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S. Romano, C. Pierrottet, P. Fogagnolo, G. Taibbi, I. Mena, N. Orzalesi; A Comparison Between Heidelberg Retina Tomograph (HRT III) and Ophthalmoscopic Assessment of Optic Nerve Head in Patients With Retinitis Pigmentosa. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3742.
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To compare the diagnostic assessment of optic nerve head (ONH) by indirect ophthalmoscopy and HRT III in patients with retinitis pigmentosa.
This study included 46 eyes of 27 patients with diagnosis of retinitis pigmentosa. An expert evaluator (kappa = 0.82) addressed optic nerve head (ONH) pallor and vertical cup/disc ratio (C/D) by means of slit-lamp indirect ophthalmoscopy (IO); ONH HRT (performed by a single operator, kappa = 0.90) was also performed. ONH were divided in normal (16/46) and pale (30/46) based on ophthalmoscopic appearance; for each group, C/D values obtained by IO and HRT were compared by means of t-test. HRT image quality, defined as standard deviation (SD), was also addressed. Difference in results was analysed by means of regression analysis.
C/D for patients with normal discs was 0.30 ± 0.11 with IO and 0.30 ± 0.23 with HRT (P=0.95, R-square = 0.40). In the group with pale ONH a difference of 0.18 was found (IO, 0.34 ± 0.14; HRT, 0.53 ± 0.24, P=0.0006), with a poor correlation between the two techniques (R-square = 0.18). SD of HRT images was significantly higher in normal than pale ONH (P=0.007) and it was a positive predictor for high difference in C/D evaluation by the two techniques (P = 0.0076, regression analysis).
For normal ONH, C/D evaluation by IO and HRT was very similar. On the other hand, a significant difference between the two techniques was found in the group with pale ONH. This could be due to lower image quality in more severe stages of the disease and/or also to an abnormal reflectance of pale discs, which would increase the difficulty of HRT assessment.
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