Document Detail

Comparing the detection and agreement of parapapillary atrophy progression using digital optic disk photographs and alternation flicker.
MedLine Citation:
PMID:  20393740     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Parapapillary atrophy (PPA) progression has been associated with progressive glaucoma, but has proven to be difficult to assess clinically. We compared inter- and intra-observer agreement using a novel automated alternation flicker technology and side-by-side digital photography inspection for the evaluation of PPA progression. METHODS: Consecutive patients with serial digital optic nerve photographs at least 1 year apart were included. Two graders (NR, BV) masked to image chronology assessed a set of photographs for progressive PPA using predefined criteria based on reference photographs containing mild, moderate, extensive or no PPA progression. At a separate session, the graders evaluated photographs using alternation flicker (EyeIC, Narberth, PA, USA) applying the same criteria. The order of patients and technique was randomized. Graders then assessed the same set of flickers and photographs a second time with the order of presentation reversed. The main outcome measure was the assessment of progressive PPA as identified by alternation flicker and digital photography inspection. Inter- and intra-observer agreement using each technique was assessed using the kappa statistic. A bootstrap method for comparing correlated kappa coefficients was used to assess statistical significance. RESULTS: Serial photographs from 131 eyes of 68 patients were evaluated. Both graders identified significantly more cases of PPA progression using flicker compared to photography (27-34% vs 8-13%; both p< or =0.003). Inter-observer agreement using flicker was better than using photographs (kappa=0.52 vs 0.18, p=0.02). Intra-observer agreement was similar for both graders (photos: kappa=0.58 vs 0.57, p=0.97; flicker: kappa=0.61 vs 0.70, p=0.37). When progression was assessed by the number of progressive quadrants identified by each grader using a weighted kappa statistic, flicker inter-observer agreement was still moderate (kappa=0.45) and significantly better (p=0.01) than photography, which showed poor agreement (kappa=0.15). Intra-observer agreement with a weighted kappa for quadrant progression was also similar for both graders (photos: grader 1 kappa=0.53 vs grader 2 kappa=0.52, p=0.92; flickers: grader 1 kappa=0.58 vs grader 2 kappa=0.69, p=0.22). Conclusion Flicker identified more cases of progressive PPA than photographic review. Agreement between observers was significantly higher when using the automated flicker technology.
Brian L VanderBeek; Scott D Smith; Nathan M Radcliffe
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie     Volume:  248     ISSN:  1435-702X     ISO Abbreviation:  Graefes Arch. Clin. Exp. Ophthalmol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-04     Completed Date:  2010-09-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8205248     Medline TA:  Graefes Arch Clin Exp Ophthalmol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1313-7     Citation Subset:  IM    
Department of Ophthalmology, Weill Cornell Medical College, Weill Greenberg Center, 1305 York Ave. at East 70th St., New York, NY 10021, USA.
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MeSH Terms
Diagnostic Techniques, Ophthalmological*
Disease Progression
Follow-Up Studies
Glaucoma / diagnosis*
Image Interpretation, Computer-Assisted / methods*
Observer Variation
Ocular Hypertension / diagnosis
Optic Atrophy / diagnosis*
Optic Disk / pathology*
Photography / methods*
Reproducibility of Results
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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