Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, La Jolla, California 92093-0946, USA.
Ophthalmology. 2010 Mar;117(3):462-70. doi: 10.1016/j.ophtha.2009.08.012. Epub 2009 Dec 24.
To evaluate the ability of the GDx Variable Corneal Compensation (VCC) Guided Progression Analysis (GPA) software for detecting glaucomatous progression.
Observational cohort study.
The study included 453 eyes from 252 individuals followed for an average of 46+/-14 months as part of the Diagnostic Innovations in Glaucoma Study. At baseline, 29% of the eyes were classified as glaucomatous, 67% of the eyes were classified as suspects, and 5% of the eyes were classified as healthy.
Images were obtained annually with the GDx VCC and analyzed for progression using the Fast Mode of the GDx GPA software. Progression using conventional methods was determined by the GPA software for standard automated achromatic perimetry (SAP) and by masked assessment of optic disc stereophotographs by expert graders.
Sensitivity, specificity, and likelihood ratios (LRs) for detection of glaucoma progression using the GDx GPA were calculated with SAP and optic disc stereophotographs used as reference standards. Agreement among the different methods was reported using the AC(1) coefficient.
Thirty-four of the 431 glaucoma and glaucoma suspect eyes (8%) showed progression by SAP or optic disc stereophotographs. The GDx GPA detected 17 of these eyes for a sensitivity of 50%. Fourteen eyes showed progression only by the GDx GPA with a specificity of 96%. Positive and negative LRs were 12.5 and 0.5, respectively. None of the healthy eyes showed progression by the GDx GPA, with a specificity of 100% in this group. Inter-method agreement (AC(1) coefficient and 95% confidence intervals) for non-progressing and progressing eyes was 0.96 (0.94-0.97) and 0.44 (0.28-0.61), respectively.
The GDx GPA detected glaucoma progression in a significant number of cases showing progression by conventional methods, with high specificity and high positive LRs. Estimates of the accuracy for detecting progression suggest that the GDx GPA could be used to complement clinical evaluation in the detection of longitudinal change in glaucoma.
评估 GDx 可变角膜补偿 (VCC) 引导进展分析 (GPA) 软件检测青光眼进展的能力。
观察性队列研究。
该研究纳入了作为诊断性青光眼创新研究的一部分，在平均 46+/-14 个月的随访中，453 只眼来自 252 名个体。在基线时，29%的眼被归类为青光眼，67%的眼被归类为可疑青光眼，5%的眼被归类为健康。
每年用 GDx VCC 采集图像，并使用 GDx GPA 软件的快速模式进行进展分析。使用常规方法确定 GPA 软件对标准自动消色差视野计 (SAP) 和专家分级员对视盘立体照片进行的盲法评估的进展情况。
使用 SAP 和视盘立体照片作为参考标准，计算 GDx GPA 检测青光眼进展的灵敏度、特异性和似然比 (LR)。使用 AC(1)系数报告不同方法之间的一致性。
34 只（8%）青光眼和可疑青光眼眼（431 只中的 34 只）在 SAP 或视盘立体照片上显示出进展。GDx GPA 检测到其中的 17 只，灵敏度为 50%。仅 14 只眼仅通过 GDx GPA 显示进展，特异性为 96%。阳性和阴性 LR 分别为 12.5 和 0.5。在这一组中，没有一只健康眼通过 GDx GPA 显示进展，特异性为 100%。非进展眼和进展眼之间的方法间一致性（AC(1)系数和 95%置信区间）分别为 0.96（0.94-0.97）和 0.44（0.28-0.61）。
GDx GPA 在大量通过传统方法显示进展的病例中检测到青光眼进展，具有高特异性和高阳性 LR。对检测进展准确性的估计表明，GDx GPA 可用于补充临床评估，以检测青光眼的纵向变化。
