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Kulawan Rojananuangnit, Dussadee Srimaneekarn, Sakuna Jongrak; The Accuracy and Reproducibility of Optic Disc Criteria to Diagnose Glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2082.
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© ARVO (1962-2015); The Authors (2016-present)
Criteria for screening and diagnose glaucoma in survey were limited due to combination of sophisticated visual field functional test and structural optic nerve damage. We evaluated the accuracy and reproducibility of our proposed optic disc photographs appearance criteria to diagnose glaucoma.
Optic disc photographs from 308 participants including 144 glaucoma and 457 normal eyes were obtained and renamed to blind the diagnosis and were analyzed separately by three trained observers: glaucoma specialist, ophthalmology resident and technician. The criteria were 1) vertical cup-to-disc ratio (VCDR)>0.7 or 2) asymmetrical of VCDR between two eyes>0.2 or 3) reduction of neuroretinal rim<0.1 of VCDR at area 11-1 o'clock or 5-7 o'clock or 4) specific characteristic of glaucomatous optic neuropathy: neuroretinal rim notching, focal enlargement of cup, loss of RNFL, superficial splinter hemorrhage, beta zone PPA and translucency of neuroretinal rim. The accuracy of these criteria was tested by sensitivity, specificity, positive and negative predictive value, diagnostic odds ratio, ROC curve, positive and negative likelihood ratio. Kappa coefficient was applied to test the reproducibility between each observers and intra-observer reliability.
Sensitivity and specificity of our criteria from following observers were 79.9% and 87.3% by glaucoma specialist, 54.9% and 97.6% by ophthalmology resident and 48.6% and 96.3% by technician. Kappa coefficients between observers were 0.433, 0.547 and 0.603 while intra-observer reliability from resident and glaucoma specialist were 0.713 and 0.776. Positive and Negative predictive value are 0.231 and 0.989, Diagnostic odd ratio is 27.2. Positive and negative likelihood ratios are 6.291 and 0.230. ROC curve of glaucoma specialist and resident were shown in FIGURE 1. Area under each ROC curve was 0.915 and 0.868, respectively.
The proposed criteria for glaucoma diagnosis was based on only structural glaucomatous optic neuropathy could discriminate glaucoma from normal with acceptable test accuracy and reproducibility.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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