Ko Eun Kim1, Sohee Oh2, Jin Wook Jeoung3, Min Hee Suh4, Je Hyun Seo5, Martha Kim6, Ki Ho Park3, Dong Myung Kim3, Seok Hwan Kim7. 1. Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea. 2. Department of Biostatistics, Seoul National University Boramae Hospital, Seoul, South Korea. 3. Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea. 4. Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. 5. Department of Ophthalmology, Pusan National University Yangsan Hospital, Busan, South Korea. 6. Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea. 7. Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, South Korea. Electronic address: xcski@hanmail.net.
Abstract
PURPOSE: To investigate the additive role of spectral-domain optical coherence tomography (SDOCT) in the structural diagnosis in glaucoma. DESIGN: Reliability and validity analysis. METHODS: Structural examinations from 109 eyes of 109 healthy individuals and 151 eyes of 151 glaucoma patients with different severities were included. Four structural-diagnostic examination sets were prepared using stereo-optic disc photography (SDP), red-free retinal nerve fiber layer photography (RNFLP), and SDOCT: (1) SDP (S), (2) SDP and SDOCT (SO), (3) SDP and RNFLP (SR), and (4) SDP, RNFLP, and SDOCT (SRO). Five glaucoma specialists were instructed to classify subjects as normal or glaucoma using each of the 4 diagnostic sets in the order S, SO, SR, and SRO, with a 1-month interval. The interobserver agreement was evaluated using kappa (κ) statistics. The additive effect of SDOCT on the diagnostic performance of the specialists was evaluated using the generalized estimating equation. RESULTS: Five glaucoma specialists showed an excellent level of interobserver agreement on the diagnostic assessments based on the 4 sets. In the comparison of the collective diagnostic performance of the specialists, addition of SDOCT to SDP showed an approximately 2-fold significant increase in the diagnostic accuracy. Adding SDOCT to SDP significantly enhanced the specialists' structural-diagnostic ability with respect to the moderate glaucoma, though not mild or advanced glaucoma. CONCLUSIONS: SDOCT significantly enhanced the diagnostic accuracy of the glaucoma specialists' performance, showing its additive diagnostic value in judging glaucomatous structural damage, especially in the moderate stage of glaucoma.
PURPOSE: To investigate the additive role of spectral-domain optical coherence tomography (SDOCT) in the structural diagnosis in glaucoma. DESIGN: Reliability and validity analysis. METHODS: Structural examinations from 109 eyes of 109 healthy individuals and 151 eyes of 151 glaucomapatients with different severities were included. Four structural-diagnostic examination sets were prepared using stereo-optic disc photography (SDP), red-free retinal nerve fiber layer photography (RNFLP), and SDOCT: (1) SDP (S), (2) SDP and SDOCT (SO), (3) SDP and RNFLP (SR), and (4) SDP, RNFLP, and SDOCT (SRO). Five glaucoma specialists were instructed to classify subjects as normal or glaucoma using each of the 4 diagnostic sets in the order S, SO, SR, and SRO, with a 1-month interval. The interobserver agreement was evaluated using kappa (κ) statistics. The additive effect of SDOCT on the diagnostic performance of the specialists was evaluated using the generalized estimating equation. RESULTS: Five glaucoma specialists showed an excellent level of interobserver agreement on the diagnostic assessments based on the 4 sets. In the comparison of the collective diagnostic performance of the specialists, addition of SDOCT to SDP showed an approximately 2-fold significant increase in the diagnostic accuracy. Adding SDOCT to SDP significantly enhanced the specialists' structural-diagnostic ability with respect to the moderate glaucoma, though not mild or advanced glaucoma. CONCLUSIONS:SDOCT significantly enhanced the diagnostic accuracy of the glaucoma specialists' performance, showing its additive diagnostic value in judging glaucomatous structural damage, especially in the moderate stage of glaucoma.