青光眼视神经损害进展的一致性分析研究

目的 分析眼底照相联合图像配准进行闪烁对比方法 评价青光眼视神经损害进展在观察者之间及观察者自身的一致性评价,分析视神经损害进展在青光眼病情进展评价的作用.方法 回顾性分析研究.对北京同仁医院1993年7月至2010年3月长期随诊的青光眼患者203例(273只眼),其基线眼底照片及随诊眼底照片在计算机图像配准软件处理后,两张眼底照片可进行闪烁显示,对比分析其视神经损害是否发生了进展,由三位青光眼专科医师进行判断.青光眼视神经损害进展的标准:(1)盘沿丢失发生进展.(2)神经纤维层缺损发生进展.每位观察者评价两次,时间间隔半年.应用一致率及Kappa分析评价观察者自身及观察者之间的一致性.结果 三位观察者自身对青光眼视神经损害进展的一致性评价均较好,判断的一致率在87.2%～93.4%,Kappa值在0.725～0.881(P值均＜0.05),观察者对结果 判断的可重复性均较好.三位观察者之间对青光眼视神经损害进展的一致性亦较好,观察者两两之间的一致率在87.5%～92.3%,Kappa值在0.718～0.851(P值均＜0.05),观察者之间的一致性在高度一致到近完全一致.三位观察者均认为发生青光眼视神经进展者178只眼,占65.2%,均认为无青光眼视神经进展者54只眼,占19.5%.结论 应用眼底照相联合计算机图像处理软件使前后两次视神经图像进行叠加闪烁法,在判断视神经损害进展方面,三位青光眼专科医师的一致性较好,视神经闪烁对比法是监测青光眼视神经损害进展一种较好地方法.

Abstract：

Objective To determine the inter-observer and intra-observer agreement in assessing progressive disc changes from alternation flicker photographs. Methods Retrospective cases series. Serial sets of optic nerve photographs of 273 eyes of 203 glaucoma patients followed up from July 1993to March 2010 in Tongren Hospital were included for analysis. The earliest baseline and most recent follow-up photos were included. The digital images were aligned and alternated to determine structural optic nerve change by three glaucoma specialists. The assessment criteria for the automated flicker images were the progression of disc rim loss and retina nerve fiber layer defect. Every observer evaluated the flicker images twice, time intervals was half a year. The statistical significance of differences between the levels of inter- and intra-observer agreement was performed using Kappa coefficients.Results The intra-observer agreement of the three specialists were all high, the concordance rate was 87.2% ~ 93.4%, Kappa value was 0.725 ～ 0.881 (P <0.05). Flicker inter-observer agreement was still high, the concordance rate was 87.5% ～ 92.3%, Kappa value was 0.718～0.851 (P <0.05). All the three specialists thought that there were 178 eyes (65.2%) with progressive optic nerve, and 54 eyes (19.5%) with non-progressive optic nerve. Conclusions Inter-observer and intra-observer agreement among three glaucoma specialists in judging progressive optic disc change from alternation flicker photographs are very high. Altemation flicker photograph is a good method to determine the progression of glaucoma.

Agreement in assessing progressive disc changes from alternation flicker photographs in glaucoma patients

Objective To determine the inter-observer and intra-observer agreement in assessing progressive disc changes from alternation flicker photographs. Methods Retrospective cases series. Serial sets of optic nerve photographs of 273 eyes of 203 glaucoma patients followed up from July 1993to March 2010 in Tongren Hospital were included for analysis. The earliest baseline and most recent follow-up photos were included. The digital images were aligned and alternated to determine structural optic nerve change by three glaucoma specialists. The assessment criteria for the automated flicker images were the progression of disc rim loss and retina nerve fiber layer defect. Every observer evaluated the flicker images twice, time intervals was half a year. The statistical significance of differences between the levels of inter- and intra-observer agreement was performed using Kappa coefficients.Results The intra-observer agreement of the three specialists were all high, the concordance rate was 87.2% ~ 93.4%, Kappa value was 0.725 ～ 0.881 (P <0.05). Flicker inter-observer agreement was still high, the concordance rate was 87.5% ～ 92.3%, Kappa value was 0.718～0.851 (P <0.05). All the three specialists thought that there were 178 eyes (65.2%) with progressive optic nerve, and 54 eyes (19.5%) with non-progressive optic nerve. Conclusions Inter-observer and intra-observer agreement among three glaucoma specialists in judging progressive optic disc change from alternation flicker photographs are very high. Altemation flicker photograph is a good method to determine the progression of glaucoma.