Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) study

John C. Ervin, Hans G. Lemij, Richard P. Mills, Harry A Quigley, Hilary W. Thompson, Claude F. Burgoyne

Research output: Contribution to journalArticle

Abstract

Purpose: To compare optic nerve head (ONH) surface change detection by confocal scanning laser tomography (CSLT) within the LSU Experimental Glaucoma (LEG) study to expert clinicians viewing the LEG stereophotographs. Design: Experimental study. Participants: Four fellowship-trained glaucoma specialists. Methods: In the LEG study, six 15° CSLT images (TopSS, Laser Diagnostics Technologies, San Diego, CA) and four 2× optic disc stereophotographs were obtained from both eyes of 12 monkeys on 3 separate days and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. ONH surface change detection within the CSLT images is described in our companion report. In this report, the preliminary study compared change detection by the CSLT multivariate strategy with that of a single clinician viewing stereophotograph pairs on three separate occasions as the "gold standard." The main study compared change detection by three additional clinicians viewing a subset of LEG stereophotograph pairs on three separate occasions with that of the CSLT multivariate strategy as the "gold standard." Clinician change detection was assessed for partial (two of three occasions) or complete (three of three occasions) agreement. Three comparison groups within the main study are emphasized: 44 group A comparisons assessed false-positive change detection (specificity); 38 group B comparisons assessed change detection within 38 instances (11 onset and 27 progression events) of CSLT-detected study eye change; and 30 group C comparisons assessed change detection within 30 instances in which the CSLT failed to detect change in study eyes. Main Outcome Measures: Clinician change detection within each comparison with either partial or complete agreement. Results: Within the main study, intrareading (-.29 to 0.67) and interreading (0.24-0.56) session agreement for each clinician was slight to moderate by kappa test. Good specificity (less than 10% false-positive change detection) was achieved within the 44 group A comparisons by two of the three clinicians, but only when the more stringent criterion (change detection on three of three occasions) was applied. Of the 38 group B comparisons (in which the CSLT detected change), the two clinicians who achieved good specificity in group A failed to detect change in 25 and 16 instances, respectively, using the more stringent (three of three) criterion. Similarly, of the 30 group C comparisons (in which the CSLT failed to detect change), these two clinicians detected change in three and seven instances, respectively, but in only one comparison did they both detect change. Conclusions: This study provides the first direct evidence that an existing CSLT may reasonably meet or exceed the ONH surface change detection performance of fellowship-trained glaucoma specialists in at least those eyes with good CSLT reproducibility.

Original languageEnglish (US)
Pages (from-to)467-481
Number of pages15
JournalOphthalmology
Volume109
Issue number3
DOIs
StatePublished - 2002

Fingerprint

Glaucoma
Lasers
Tomography
Optic Disk
Intraocular Pressure
Haplorhini
Research Design
Outcome Assessment (Health Care)
Technology

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) study. / Ervin, John C.; Lemij, Hans G.; Mills, Richard P.; Quigley, Harry A; Thompson, Hilary W.; Burgoyne, Claude F.

In: Ophthalmology, Vol. 109, No. 3, 2002, p. 467-481.

