinical examinations with Reading Center evaluations of data recorded in epidemiologic studies. Clinical and Reading Center examiners made independent ophthalmic diagnoses of 133 right and 132 left eyes of 138 adults in the Visual Acuity Impairment Survey Pilot Study, carried out in three US cities, Boston, Detroit, and Minneapolis, in August 1981-December 1982. The Reading Center diagnosed eye conditions using only photographic and visual field data collected at the time of the clinical examination. In the comparisons of clinical and Reading Center evaluations reported here, only eyes judged by the examiners to have pathology severe enough to reduce visual acuity to 6/9 or worse were classified as having pathology. (No visual acuity criterion was required for the diagnosis of glaucoma or diabetic retinopathy.) There was agreement in diagnostic assessments between clinical and Reading Center examiners in about 80% of eyes. The kappa statistic, which adjusts for chance agreement, was in the fair to good range: 0.60 for 133 right eyes and 0.62 for 132 left eyes. When the Reading Center examiners were provided with additional information on medical history, refractive error and best corrected visual acuity, the agreement between clinical and Reading Center assessments among the subset of eyes with 6/9 or worse vision again was in the fair to good range, with kappas of 0.61 for 45 right eyes and 0.68 for 48 left eyes. Inter-observer agreement between Reading Center examiners in diagnosing pathology was in the good to excellent range. Use of Reading Centers in future epidemiologic studies should be considered, but elimination of the clinical examinations is not recommended until modifications in the protocol described here have been made and shown to improve levels of agreement between clinical and Reading Center examiners.