利用视网膜摄影评估长期航天飞行机组人员的视盘水肿。
Evaluation of Optic Disc Edema in Long-Duration Spaceflight Crewmembers Using Retinal Photography.
机构信息
The University of Texas Medical Branch at Galveston (WV), Galveston, Texas; MEI Technologies Inc (SM), Houston, Texas; NASA Johnson Space Center (TB, WT, MVB), Houston, Texas; KBR (AS), Houston, Texas; The University of Texas Health Science Center at Houston School of Public Health (CS), Houston, Texas; Coastal Eye Associates (CG), Webster, Texas; Department of Ophthalmology (AL), Houston Methodist Hospital, Houston, Texas; Gagarin Research and Test Cosmonaut Training Center (SD, VM), Star City, Russian Federation; Canadian Space Agency (PH), Chapman Space Centre, Longueuil, Canada; Institute of Biomedical Problems (IM), Russian Academy of Science, Moscow, Russian Federation; German Aerospace Center (CS), Cologne, Germany; Department of Ophthalmology (AT-S), Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; and School of Medicine and Dentistry (SF), Flaum Eye Institute, University of Rochester, Rochester, New York.
出版信息
J Neuroophthalmol. 2023 Sep 1;43(3):364-369. doi: 10.1097/WNO.0000000000001787. Epub 2023 Jan 4.
BACKGROUND
Long-duration spaceflight crewmembers are at risk for spaceflight-associated neuro-ocular syndrome (SANS). One of the earliest manifestations of SANS is optic disc edema (ODE), which could be missed using the subjective Frisén scale. The primary objective of this study is to determine the inter-rater and intrarater reliability of Frisén grade for SANS-induced ODE among a trained observer cohort. The secondary objective is to propose a standardized evaluation process for SANS-induced ODE across International Space Station Partner Agencies.
METHODS
Retrospective, double-blinded diagnostic study. Preflight and postflight fundus photographs were presented to subject matter experts who identified and graded ODE. Pairs of images were also compared side-by-side for disc ranking. Grader concordance was assessed for Frisén grading and disc ranking.
RESULTS
Expert graders identified Grade 1 ODE in 17.35% of images from 62 crewmembers (9 female, mean [SD] age, 47.81 [5.19] years). Grades 2 and 3 were identified less than 2% of the time. Concordance in Frisén grades among pairs of graders was 70.99%. Graders identified a difference in preflight and postflight fundus photographs 17.21% of the time when using disc ranking. Pairs of graders had complete concordance in disc ranking 79.79% of the time. Perfect intrarater agreement between Frisén grade and disc ranking occurred 77.7% of the time.
CONCLUSIONS
These findings demonstrate intergrader and intragrader variability when using the Frisén scale to identify SANS-induced ODE, which is typically milder in presentation than terrestrial cases of idiopathic intracranial hypertension. It is possible to miss early ODE on fundoscopy alone, making it insufficient as a sole criterion for the diagnosis of SANS. A more sensitive and objective method of surveillance is necessary to monitor international crewmembers for ODE, perhaps using a multimodal approach that includes technology such as optical coherence tomography.
背景
长时间飞行的航天员有发生航天相关神经眼综合征（SANS）的风险。SANS 的最早表现之一是视盘水肿（ODE），使用主观 Frisén 量表可能会漏诊。本研究的主要目的是确定在经过培训的观察者队列中，Frise 分级法对 SANS 引起的 ODE 的组内和组间可靠性。次要目标是为国际空间站合作机构之间的 SANS 引起的 ODE 提出标准化评估流程。
方法
回顾性、双盲诊断研究。向主题专家展示飞行前和飞行后的眼底照片，以识别和分级 ODE。还并排比较了成对的图像以进行视盘分级。评估了 Frise 分级和视盘分级的评分者一致性。
结果
来自 62 名航天员（9 名女性，平均[标准差]年龄 47.81[5.19]岁）的 17.35%的图像中，专家分级员确定了 1 级 ODE。2 级和 3 级的发生率不到 2%。两名评分者之间的 Frisén 分级一致性为 70.99%。当使用视盘分级时，评分者在 17.21%的时间内识别出飞行前和飞行后的眼底照片之间的差异。两名评分者在视盘分级方面完全一致的时间为 79.79%。Frise 分级与视盘分级之间的完全组内一致性发生了 77.7%的时间。
结论
这些发现表明，在使用 Frisén 量表识别 SANS 引起的 ODE 时，存在组内和组间的变异性，这通常比特发性颅内高压的陆地病例表现更轻微。仅通过眼底镜检查可能会漏诊早期 ODE，因此仅凭其作为 SANS 诊断的单一标准是不够的。需要一种更敏感和客观的监测方法来监测国际航天员的 ODE，也许可以使用包括光学相干断层扫描等技术的多模态方法。
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