在年龄相关性黄斑变性的 En Face OCT 成像中诊断持续性高传输缺陷。
Diagnosing Persistent Hypertransmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration.
机构信息
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Italy.
出版信息
Ophthalmol Retina. 2022 May;6(5):387-397. doi: 10.1016/j.oret.2022.01.011. Epub 2022 Jan 31.
PURPOSE
A training exercise was performed to study the ability of graders to reliably identify precursor lesions to geographic atrophy (GA), known as persistent choroidal hypertransmission defects (hyperTDs), using en face OCT images from eyes with nonexudative age-related macular degeneration (AMD).
DESIGN
Intergrader agreement study.
PARTICIPANTS
Eleven graders participated in this exercise.
METHODS
Formal training on how to identify persistent hyperTDs on en face OCT images was provided to the graders. A persistent hyperTD was defined as a bright lesion having a greatest linear dimension (GLD) of at least 250 μm. Training consisted of a tutorial session followed by the grading of 3 pretest exercises, each consisting of 3 cases. After all graders scored 100% on the pretest exercises, they performed a final exercise consisting of 30 en face OCT images from 29 eyes with nonexudative AMD containing 107 hyperTDs that each grader needed to evaluate. The cases contained a variety of AMD-related atrophic lesions.
MAIN OUTCOME MEASURES
The sensitivity, positive predictive value (PPV), and modified accuracy were assessed for each grader.
RESULTS
A total of 1177 hyperTDs from 30 en face OCT images were reviewed by the graders. The mean sensitivity, PPV, and modified accuracy for all the graders were calculated to be 99.0%, 99.2%, and 98.2%, respectively. There was a 97% agreement observed between all the graders (first-order agreement coefficient [AC] = 0.97). Internal graders from the Bascom Palmer Eye Institute had a slightly higher agreement compared with the external graders (AC = 0.98 vs. AC = 0.96). The hyperTDs most often incorrectly identified included the following features: (1) hyperTDs containing hypotransmission defect cores, (2) single hyperTDs that were incorrectly graded as 2 separate lesions, and (3) hyperTDs with borderline GLDs that were close to 250 μm.
CONCLUSIONS
The accurate detection of persistent hyperTDs on en face OCT images by graders demonstrates the feasibility of using this OCT biomarker to identify disease progression in eyes with nonexudative AMD, especially when used as a clinical trial end point in studies designed to test new therapies that may slow disease progression from intermediate AMD to GA.
目的
利用来自非渗出性年龄相关性黄斑变性（AMD）患者的 OCT 眼前节图像，进行一项关于分级员可靠识别地理萎缩（GA）前病变（即持续性脉络膜高透过缺陷（hyperTDs））能力的培训研究。
设计
组内一致性研究。
参与者
11 名分级员参与了此项研究。
方法
对分级员进行了如何在 OCT 眼前节图像上识别持续性 hyperTDs 的正式培训。将具有至少 250μm 最大线性尺寸（GLD）的亮斑定义为持续性 hyperTD。培训包括一个教程环节，然后是 3 个预测试练习的评分，每个练习包含 3 个病例。在所有分级员在预测试练习中都获得 100%的分数后，他们进行了最后一项练习，该练习包含 29 只非渗出性 AMD 患者的 30 张 OCT 眼前节图像，这些图像中包含 107 个需要每个分级员评估的 hyperTD。这些病例包含了各种 AMD 相关的萎缩性病变。
主要观察指标
为每位分级员评估敏感性、阳性预测值（PPV）和修正准确性。
结果
对 30 张 OCT 眼前节图像中的 1177 个 hyperTD 进行了分级员的评估。计算出所有分级员的平均敏感性、PPV 和修正准确性分别为 99.0%、99.2%和 98.2%。所有分级员之间的一致性为 97%（一级一致性系数[AC]为 0.97）。与外部分级员相比，来自 Bascom Palmer 眼科研究所的内部分级员的一致性略高（AC 为 0.98 与 AC 为 0.96）。最常被错误识别的 hyperTDs 包括以下特征：（1）包含低透过性缺陷核心的 hyperTDs；（2）被错误地划分为 2 个单独病变的单个 hyperTD；（3）GLD 接近 250μm 的边界性 hyperTD。
结论
分级员在 OCT 眼前节图像上准确地检测到持续性 hyperTDs，表明使用这种 OCT 生物标志物来识别非渗出性 AMD 患者的疾病进展是可行的，尤其是当它被用作旨在测试可能减缓从中度 AMD 向 GA 进展的新疗法的临床试验终点时。
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