June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Method for Objective Grading of Tonography Tracings
Author Affiliations & Notes
  • Arthur J Sit
    Ophthalmology, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Carol B Toris
    Ophthalmology, The Ohio State University, Columbus, Ohio, United States
  • Vikas Gulati
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Arash Kazemi
    Ophthalmology, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Jesse Gilbert
    Ophthalmology, The Ohio State University, Columbus, Ohio, United States
  • Shan Fan
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • David Reed
    Ophthalmology, The Ohio State University, Columbus, Ohio, United States
  • Sayoko Eileen Moroi
    Ophthalmology, The Ohio State University, Columbus, Ohio, United States
  • Footnotes
    Commercial Relationships   Arthur Sit Allergan Inc., Code C (Consultant/Contractor), PolyActiva Pty, Code C (Consultant/Contractor), Bausch Health Inc., Code F (Financial Support), Qlaris Bio Inc., Code F (Financial Support), Injectsense Inc., Code I (Personal Financial Interest); Carol Toris None; Vikas Gulati None; Arash Kazemi None; Jesse Gilbert None; Shan Fan None; David Reed None; Sayoko Moroi None
  • Footnotes
    Support  NIH/NEI Grant R01EY022124
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3299 – A0399. doi:
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      Arthur J Sit, Carol B Toris, Vikas Gulati, Arash Kazemi, Jesse Gilbert, Shan Fan, David Reed, Sayoko Eileen Moroi; Method for Objective Grading of Tonography Tracings. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3299 – A0399.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Tonography is the standard method for non-invasive measurement of outflow facility, a critical component of aqueous humor dynamics. With this technique, a pressure decay curve is obtained when a weighted tonometer probe is placed on the eye for several minutes. However, obtaining high quality tracings can be challenging and use of poor-quality tracings can adversely affect the validity of measurements. Also, assessment of tracing quality has typically been subjective, leading to potential bias. The purpose of this study was to develop an objective method for assessing quality of tonography tracings.

Methods : Pneumatonography tracings were obtained from an ongoing multicenter study of aqueous humor dynamics (ClinicalTrials.gov NCT04412096) in participants with glaucoma or ocular hypertension within the Eye Dynamics and Engineering Network (EDEN). IOP was captured digitally at 40 Hz over 2 minutes with a 10 gram weighted probe. A linear best-fit line was obtained for each tracing and root mean square error (RMSE) was calculated as a measure of fit quality. Each tracing was also graded by 7 experienced tonographers using a 1 (worst) to 10 (best, Fig 1) scale for quality (Expert score). A Reference set of 35 tracings was used to determine the relationship between RMSE and Expert score using a logarithmic curve. This relationship was used to calculate a predicted score in a second Test set of 20 tracings. The differences between the predicted scores and the Expert scores were evaluated using Bland-Altman analysis.

Results : The relationship between Expert scores and RMSE was described by the equation: EDEN score= -4.236 ln(RMSE)+7.6569, where the EDEN score is the predicted quality score using a 1-10 scale. For the Test set, there was a very strong correlation between EDEN predicted scores and Expert scores (R=0.94, Fig 2A) using this equation. The mean difference between Expert and EDEN scores was -0.30 ± 0.86 (SD), and the limits of agreement were between -1.99 and +1.39 (Fig 2B).

Conclusions : Objective assessment of pneumatonography tracings can be performed using RMSE of a fitted line and calculation of predicted EDEN quality score on a 1-10 scale. Mean EDEN scores are slightly higher than mean Expert scores, which may result in acceptance of tracing that may be deemed poor quality by expert grading. Further research is needed to determine appropriate cutoff values.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Example of poor (1A) and good (1B) quality tracings

Example of poor (1A) and good (1B) quality tracings

 

Expert vs EDEN Scores

Expert vs EDEN Scores

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