Neil Lagali1, Enea Poletti2, Dipika V Patel3, Charles N J McGhee3, Pedram Hamrah4, Ahmad Kheirkhah4, Mitra Tavakoli5, Ioannis N Petropoulos6, Rayaz A Malik6, Tor Paaske Utheim7, Andrey Zhivov8, Oliver Stachs8, Karen Falke8, Sabine Peschel8, Rudolf Guthoff8, Cecilia Chao9, Blanka Golebiowski9, Fiona Stapleton9, Alfredo Ruggeri2. 1. Department of Ophthalmology Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 2. Department of Information Engineering, University of Padova, Padova, Italy. 3. Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 4. Ocular Surface Imaging Center, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States. 5. Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom. 6. Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom 6Weill Cornell Medical College in Qatar, Qatar Foundation, Education City, Doha, Qatar. 7. Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway 8Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway. 8. Department of Ophthalmology, University of Rostock, Rostock, Germany. 9. School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
Abstract
PURPOSE: We examined agreement among experts in the assessment of corneal subbasal nerve tortuosity. METHODS: Images of corneal subbasal nerves were obtained from investigators at seven sites (Auckland, Boston, Linköping, Manchester, Oslo, Rostock, and Sydney) using laser-scanning in vivo confocal microscopy. A set of 30 images was assembled and ordered by increasing tortuosity by 10 expert graders from the seven sites. In a first experiment, graders assessed tortuosity without a specific definition and performed grading three times, with at least 1 week between sessions. In a second experiment, graders assessed the same image set using four focused tortuosity definitions. Intersession and intergrader repeatability for the experiments were determined using the Spearman rank correlation. RESULTS: Expert graders without a specific tortuosity definition had high intersession (Spearman correlation coefficient 0.80), but poor intergrader (0.62) repeatability. Specific definitions improved intergrader repeatability to 0.79. In particular, tortuosity defined by frequent small-amplitude directional changes (short range tortuosity) or by infrequent large-amplitude directional changes (long range tortuosity), indicated largely independent measures and resulted in improved repeatability across the graders. A further refinement, grading only the most tortuous nerve in a given image, improved the average correlation of a given grader's ordering of images with the group average to 0.86 to 0.90. CONCLUSIONS: Definitions of tortuosity specifying short or long-range tortuosity and considering only the most tortuous nerve in an image improved the agreement in tortuosity grading among a group of expert observers. These definitions could improve accuracy and consistency in quantifying subbasal nerve tortuosity in clinical studies.
PURPOSE: We examined agreement among experts in the assessment of corneal subbasal nerve tortuosity. METHODS: Images of corneal subbasal nerves were obtained from investigators at seven sites (Auckland, Boston, Linköping, Manchester, Oslo, Rostock, and Sydney) using laser-scanning in vivo confocal microscopy. A set of 30 images was assembled and ordered by increasing tortuosity by 10 expert graders from the seven sites. In a first experiment, graders assessed tortuosity without a specific definition and performed grading three times, with at least 1 week between sessions. In a second experiment, graders assessed the same image set using four focused tortuosity definitions. Intersession and intergrader repeatability for the experiments were determined using the Spearman rank correlation. RESULTS: Expert graders without a specific tortuosity definition had high intersession (Spearman correlation coefficient 0.80), but poor intergrader (0.62) repeatability. Specific definitions improved intergrader repeatability to 0.79. In particular, tortuosity defined by frequent small-amplitude directional changes (short range tortuosity) or by infrequent large-amplitude directional changes (long range tortuosity), indicated largely independent measures and resulted in improved repeatability across the graders. A further refinement, grading only the most tortuous nerve in a given image, improved the average correlation of a given grader's ordering of images with the group average to 0.86 to 0.90. CONCLUSIONS: Definitions of tortuosity specifying short or long-range tortuosity and considering only the most tortuous nerve in an image improved the agreement in tortuosity grading among a group of expert observers. These definitions could improve accuracy and consistency in quantifying subbasal nerve tortuosity in clinical studies.
Authors: Krisandra Kneer; Michael B Green; Jenna Meyer; Celeste B Rich; Martin S Minns; Vickery Trinkaus-Randall Journal: Exp Eye Res Date: 2018-06-05 Impact factor: 3.467
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