Improving glaucoma staging in clinical practice by combining the ICD-10 glaucoma severity classification system and optical coherence tomography.
Improving glaucoma staging in clinical practice by combining the ICD-10 glaucoma severity classification system and optical coherence tomography.
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DOI：
10.1038/s41433-023-02650-5
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发表时间：
2024-01
期刊：
影响因子：
3.9
通讯作者：
Hood, Donald C.
中科院分区：
文献类型：
--
作者：
Leshno, Ari;Tsamis, Emmanouil;Harizman, Noga;De Moraes, Carlos Gustavo;La Bruna, Sol;Rai, Anvit;Garg-Shukla, Aakriti;Cioffi, George A.;Wang, Qing;Liebmann, Jeffrey M.;Hood, Donald C.
用于青光眼严重程度分类的国际疾病分类第 10 版 (ICD-10) 代码基于 24-2 视野 (VF) 测试。本研究的目的是评估除了功能数据之外，为临床医生提供光学相干断层扫描 (OCT) 数据对于临床实践中青光眼分期的附加价值。根据 ICD-10 指南的原则，对 54 只青光眼眼睛进行了疾病分类。使用 24-2 VF 测试和 10-2 VF 测试（有或没有 OCT 信息）以遮蔽方式对眼睛进行独立分级。严重程度的参考标准（RS）是使用先前发布的青光眼损伤的自动结构功能地形协议并利用所有可用信息来确定的。 RS 将眼睛分为轻度、中度和晚期，分别有 3 例、16 例和 35 例。基于 24-2 和 10-2 的单独和组合评分与 RS 显着不同（均 P<0.005），Kappa 一致性分别为 0.26、0.45 和 0.42（P<0.001）。使用 OCT 结合任一 VF 进行的分类与 RS 没有显着差异 (P > 0.3)，Kappa 一致性分别为 0.56 和 0.57 (P < 0.001)。将 24-2 与 OCT 相结合，高估的严重程度较小，而 10-2 与 OCT 相结合，低估的程度则较少。与单独使用 VF 数据相比，结合 OCT 和 VF 数据可以更好地对青光眼严重程度进行分期。鉴于与 RS 的高度一致性以及对严重性的高估较少，24-2 和 OCT 组合似乎是最合适的。将结构信息纳入疾病阶段，使临床医生能够为个体患者设定更合适的基于严重程度的治疗目标。
The International Classification of Disease, 10th revision (ICD-10) codes used for glaucoma severity classification are based on the 24-2 visual-field (VF) test. This study aim was to assess the added value of providing clinicians with optical coherence tomography (OCT) data, in addition to functional data, for glaucoma staging in clinical practice. Disease classification was determined for 54 glaucoma eyes, according to the principles of the ICD-10 guidelines. Eyes were independently graded in a masked fashion using the 24-2 VF test and 10-2 VF test, with and without OCT information. The reference standard (RS) for severity was determined using a previously published automated structure-function topographic agreement for glaucomatous damage using all available information. The RS classified eyes as mild, moderate and advanced in 3, 16 and 35 cases, respectively. Individual and combined 24-2 and 10-2 based gradings were significantly different from the RS (all P < 0.005), with Kappa agreements of 0.26, 0.45 and 0.42 respectively (P < 0.001). Classifications using OCT combined with either of the VF were not-significantly different from the RS (P > 0.3) with Kappa agreements of 0.56 and 0.57 respectively (P < 0.001). Combining 24-2 with OCT had less severity overestimations while 10-2 with OCT had fewer underestimations. Combining OCT and VF data provides better staging of glaucoma severity than VF data alone. The 24-2 and OCT combination seems most appropriate given the high concordance with the RS and less overestimation of severity. Incorporating structural information into disease stages allows clinicians to set more appropriate severity-based treatment targets for individual patients.
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