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A. Viestenz, R. Laemmer, F. Linde, A. Langenbucher, C. Y. Mardin; Evaluation of Parapapillary Autofluorescence Measurement Reliability. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4619.
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Eyes suffering from ocular hypertension or manifest glaucoma showed a pronounced autofluorescence in the parapapillary atrophic zone alpha. The aim of this study was to evaluate the reproducibility of parapapillary autofluorescence (PAF)-planimetry for further glaucoma diagnostics.
Thirty six eyes (randomised selection) of 22 consecutive patients (7 PSX glaucoma, 6 normal tension glaucoma, 9 primary open angle glaucoma) of the Department of Ophthalmology (Erlangen) were examined on three days with the HRA (Heidelberg-Retina-Angiograph II): The fundus was excited with an argon-laser (wavelength 488 nm) using confocal scanning laser ophthalmoscopy and the emitted light above 500 nm wavelength was detected. The reproducibility of 15 HRA images was analyzed (intraindividual analysis, 5 images per day on 3 days). Evaluating the intra-/interobserver-reliability, the PAF was measured by 2 experienced ophthalmologists (U1 and U2) and one beginner (U3) analyzing 5 images of the third examination day. A standardized glaucoma analysis was performed in each patient.
The mean PAF was evaluated by the different observers: U1 0.154 ± 0.069 mm² [range: 0.04 - 0.29], U2 0.148 ± 0.094mm² [0.03 - 0.37], and U3 0.243 ± 0.135 mm² [0.05 - 0.68] on third day. Cronbach's alpha was 0.716 for the interobserver reliability. The intraobserver reliability for the PAF measurements on three different days was for all three investigators more than 0.91.
Manual PAF-analysis shows good intraobserver reproducibility in contrast to interobserver analysis. Only well experienced and trained ophthalmologists should be allowed to perform this measurement for clinical investigation. A computerized PAF detection should simplify and standardize the PAF-measurement.
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