Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.
Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Indian J Ophthalmol. 2024 Apr 1;72(4):526-532. doi: 10.4103/IJO.IJO_3396_22. Epub 2024 Mar 8.
This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography.
This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021. Each expert provided a predicted probability that the ulcer was either bacterial or fungal. Using these data, we performed multivariable linear regression to identify factors predictive of expert performance, accounting for primary practice location and surrogate measures to infer local fungal ulcer prevalence, including locality, latitude, and dew point. In addition, Brier score decomposition was used to determine experts' reliability ("calibration") and resolution ("boldness") and were compared between local (Indian) and external (non-Indian) experts.
Sixty-six experts from 16 countries participated. Indian practice location was the only independently significant predictor of performance in multivariable linear regression. Resolution among Indian experts was significantly better (0.08) than among non-Indian experts (0.01; P < 0.001), indicating greater confidence in their predictions. There was no significant difference in reliability between the two groups ( P = 0.40).
Local cornea experts outperformed their international counterparts independent of regional variability in tropical risk factors for fungal keratitis. This may be explained by regional characteristics of infectious ulcers with which local corneal specialists are familiar.
本研究旨在确定基于角膜摄影，当地（印度）和外部（非印度）角膜专家在识别细菌性和真菌性角膜炎方面表现差异和分类错误的来源。
这是一项对评估角膜专家通过角膜摄影识别急性细菌性与真菌性角膜炎能力的调查数据的二次分析。此前，在 2021 年 4 月至 7 月期间，100 名来自印度南部患有急性细菌性或真菌性角膜炎的 100 名患者的 100 只眼睛的 100 张图像被提供给了一个国际角膜专家队列进行解读。每位专家都提供了溃疡是细菌性还是真菌性的预测概率。利用这些数据，我们进行了多变量线性回归分析，以确定预测专家表现的因素，同时考虑了主要的实践地点和推断当地真菌性溃疡流行率的替代指标，包括地理位置、纬度和露点。此外，还使用 Brier 得分分解法来确定专家的可靠性（“校准”）和分辨率（“大胆”），并在当地（印度）和外部（非印度）专家之间进行比较。
来自 16 个国家的 66 名专家参与了研究。在多变量线性回归中，印度的实践地点是表现的唯一独立显著预测因素。印度专家的分辨率明显更好（0.08 比 0.01；P < 0.001），表明对他们的预测更有信心。两组之间的可靠性没有显著差异（P = 0.40）。
当地角膜专家的表现优于国际同行，而与真菌性角膜炎热带危险因素的区域变异性无关。这可能是由于当地角膜专家熟悉的感染性溃疡的区域特征所致。
