Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph

Gianmarco Vizzeri, Robert N. Weinreb, Jose M. Martinez de la Casa, Luciana M. Alencar, Christopher Bowd, Madhusudhanan Balasubramanian, Felipe A. Medeiros, Pamela Sample, Linda M. Zangwill

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: To assess the degree of concordance among clinicians reviewing 3 Heidelberg retina tomograph (HRT) printouts used to detect progression, the Moorfields regression analysis (MRA), the topographic change analysis (TCA), and trend analysis (TA), and to compare with progression identified by stereophotographs. Design: Observational cohort study. Participants: We longitudinally followed 237 eyes of 168 patients (50 glaucomatous eyes, 187 glaucoma suspects) from the Diagnostic Innovation in Glaucoma Study (mean follow-up, 46.8±14.2 months), with a minimum of 4 HRT images (range, 4-8). Methods: Three experienced observers judged the presence of progression using the HRT follow-up printouts available for each HRT method of analysis (MRA, TCA, TA). The overall assessment was based on majority rule, with ≥2 graders agreeing on the classification. Main Outcome Measures: Observers agreement in assessing HRT progression and agreement for progression or no progression between the HRT methods of analysis and the reference standard represented by masked stereophotograph assessment. The κ test was used to assess the interobserver agreement. Results: In general, agreement among clinicians for subjective assessment of progression based on HRT printouts was moderate to good; agreement (κ) ranged from 0.52 to 0.71 for MRA, 0.61 to 0.63 for TCA, and 0.45 to 0.74 for TA. Of the 237 eyes, 16 (6.8%) were found to progress during follow-up based on masked stereophotograph assessment. Agreement for progression/no progression between the HRT methods and stereophotography was similar among MRA (84.8%, agreement on 5 progressing eyes and 196 nonprogressing eyes; κ = 0.14), TCA, (82.3%, agreement on 8 progressing eyes and 187 nonprogressing eyes; κ = 0.2), and TA (84%, agreement on 2 progressing eyes and 197 nonprogressing eyes; κ = 0.01). Conclusions: Clinicians' agreement in identifying suspected glaucomatous progression using different HRT methods of analysis was moderate to good and was similar among all methods, including MRA, which is not designed to detect progression. Agreement between progression identified by HRT and masked stereophotograph assessment was poor. These results suggest that assessment of the HRT and stereophotography may be identifying different aspects of structural change. Financial Disclosure(s): Proprietary or commercial disclosures may be found after the references.

Original languageEnglish (US)
Pages (from-to)14-24
Number of pages11
JournalOphthalmology
Volume116
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Retina
Regression Analysis
Disclosure
Ocular Hypertension
Glaucoma
Observational Studies
Cohort Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Vizzeri, G., Weinreb, R. N., Martinez de la Casa, J. M., Alencar, L. M., Bowd, C., Balasubramanian, M., ... Zangwill, L. M. (2009). Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph. Ophthalmology, 116(1), 14-24. https://doi.org/10.1016/j.ophtha.2008.08.030

Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph. / Vizzeri, Gianmarco; Weinreb, Robert N.; Martinez de la Casa, Jose M.; Alencar, Luciana M.; Bowd, Christopher; Balasubramanian, Madhusudhanan; Medeiros, Felipe A.; Sample, Pamela; Zangwill, Linda M.

In: Ophthalmology, Vol. 116, No. 1, 01.2009, p. 14-24.