Research output: Contribution to journalArticle

Ervin, John C. ; Lemij, Hans G. ; Mills, Richard P. ; Quigley, Harry A ; Thompson, Hilary W. ; Burgoyne, Claude F. / Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) study. In: Ophthalmology. 2002 ; Vol. 109, No. 3. pp. 467-481.
@article{6f50af43f277489dadb3af8aaa6a7fb3,
title = "Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) study",
abstract = "Purpose: To compare optic nerve head (ONH) surface change detection by confocal scanning laser tomography (CSLT) within the LSU Experimental Glaucoma (LEG) study to expert clinicians viewing the LEG stereophotographs. Design: Experimental study. Participants: Four fellowship-trained glaucoma specialists. Methods: In the LEG study, six 15° CSLT images (TopSS, Laser Diagnostics Technologies, San Diego, CA) and four 2× optic disc stereophotographs were obtained from both eyes of 12 monkeys on 3 separate days and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. ONH surface change detection within the CSLT images is described in our companion report. In this report, the preliminary study compared change detection by the CSLT multivariate strategy with that of a single clinician viewing stereophotograph pairs on three separate occasions as the {"}gold standard.{"} The main study compared change detection by three additional clinicians viewing a subset of LEG stereophotograph pairs on three separate occasions with that of the CSLT multivariate strategy as the {"}gold standard.{"} Clinician change detection was assessed for partial (two of three occasions) or complete (three of three occasions) agreement. Three comparison groups within the main study are emphasized: 44 group A comparisons assessed false-positive change detection (specificity); 38 group B comparisons assessed change detection within 38 instances (11 onset and 27 progression events) of CSLT-detected study eye change; and 30 group C comparisons assessed change detection within 30 instances in which the CSLT failed to detect change in study eyes. Main Outcome Measures: Clinician change detection within each comparison with either partial or complete agreement. Results: Within the main study, intrareading (-.29 to 0.67) and interreading (0.24-0.56) session agreement for each clinician was slight to moderate by kappa test. Good specificity (less than 10{\%} false-positive change detection) was achieved within the 44 group A comparisons by two of the three clinicians, but only when the more stringent criterion (change detection on three of three occasions) was applied. Of the 38 group B comparisons (in which the CSLT detected change), the two clinicians who achieved good specificity in group A failed to detect change in 25 and 16 instances, respectively, using the more stringent (three of three) criterion. Similarly, of the 30 group C comparisons (in which the CSLT failed to detect change), these two clinicians detected change in three and seven instances, respectively, but in only one comparison did they both detect change. Conclusions: This study provides the first direct evidence that an existing CSLT may reasonably meet or exceed the ONH surface change detection performance of fellowship-trained glaucoma specialists in at least those eyes with good CSLT reproducibility.",
author = "Ervin, {John C.} and Lemij, {Hans G.} and Mills, {Richard P.} and Quigley, {Harry A} and Thompson, {Hilary W.} and Burgoyne, {Claude F.}",
year = "2002",
doi = "10.1016/S0161-6420(01)01004-1",
language = "English (US)",
volume = "109",
pages = "467--481",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Clinician change detection viewing longitudinal stereophotographs compared to confocal scanning laser tomography in the LSU Experimental Glaucoma (LEG) study

AU - Ervin, John C.

AU - Lemij, Hans G.

AU - Mills, Richard P.

AU - Quigley, Harry A

AU - Thompson, Hilary W.

AU - Burgoyne, Claude F.

PY - 2002

Y1 - 2002

N2 - Purpose: To compare optic nerve head (ONH) surface change detection by confocal scanning laser tomography (CSLT) within the LSU Experimental Glaucoma (LEG) study to expert clinicians viewing the LEG stereophotographs. Design: Experimental study. Participants: Four fellowship-trained glaucoma specialists. Methods: In the LEG study, six 15° CSLT images (TopSS, Laser Diagnostics Technologies, San Diego, CA) and four 2× optic disc stereophotographs were obtained from both eyes of 12 monkeys on 3 separate days and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. ONH surface change detection within the CSLT images is described in our companion report. In this report, the preliminary study compared change detection by the CSLT multivariate strategy with that of a single clinician viewing stereophotograph pairs on three separate occasions as the "gold standard." The main study compared change detection by three additional clinicians viewing a subset of LEG stereophotograph pairs on three separate occasions with that of the CSLT multivariate strategy as the "gold standard." Clinician change detection was assessed for partial (two of three occasions) or complete (three of three occasions) agreement. Three comparison groups within the main study are emphasized: 44 group A comparisons assessed false-positive change detection (specificity); 38 group B comparisons assessed change detection within 38 instances (11 onset and 27 progression events) of CSLT-detected study eye change; and 30 group C comparisons assessed change detection within 30 instances in which the CSLT failed to detect change in study eyes. Main Outcome Measures: Clinician change detection within each comparison with either partial or complete agreement. Results: Within the main study, intrareading (-.29 to 0.67) and interreading (0.24-0.56) session agreement for each clinician was slight to moderate by kappa test. Good specificity (less than 10% false-positive change detection) was achieved within the 44 group A comparisons by two of the three clinicians, but only when the more stringent criterion (change detection on three of three occasions) was applied. Of the 38 group B comparisons (in which the CSLT detected change), the two clinicians who achieved good specificity in group A failed to detect change in 25 and 16 instances, respectively, using the more stringent (three of three) criterion. Similarly, of the 30 group C comparisons (in which the CSLT failed to detect change), these two clinicians detected change in three and seven instances, respectively, but in only one comparison did they both detect change. Conclusions: This study provides the first direct evidence that an existing CSLT may reasonably meet or exceed the ONH surface change detection performance of fellowship-trained glaucoma specialists in at least those eyes with good CSLT reproducibility.

