From the Bernard and Shirlee Brown Glaucoma Research Laboratory (A.L. N.H., G.A.C., Q.W., C.G.D.M., J.M.L., D.C.H.), Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA; Sackler Faculty of Medicine (A.L.), Tel Aviv University, Tel Aviv, Israel.
Department of Psychology (E.T., S.L.B., D.C.H.), Columbia University, New York, New York, USA.
Am J Ophthalmol. 2022 Dec;244:133-142. doi: 10.1016/j.ajo.2022.08.009. Epub 2022 Aug 23.
To evaluate the International Classification of Disease, Tenth Revision (ICD-10) codes used for glaucoma severity classification, which are based on the location of visual field (VF) defects; given the known poor sensitivity of the 24-2 visual field test to early disease and macular damage, we hypothesized that the ICD-10 codes would not accurately reflect the extent of glaucomatous damage.
Retrospective validity and reliability analysis.
We evaluated 80 eyes with glaucomatous optic neuropathy (GON). Masked reviewers assigned an ICD-10 severity grade based on 24-2 VF. Two additional masked examiners determined the presence of optical coherence tomography (OCT) structural damage in each hemifield and/or central 5 degrees to define an OCT-based equivalent ICD-10 classification.
A total of 80 eyes with GON were classified as mild, moderate and advanced in 15, 23, and 42 cases, respectively, based on the 24-2 VF, and in 6, 7, and 67 cases, respectively, based on OCT. The OCT classifications were more severe in 29 of 80 cases (36%). In 33 cases (41.3%), macular damage detected by OCT was missed by the 24-2. In 4 of 80 cases (5%), the VF overestimated the severity, likely due to variability of the 24-2 test.
The ICD-10 system relies solely on damage seen on the 24-2 and as provides a 24-2 functional score rather than a "glaucoma" severity score. OCT revealed wide variation of damage across grades, with a significant proportion of the eyes showing macular structural damage missed with the 24-2 VF. Adding OCT information to the ICD-10 system would help it to more accurately reflect the extent of glaucomatous damage.
评估基于视野（VF）缺损位置的国际疾病分类第 10 版（ICD-10）青光眼严重程度分类编码；鉴于 24-2 视野检查对早期疾病和黄斑损伤的敏感性较差，我们假设 ICD-10 编码不能准确反映青光眼损伤的程度。
回顾性有效性和可靠性分析。
我们评估了 80 只患有青光眼视神经病变（GON）的眼睛。盲法审核员根据 24-2VF 分配 ICD-10 严重程度等级。另外两名盲法检查者确定了每个半视野和/或中央 5 度的光学相干断层扫描（OCT）结构损伤，以定义基于 OCT 的等效 ICD-10 分类。
根据 24-2VF，80 只 GON 眼分别被分类为轻度、中度和重度，分别为 15、23 和 42 例，而根据 OCT 分别为 6、7 和 67 例。在 80 例中有 29 例（36%）OCT 分类更严重。在 33 例（41.3%）中，OCT 检测到的黄斑损伤被 24-2 漏诊。在 80 例中有 4 例（5%），VF 高估了严重程度，可能是由于 24-2 测试的变异性。
ICD-10 系统仅依赖于 24-2 上的损伤，提供的是 24-2 功能评分，而不是“青光眼”严重程度评分。OCT 显示各级损伤差异很大，相当一部分眼睛的黄斑结构损伤被 24-2VF 漏诊。将 OCT 信息添加到 ICD-10 系统中可以帮助更准确地反映青光眼损伤的程度。
