Zangwill L, Shakiba S, Caprioli J, Weinreb R N
Department of Ophthalmology, University of California, San Diego, La Jolla 92093-0946, USA.
Am J Ophthalmol. 1995 Apr;119(4):415-21. doi: 10.1016/s0002-9394(14)71226-7.
We assessed agreement between cup/disk ratio measurements obtained by glaucoma expert evaluation of stereoscopic photographs of the optic disk and those obtained with a confocal scanning laser ophthalmoscope.
Three glaucoma experts estimated vertical and horizontal cup/disk ratios from stereoscopic photographs of 15 normal subjects and 15 patients with glaucoma. These estimates were compared to vertical, horizontal, and area cup/disk ratios measured with a confocal scanning laser ophthalmoscope. Intraobserver and interobserver agreements were also estimated.
Agreement between clinicians and the confocal scanning laser ophthalmoscope varied by clinician. Agreement was moderate to substantial for vertical cup/disk ratio and fair to moderate for horizontal cup/disk ratio; kappas ranged from 0.57 to 0.72 and from 0.21 to 0.55, respectively. The mean confocal scanning laser ophthalmoscope area cup/disk ratio measurements were smaller than each clinician's mean vertical and horizontal cup/disk ratio estimates; differences ranged from 0.10 to 0.24 and from 0.06 to 0.16, respectively. Differences were smaller between clinician estimates and instrument measurements of horizontal and vertical cup/disk ratios of patients with glaucoma than normal subjects.
These results demonstrate good agreement between confocal scanning laser ophthalmoscope measurements and clinician estimates of the vertical cup/disk ratios from stereoscopic photographs, particularly of patients with glaucoma. However, as differences between clinician and instrument estimates of cup/disk ratios were found, new quantitative criteria must be established for characterizing a disk as glaucomatous using confocal scanning laser ophthalmoscopy.
我们评估了通过青光眼专家对视盘立体照片的评估所获得的杯盘比测量值与通过共焦扫描激光眼科显微镜所获得的杯盘比测量值之间的一致性。
三位青光眼专家从15名正常受试者和15名青光眼患者的立体照片中估计垂直和水平杯盘比。将这些估计值与用共焦扫描激光眼科显微镜测量的垂直、水平和面积杯盘比进行比较。还估计了观察者内和观察者间的一致性。
临床医生与共焦扫描激光眼科显微镜之间的一致性因临床医生而异。垂直杯盘比的一致性为中等至高度，水平杯盘比的一致性为一般至中等；卡帕值分别为0.57至0.72和0.21至0.55。共焦扫描激光眼科显微镜测量的平均面积杯盘比值小于每位临床医生的平均垂直和水平杯盘比估计值；差异分别为0.10至0.24和0.06至0.16。青光眼患者水平和垂直杯盘比的临床医生估计值与仪器测量值之间的差异小于正常受试者。
这些结果表明，共焦扫描激光眼科显微镜测量值与临床医生从立体照片估计的垂直杯盘比之间具有良好的一致性，尤其是对于青光眼患者。然而，由于发现临床医生和仪器对杯盘比的估计存在差异，必须建立新的定量标准，以便使用共焦扫描激光眼科显微镜将视盘表征为青光眼性视盘。
