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Carlos Barbosa, Luis Biteli, Roberto Vessani, Mauro Leite, Augusto Paranhos, Tiago Prata; Use of Optical Coherence Tomography in Clinical Practice: Does it Influence the Diagnostic Decision of Glaucoma Specialists and Non-specialists?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1899.
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To evaluate whether spectral domain optical coherence tomography results influence the diagnostic decision among glaucoma specialists and general ophthalmologists in a clinical setting
Four glaucoma specialists and seven non-specialists were enrolled in this observational study. The complete clinical data, including intraocular pressure, visual fields (VFs) and stereophotographs, of 10 patients were randomly presented to the examiners and they were required to classify each case in (1) glaucoma, (2) healthy or (3) inconclusive. Later, the SD-OCT results of each case were provided for the examiners, who were required to reassess their diagnosis. The 10 clinical cases consisted of glaucomatous and healthy patients. To be considered glaucomatous, patients had to have evidence of progressive glaucomatous optic neuropathy (GON) with normal VFs or suspicious appearance of the optic disc with peripapillary hemorrhage and normal/inconclusive VFs. Healthy patients had to have suspicious appearance of the optic disc, normal VFs and no evidence of progressive GON for at least 2 years without treatment. The follow-up visits, which were used to confirm the diagnosis, were not presented to the ophthalmologists. Kappa statistics was used to evaluate the agreement between glaucoma specialists and non-specialists
Six glaucoma patients and four healthy individuals were enrolled. The glaucoma specialists were able to detect 33% of glaucoma cases before and 71% after the OCT imaging. Non-specialist were able to detect 40% of glaucoma cases before and 62% after the the OCT imaging. On the other hand, without the aid of SD-OCT, general ophthalmologists tended to misclassify more healthy cases as glaucomatous when compared to glaucoma specialists. The within group agreement for the glaucoma specialists group went from weak agreement (k=0.19) to fair agreement (k=0.31) after the OCT. The within group agreement for the non-specialists group was weak both before (k=0.04) and after (k=0.07) the OCT. Using the mode of the answers in each group, the agreement between specialists and non-specialists went from fair agreement (k=0.24) to substantial agreement (k=0.81) after the OCT imaging
Ancillary imaging using SD-OCT yielded an increase in the agreement for the diagnostic decision between glaucoma specialists and general ophthalmologists
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