使用直接检眼镜最能准确评估哪些视盘参数？

Theodossiades J, Murdoch I

Moorfields Eye Unit, Ealing Hospital, Middlesex, UK.

Eye (Lond). 2001 Jun;15(Pt 3):283-7. doi: 10.1038/eye.2001.95.

PURPOSE

It has been suggested that over-reliance on the cup-to-disc ratio is a major factor in the misinterpretation of the optic disc. In spite of this optometrist assessment of the optic disc tends to be restricted to measurement of the cup-to-disc ratio and cup depth only. Would interpretation of the disc improve if optometrists were to evaluate other parameters? The aim of this study was to evaluate the accuracy of optometrist assessment of nine parameters of the optic nerve head using direct ophthalmoscopy.

METHODS

Eight optometrists evaluated nine parameters of the optic nerve head (vertical disc diameter, vertical cup-to-disc ratio, neuroretinal rim configuration, cup shape, neuroretinal rim colour, vessel path, presence/ absence of haemorrhage, extent and location of peripapillary atrophy and classification of health status of the disc) in 50 eyes of 50 patients using direct ophthalmoscopy. Intensive training in optic nerve head assessment was given prior to assessing the patients. Criteria for evaluation were discussed. The 'gold standard' reference was the classification of the parameters by a consultant ophthalmologist with a special interest in glaucoma.

RESULTS

Interobserver agreement for vertical cup-to-disc ratio was almost perfect (mean weighted kappa 0.84). Agreement for neuroretinal rim configuration, cup shape, haemorrhage and final classification of the disc was good (mean kappa 0.62-0.67). There was moderate agreement for vessel configuration (mean kappa 0.53). For assessment of peripapillary atrophy, disc size and neuroretinal rim colour, agreement was fair (mean kappa 0.22-0.34).

CONCLUSIONS

Accuracy of assessment was greatest for vertical cup-to-disc ratio, neuroretinal rim configuration and cup shape. Improved agreement has been demonstrated for the final classification of the disc compared with previous reports. The combination of training and assessment of additional disc parameters appears to improve interpretation of the optic nerve head by optometrists.

目的

有人认为过度依赖杯盘比是对视盘解读错误的主要因素。尽管如此，验光师对视盘的评估往往仅限于杯盘比和杯深的测量。如果验光师评估其他参数，对视盘的解读会有所改善吗？本研究的目的是使用直接检眼镜评估验光师对视神经乳头九个参数评估的准确性。

方法

八位验光师使用直接检眼镜对50例患者的50只眼睛的视神经乳头九个参数（垂直视盘直径、垂直杯盘比、神经视网膜边缘形态、杯状形态、神经视网膜边缘颜色、血管走行、有无出血、视乳头周围萎缩的范围和位置以及视盘健康状况分类）进行评估。在评估患者之前，给予视神经乳头评估方面的强化培训。讨论了评估标准。“金标准”参考是由一位对青光眼有特殊兴趣的眼科顾问医生对参数的分类。

结果

观察者间垂直杯盘比的一致性几乎完美（平均加权kappa值为0.84）。神经视网膜边缘形态、杯状形态、出血和视盘最终分类的一致性良好（平均kappa值为0.62 - 0.67）。血管形态的一致性中等（平均kappa值为0.53）。对视乳头周围萎缩、视盘大小和神经视网膜边缘颜色的评估，一致性一般（平均kappa值为0.22 - 0.34）。