Martus P, Korth M, Horn F, Jünemann A, Wisse M, Jonas J B
Department of Medical Statistics and Documentation, University of Erlangen-Nürnberg, Erlangen, Germany.
Invest Ophthalmol Vis Sci. 1998 Aug;39(9):1567-74.
To evaluate whether the combination of two psychophysical and two electrophysiological procedures improves diagnostic validity compared with single procedures.
In a clinical study, 73 patients with glaucoma from the University Eye Hospital in Erlangen and 122 healthy control subjects from the university staff, ranging in age from 19 to 62 years, underwent measurement of temporal contrast sensitivity using a full-field flicker test, spatiotemporal contrast sensitivity, blue-on-yellow visual evoked potential (VEP), and a black-and-white, pattern-reversal electroretinogram. Diagnostic reference criteria included applanation tonometry, optic disc morphometry, and automated perimetry. Sensitivity was determined univariately with a fixed specificity of 80% and in a multivariate approach using logistic regression analysis. The classification rate was estimated using the leaving-one-out method. The correlation with intraocular pressure, visual field defects, and optic nerve defects was determined.
Contrast sensitivity measurements and the blue-on-yellow pattern-onset VEP showed comparable sensitivity (85%, 84%, and 85%) with 80% specificity, and a pattern-reversal electroretinogram showed lower sensitivity (64%). The first three methods contributed independent information to a diagnostic score. This score improved sensitivity to 94%, with a specificity of 89%. All procedures moderately correlated with the neuroretinal rim area of the optic disc (r=0.32-0.46). The psychophysical tests showed a higher correlation with visual field defects (r > 0.5) than the electrophysiological tests (r < 0.3).
The multivariate approach substantially increased the diagnostic validity compared with single procedures. This was probably because the diagnostic procedures under investigation tested different aspects of visual function.
评估与单一程序相比，两种心理物理学和两种电生理学程序的组合是否能提高诊断有效性。
在一项临床研究中，来自埃尔朗根大学眼科医院的73例青光眼患者和122名年龄在19至62岁之间的大学工作人员中的健康对照者，接受了使用全视野闪烁试验测量颞侧对比敏感度、时空对比敏感度、蓝-黄视觉诱发电位（VEP）以及黑白模式翻转视网膜电图的检查。诊断参考标准包括压平眼压测量、视盘形态测量和自动视野检查。采用固定特异性为80%的单变量方法以及使用逻辑回归分析的多变量方法确定敏感度。使用留一法估计分类率。确定与眼压、视野缺损和视神经缺损的相关性。
对比敏感度测量和蓝-黄模式起始VEP在特异性为80%时显示出相当的敏感度（85%、84%和85%），而模式翻转视网膜电图显示出较低的敏感度（64%）。前三种方法为诊断评分提供了独立信息。该评分将敏感度提高到94%，特异性为89%。所有程序与视盘的神经视网膜边缘面积均呈中度相关（r = 0.32 - 0.46）。心理物理学测试与视野缺损的相关性（r > 0.5）高于电生理学测试（r < 0.3）。
与单一程序相比，多变量方法显著提高了诊断有效性。这可能是因为所研究的诊断程序测试了视觉功能的不同方面。
