Michele Iester1, Guido Corallo, Elisabetta Capris, Paolo Capris. 1. Anatomical-Clinical Laboratory for Functional Diagnosis and Treatment of Glaucoma and Neuroophthalmology, Eye Clinic, Department of Neurological Science, Ophthalmology, Genetics, University of Genova, Genova, Italy. iester@unige.it
Abstract
PURPOSE: To examine the level of agreement among 3 clinicians in assessing glaucoma visual field progression by using 2 different methods. METHODS: Each visual field was assessed by Humphrey Field Analyzer (HFA), program SITA standard 30-2 or 24-2. In each printout the first 3 fields were excluded to minimize learning effect: the fourth and fifth full-threshold or SITA Standard examinations were used as baseline. Three clinicians assessed the progression status of each series using both HFA overview printouts and the guided progression analysis (GPA). The level of agreement among the clinicians was evaluated using a weighted kappa statistic (k). RESULTS: A total of 510 tests, comprising 83 eyes with an average of 6.1 tests each, was assessed by the 3 specialists. The mean follow-up time was 5.8 ± 1.75 years (mean ± standard deviation). When the intraobserver intermethod agreement was evaluated, k ranged from 0.5 to 0.7. When the interobserver agreement was analyzed, if HFA overview printouts were used, k ranged from 0.4 to 0.7. But when GPA was used, k ranged from 0.2 to 0.6. The level of agreement on progression status between the clinicians was always higher when they used HFA overview printouts (median k = 0.54) than when they used GPA (median k = 0.37). CONCLUSIONS: Agreement among expert clinicians about visual field progression status was moderate when GPA printouts were used. Clinicians' agreement about patients' visual field progression status was better when HFA overview printouts were used than with GPA printouts.
PURPOSE: To examine the level of agreement among 3 clinicians in assessing glaucoma visual field progression by using 2 different methods. METHODS: Each visual field was assessed by Humphrey Field Analyzer (HFA), program SITA standard 30-2 or 24-2. In each printout the first 3 fields were excluded to minimize learning effect: the fourth and fifth full-threshold or SITA Standard examinations were used as baseline. Three clinicians assessed the progression status of each series using both HFA overview printouts and the guided progression analysis (GPA). The level of agreement among the clinicians was evaluated using a weighted kappa statistic (k). RESULTS: A total of 510 tests, comprising 83 eyes with an average of 6.1 tests each, was assessed by the 3 specialists. The mean follow-up time was 5.8 ± 1.75 years (mean ± standard deviation). When the intraobserver intermethod agreement was evaluated, k ranged from 0.5 to 0.7. When the interobserver agreement was analyzed, if HFA overview printouts were used, k ranged from 0.4 to 0.7. But when GPA was used, k ranged from 0.2 to 0.6. The level of agreement on progression status between the clinicians was always higher when they used HFA overview printouts (median k = 0.54) than when they used GPA (median k = 0.37). CONCLUSIONS: Agreement among expert clinicians about visual field progression status was moderate when GPA printouts were used. Clinicians' agreement about patients' visual field progression status was better when HFA overview printouts were used than with GPA printouts.