Yang Yunsik, Vitale Susan, Ding Yulan, O'Connell Stephen R, Alexander Judith, Bressler Neil M, Schachat Andrew P, Zeimer Ran
Department of Ophthalmology, Wonkwang Medical Science Center, Wonkwang University School of Medicine, Korea.
Ophthalmic Surg Lasers Imaging. 2003 Jan-Feb;34(1):7-16.
To evaluate the ability of a retina specialist's grading of 30 degrees color stereoscopic fundus photographs to identify areas of significant retinal thickening as assessed by the Retinal Thickness Analyzer (RTA) and to determine whether this ability was affected by the presence of retinal pathology.
Thirty-two eyes in 29 patients clinically diagnosed as having diabetic macular edema underwent RTA scanning and nonsimultaneous 30 degrees color stereoscopic fundus photography. Retinal thickness maps of the macular area were generated, and regions with significant retinal thickening (> or = 2 SD above normal values) were identified. A retina specialist reader, masked to the RTA measurements, identified areas with macular edema on the stereoscopic fundus photographs, which subsequently were overlaid on the retinal thickness maps. The sensitivity (percent of significant retinal thickening areas identified by the retina specialist grading the stereoscopic fundus photographs) was calculated separately for areas with and without retinal pathology. Specificity of the stereoscopic fundus photograph grading was assessed similarly.
The retina specialist's stereoscopic fundus photography grading identified 78.8% of areas with significant retinal thickening (range over eyes: 20.4%-100%) and was slightly more likely to identify significant retinal thickening when pathology was present (89.6%) than when pathology was not present (78.4%; pooled risk ratio, 1.14 [95% CI = 0.54, 2.42]). Specificity of stereoscopic fundus photography grading was 58%, ie, 42% of areas without significant retinal thickening were (incorrectly) identified as edematous by the stereoscopic fundus photograph grading. This misidentification was more likely if pathology was present (76.9%) than if pathology was not present (41.1%; pooled risk ratio, 1.87 [95% CI = 1.28, 2.73]).
This study shows the determination of macular edema by a retina specialist reading color stereoscopic fundus photographs is sensitive but not specific with reference to edema identified by the RTA. Furthermore, the presence of retinopathy tends to cause false-positive readings with reference to edema identified by the RTA. These findings indicate the need to use objective, quantitative methods in clinical studies to detect and monitor macular edema.
评估视网膜专科医生对30度彩色立体眼底照片的分级能力，以识别经视网膜厚度分析仪（RTA）评估的视网膜显著增厚区域，并确定这种能力是否受视网膜病变的影响。
对29例临床诊断为糖尿病性黄斑水肿患者的32只眼睛进行RTA扫描和非同步30度彩色立体眼底照相。生成黄斑区的视网膜厚度图，并识别出视网膜显著增厚（高于正常值2个标准差及以上）的区域。一名对RTA测量结果不知情的视网膜专科医生阅片者，在立体眼底照片上识别出黄斑水肿区域，随后将其叠加在视网膜厚度图上。分别计算有视网膜病变和无视网膜病变区域的敏感度（由阅片者对立体眼底照片分级识别出的视网膜显著增厚区域的百分比）。同样评估立体眼底照片分级的特异度。
视网膜专科医生的立体眼底照片分级识别出78.8%的视网膜显著增厚区域（各眼范围：20.4%-100%），并且存在病变时（89.6%）比不存在病变时（78.4%；合并风险比，1.14[95%CI=0.54,2.42]）更有可能识别出视网膜显著增厚。立体眼底照片分级的特异度为58%，即42%无视网膜显著增厚的区域被立体眼底照片分级（错误地）识别为水肿。存在病变时（76.9%）比不存在病变时（41.1%；合并风险比，1.87[95%CI=1.28,2.73]）这种错误识别更有可能发生。
本研究表明，视网膜专科医生通过阅读彩色立体眼底照片判断黄斑水肿具有敏感性，但相对于RTA识别的水肿而言不具有特异性。此外，视网膜病变的存在往往会导致相对于RTA识别的水肿出现假阳性读数。这些发现表明在临床研究中需要使用客观、定量的方法来检测和监测黄斑水肿。
