Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ophthalmology. 2011 Jan;118(1):60-5. doi: 10.1016/j.ophtha.2010.04.038. Epub 2010 Aug 17.
To determine the extent of interobserver agreement and intraobserver reproducibility of the subjective determination of visual field progression with achromatic automated static perimetry in eyes with glaucoma, and to determine the impact of access to Glaucoma Progression Analysis (GPA) data on interobserver agreement.
Retrospective, observational case series.
Five glaucoma subspecialists from 5 different academic medical centers.
Five visual field tests from each of 100 eyes of 83 patients being monitored for glaucoma were retrospectively identified and subjectively and independently evaluated by the 5 glaucoma subspecialists. Each set of visual fields was classified regarding progression as "none," "questionable," "probable," or "definite." More than 1 month later, the same expert observers reevaluated the same sets of visual field tests to allow determination of intraobserver reproducibility. A final subjective evaluation regarding progression was performed 3 months later, at which time the expert observers had access to the GPA printout.
The level of interobserver agreement and intraobserver reproducibility was estimated using kappa statistics on the raw classification data and also on dichotomized data in which "none" and "questionable" progression were reclassified together as nonprogressed and " probable" and "definite" were reclassified as progressed.
Intraobserver reproducibility was good to excellent (kappa = 0.62-0.78) for the raw data and moderate to good (kappa = 0.58-0.71) for the dichotomized data. Interobserver agreement was moderate (kappa = 0.45; 95% confidence interval [CI], 0.35-0.55) for the raw classification data and also for dichotomized data (kappa = 0.55; 95% CI, 0.46-0.64). Access to the GPA printout did not significantly change the level of interobserver agreement.
Five glaucoma experts had good to excellent reproducibility of the determination of visual field progression compared with earlier evaluation of the same field sets. Agreement among the experts with each other was only moderate, and did not improve when each had access to GPA results. .
确定在青光眼患者中使用无彩色自动静态视野计进行主观视野进展判断的观察者间一致性和观察者内可重复性的程度，并确定获得青光眼进展分析（GPA）数据对观察者间一致性的影响。
回顾性、观察性病例系列。
来自 5 个不同学术医疗中心的 5 名青光眼专家。
从 83 名正在接受青光眼监测的患者的 100 只眼中回顾性地确定并由 5 名青光眼专家独立地评估每只眼的 5 份视野检查。将每一组视野检查分为“无”、“可疑”、“可能”或“明确”进展。1 个多月后，同一位专家观察者重新评估相同的视野检查以确定观察者内的可重复性。3 个月后进行最终的主观进展评估，此时专家观察者可以访问 GPA 打印输出。
使用原始分类数据的kappa 统计量和将“无”和“可疑”进展重新分类为未进展，以及将“可能”和“明确”进展重新分类为进展的二分类数据来评估观察者间一致性和观察者内可重复性的程度。
原始数据的观察者内可重复性良好至极好（kappa = 0.62-0.78），二分类数据的可重复性为中等至良好（kappa = 0.58-0.71）。原始分类数据的观察者间一致性为中等（kappa = 0.45；95%置信区间[CI]，0.35-0.55），二分类数据的一致性也为中等（kappa = 0.55；95%CI，0.46-0.64）。获得 GPA 打印输出并未显著改变观察者间一致性的水平。
与早期评估相同的视野数据集相比，5 名青光眼专家在确定视野进展方面具有良好至极好的可重复性。专家之间的一致性仅为中等，并且当每个人都可以访问 GPA 结果时，一致性并没有提高。