Research output: Contribution to journalArticle

Vizzeri, G, Weinreb, RN, Martinez de la Casa, JM, Alencar, LM, Bowd, C, Balasubramanian, M, Medeiros, FA, Sample, P & Zangwill, LM 2009, 'Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph', Ophthalmology, vol. 116, no. 1, pp. 14-24. https://doi.org/10.1016/j.ophtha.2008.08.030
Vizzeri G, Weinreb RN, Martinez de la Casa JM, Alencar LM, Bowd C, Balasubramanian M et al. Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph. Ophthalmology. 2009 Jan;116(1):14-24. https://doi.org/10.1016/j.ophtha.2008.08.030
Vizzeri, Gianmarco ; Weinreb, Robert N. ; Martinez de la Casa, Jose M. ; Alencar, Luciana M. ; Bowd, Christopher ; Balasubramanian, Madhusudhanan ; Medeiros, Felipe A. ; Sample, Pamela ; Zangwill, Linda M. / Clinicians Agreement in Establishing Glaucomatous Progression Using the Heidelberg Retina Tomograph. In: Ophthalmology. 2009 ; Vol. 116, No. 1. pp. 14-24.
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abstract = "Purpose: To assess the degree of concordance among clinicians reviewing 3 Heidelberg retina tomograph (HRT) printouts used to detect progression, the Moorfields regression analysis (MRA), the topographic change analysis (TCA), and trend analysis (TA), and to compare with progression identified by stereophotographs. Design: Observational cohort study. Participants: We longitudinally followed 237 eyes of 168 patients (50 glaucomatous eyes, 187 glaucoma suspects) from the Diagnostic Innovation in Glaucoma Study (mean follow-up, 46.8±14.2 months), with a minimum of 4 HRT images (range, 4-8). Methods: Three experienced observers judged the presence of progression using the HRT follow-up printouts available for each HRT method of analysis (MRA, TCA, TA). The overall assessment was based on majority rule, with ≥2 graders agreeing on the classification. Main Outcome Measures: Observers agreement in assessing HRT progression and agreement for progression or no progression between the HRT methods of analysis and the reference standard represented by masked stereophotograph assessment. The κ test was used to assess the interobserver agreement. Results: In general, agreement among clinicians for subjective assessment of progression based on HRT printouts was moderate to good; agreement (κ) ranged from 0.52 to 0.71 for MRA, 0.61 to 0.63 for TCA, and 0.45 to 0.74 for TA. Of the 237 eyes, 16 (6.8{\%}) were found to progress during follow-up based on masked stereophotograph assessment. Agreement for progression/no progression between the HRT methods and stereophotography was similar among MRA (84.8{\%}, agreement on 5 progressing eyes and 196 nonprogressing eyes; κ = 0.14), TCA, (82.3{\%}, agreement on 8 progressing eyes and 187 nonprogressing eyes; κ = 0.2), and TA (84{\%}, agreement on 2 progressing eyes and 197 nonprogressing eyes; κ = 0.01). Conclusions: Clinicians' agreement in identifying suspected glaucomatous progression using different HRT methods of analysis was moderate to good and was similar among all methods, including MRA, which is not designed to detect progression. Agreement between progression identified by HRT and masked stereophotograph assessment was poor. These results suggest that assessment of the HRT and stereophotography may be identifying different aspects of structural change. Financial Disclosure(s): Proprietary or commercial disclosures may be found after the references.",
author = "Gianmarco Vizzeri and Weinreb, {Robert N.} and {Martinez de la Casa}, {Jose M.} and Alencar, {Luciana M.} and Christopher Bowd and Madhusudhanan Balasubramanian and Medeiros, {Felipe A.} and Pamela Sample and Zangwill, {Linda M.}",
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AU - Vizzeri, Gianmarco

AU - Weinreb, Robert N.

AU - Martinez de la Casa, Jose M.

AU - Alencar, Luciana M.

AU - Bowd, Christopher

AU - Balasubramanian, Madhusudhanan

AU - Medeiros, Felipe A.

AU - Sample, Pamela

AU - Zangwill, Linda M.

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N2 - Purpose: To assess the degree of concordance among clinicians reviewing 3 Heidelberg retina tomograph (HRT) printouts used to detect progression, the Moorfields regression analysis (MRA), the topographic change analysis (TCA), and trend analysis (TA), and to compare with progression identified by stereophotographs. Design: Observational cohort study. Participants: We longitudinally followed 237 eyes of 168 patients (50 glaucomatous eyes, 187 glaucoma suspects) from the Diagnostic Innovation in Glaucoma Study (mean follow-up, 46.8±14.2 months), with a minimum of 4 HRT images (range, 4-8). Methods: Three experienced observers judged the presence of progression using the HRT follow-up printouts available for each HRT method of analysis (MRA, TCA, TA). The overall assessment was based on majority rule, with ≥2 graders agreeing on the classification. Main Outcome Measures: Observers agreement in assessing HRT progression and agreement for progression or no progression between the HRT methods of analysis and the reference standard represented by masked stereophotograph assessment. The κ test was used to assess the interobserver agreement. Results: In general, agreement among clinicians for subjective assessment of progression based on HRT printouts was moderate to good; agreement (κ) ranged from 0.52 to 0.71 for MRA, 0.61 to 0.63 for TCA, and 0.45 to 0.74 for TA. Of the 237 eyes, 16 (6.8%) were found to progress during follow-up based on masked stereophotograph assessment. Agreement for progression/no progression between the HRT methods and stereophotography was similar among MRA (84.8%, agreement on 5 progressing eyes and 196 nonprogressing eyes; κ = 0.14), TCA, (82.3%, agreement on 8 progressing eyes and 187 nonprogressing eyes; κ = 0.2), and TA (84%, agreement on 2 progressing eyes and 197 nonprogressing eyes; κ = 0.01). Conclusions: Clinicians' agreement in identifying suspected glaucomatous progression using different HRT methods of analysis was moderate to good and was similar among all methods, including MRA, which is not designed to detect progression. Agreement between progression identified by HRT and masked stereophotograph assessment was poor. These results suggest that assessment of the HRT and stereophotography may be identifying different aspects of structural change. Financial Disclosure(s): Proprietary or commercial disclosures may be found after the references.

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