Varma R, Steinmann W C, Scott I U
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD 21205.
Ophthalmology. 1992 Feb;99(2):215-21. doi: 10.1016/s0161-6420(92)31990-6.
The authors studied intraobserver and interobserver agreement, under monoscopic and stereoscopic conditions, in estimating vertical cup-to-disc ratios and in assessing whether a disc had glaucomatous damage. Six glaucoma experts evaluated 75 optic disc photographs under both viewing conditions. The experts also re-evaluated 25 photographs. Intraobserver agreement in estimating vertical cup-to disc ratios was high (median weighted kappa, 0.79). Interobserver agreement in estimating vertical cup-to-disc ratios was moderate (stereoscopic median weighted kappa, 0.67); individual experts differed by as much as 0.2 disc diameters (DD) monoscopically and 0.16 DD stereoscopically. The observers estimated larger vertical cup-to-disc ratios when evaluating the same discs under stereoscopic conditions than under monoscopic conditions. Intraobserver agreement in assessing glaucomatous disc damage was substantial (median kappa, 0.76). Interobserver agreement in assessing glaucomatous damage was moderate (stereoscopic median kappa, 0.50). This study confirms the ability of experts to reliably evaluate the optic disc within themselves and emphasizes the need for developing standardized methods for interobserver evaluation of the optic disc in glaucoma.
作者研究了在单视和立体条件下，青光眼专家在估计垂直杯盘比以及评估视盘是否存在青光眼性损害方面的观察者内和观察者间一致性。六位青光眼专家在两种观察条件下对75张视盘照片进行了评估。专家们还对25张照片进行了重新评估。在估计垂直杯盘比方面，观察者内一致性较高（加权kappa中位数为0.79）。在估计垂直杯盘比方面，观察者间一致性为中等（立体观察加权kappa中位数为0.67）；个体专家在单视条件下的差异高达0.2个视盘直径（DD），在立体观察条件下为0.16 DD。与单视条件相比，观察者在立体条件下评估相同视盘时估计的垂直杯盘比更大。在评估青光眼性视盘损害方面，观察者内一致性较高（kappa中位数为0.76）。在评估青光眼性损害方面，观察者间一致性为中等（立体观察kappa中位数为0.50）。这项研究证实了专家可靠地自我评估视盘的能力，并强调了开发标准化方法用于青光眼视盘观察者间评估的必要性。