AB - Purpose: To compare optic nerve head (ONH) surface change detection by confocal scanning laser tomography (CSLT) within the LSU Experimental Glaucoma (LEG) study to expert clinicians viewing the LEG stereophotographs. Design: Experimental study. Participants: Four fellowship-trained glaucoma specialists. Methods: In the LEG study, six 15° CSLT images (TopSS, Laser Diagnostics Technologies, San Diego, CA) and four 2× optic disc stereophotographs were obtained from both eyes of 12 monkeys on 3 separate days and then every 2 weeks after laser to one eye (study eye) to elevate intraocular pressure. ONH surface change detection within the CSLT images is described in our companion report. In this report, the preliminary study compared change detection by the CSLT multivariate strategy with that of a single clinician viewing stereophotograph pairs on three separate occasions as the "gold standard." The main study compared change detection by three additional clinicians viewing a subset of LEG stereophotograph pairs on three separate occasions with that of the CSLT multivariate strategy as the "gold standard." Clinician change detection was assessed for partial (two of three occasions) or complete (three of three occasions) agreement. Three comparison groups within the main study are emphasized: 44 group A comparisons assessed false-positive change detection (specificity); 38 group B comparisons assessed change detection within 38 instances (11 onset and 27 progression events) of CSLT-detected study eye change; and 30 group C comparisons assessed change detection within 30 instances in which the CSLT failed to detect change in study eyes. Main Outcome Measures: Clinician change detection within each comparison with either partial or complete agreement. Results: Within the main study, intrareading (-.29 to 0.67) and interreading (0.24-0.56) session agreement for each clinician was slight to moderate by kappa test. Good specificity (less than 10% false-positive change detection) was achieved within the 44 group A comparisons by two of the three clinicians, but only when the more stringent criterion (change detection on three of three occasions) was applied. Of the 38 group B comparisons (in which the CSLT detected change), the two clinicians who achieved good specificity in group A failed to detect change in 25 and 16 instances, respectively, using the more stringent (three of three) criterion. Similarly, of the 30 group C comparisons (in which the CSLT failed to detect change), these two clinicians detected change in three and seven instances, respectively, but in only one comparison did they both detect change. Conclusions: This study provides the first direct evidence that an existing CSLT may reasonably meet or exceed the ONH surface change detection performance of fellowship-trained glaucoma specialists in at least those eyes with good CSLT reproducibility.

UR - http://www.scopus.com/inward/record.url?scp=0036191018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036191018&partnerID=8YFLogxK

U2 - 10.1016/S0161-6420(01)01004-1

DO - 10.1016/S0161-6420(01)01004-1

M3 - Article

C2 - 11874747

AN - SCOPUS:0036191018

VL - 109

SP - 467

EP - 481

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 3

ER -