Roberti Gloria, Michelessi Manuele, Tanga Lucia, Belfonte Luca, Del Grande Laura Maria, Bruno Marisa, Oddone Francesco
IRCCS-Fondazione Bietti, Via Livenza 3, 00198 Rome, Italy.
J Clin Med. 2022 Sep 20;11(19):5508. doi: 10.3390/jcm11195508.
Background: To explore the agreement between clinical judgment and Guided Progression Analysis II (GPAII) in the evaluation of visual fields (VF) progression in patients with glaucoma. Methods: Three glaucoma experts and three general ophthalmologists were asked to rate the VF series by classifying them as progressive through the observation of the overview report. The agreement between clinical judgment and GPAII event analysis (EA) and trend analysis (TA) was assessed by Cohen statistic. The sensitivity and specificity of clinical judgment in detecting the presence of progression was evaluated considering the results of GPAII as the reference standard. Results: 66 VF series were included in the study. Glaucoma experts, general ophthalmologists, GPAII EA, and GPAII TA found progression in 39%, 38%, 15%, and 21% of the VF series (p < 0.05). The clinical judgment of glaucoma experts and general ophthalmologists was discordant with GPAII EA in 27.2% and 28.7% (k = 0.35, 95% CI 0.15−0.56 and k = 0.30, 95% CI 0.09−0.52) and with GPAII TA in 21.2% and 25.7% of the VF series examined (k = 0.51, 95% CI 0.31−0.72 and k = 0.41, 95% CI 0.18−0.62). Considering the GPAII EA and TA as reference standard, glaucoma experts showed a sensitivity of 90% and 92.8% and a specificity of 69.6% and 75%, while general ophthalmologists showed a sensitivity of 80% and 78.5% and a specificity of 69.6% and 73%. Conclusions: The agreement between clinical judgment and GPAII ranges from fair to moderate. Glaucoma experts showed better ability than general ophthalmologists in detecting VF progression.
探讨临床判断与青光眼患者视野（VF）进展评估中的引导进展分析II（GPAII）之间的一致性。方法：邀请三位青光眼专家和三位普通眼科医生通过观察综述报告将VF系列分类为进展性，从而对VF系列进行评分。通过科恩统计量评估临床判断与GPAII事件分析（EA）和趋势分析（TA）之间的一致性。以GPAII的结果作为参考标准，评估临床判断在检测进展存在方面的敏感性和特异性。结果：本研究纳入了66个VF系列。青光眼专家、普通眼科医生、GPAII EA和GPAII TA分别发现39%、38%、15%和21%的VF系列存在进展（p<0.05）。青光眼专家和普通眼科医生的临床判断与GPAII EA不一致的VF系列分别为27.2%和28.7%（k = 0.35，95%CI 0.15 - 0.56和k = 0.30，95%CI 0.09 - 0.52），与GPAII TA不一致的VF系列分别为21.2%和25.7%（k = 0.51，95%CI 0.31 - 0.72和k = 0.41，95%CI 0.18 - 0.62）。以GPAII EA和TA作为参考标准，青光眼专家的敏感性分别为90%和92.8%，特异性分别为69.6%和75%，而普通眼科医生的敏感性分别为80%和78.5%，特异性分别为69.6%和73%。结论：临床判断与GPAII之间的一致性从中等到一般。青光眼专家在检测VF进展方面比普通眼科医生表现出更强的能力。
