Influência da campimetria computadorizada, da tomografia de coerência óptica, ou ambas, no diagnóstico do glaucoma por oftalmologistas não especialistas em glaucoma

• Autor(a) principal: Franco, Cláudia Gomide Vilela de Sousa
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/9178
• topic: Glaucoma; Tomografia de coerência óptica; Testes de campo visual; Disco óptico; Variações dependentes de observador; Optical coherence tomography; Visual field tests; Optic disk; Observer variation; CIENCIAS DA SAUDE::MEDICINA

The aim of this study was to assess and compare the influence of Visual Field (VF) and/or Optical Coherence Tomography (OCT) when analyzed in association with Color Retinography (CR) to differentiate glaucomatous patients from those with increased physiological cupping, by non-glaucoma specialists. Eighty patients were selected, half with glaucoma and half with physiological cupping. The patients were randomized into 4 groups according to the exam performed on their right eye, which would be shown through Power Point slides to 20 non-specialist ophthalmologists: GI (CR), GII (CR + VF), GIII (CR + OCT), GIV (CR + VF + OCT). The ophthalmologists completed a questionnaire in which they checked whether or not the patient was glaucomatous, without direct examination of the patient. Inter-rater agreement determined by Kappa test was good for GII (k: 0.63; 95% CI,0.53-0.72), moderate for GIII (k:0.58; 95% CI,0.48-0.68) and for GIV (k: 0.41; 95% CI,0.31-0.51) and low for GI (k:0.30; 95% CI,0.20-0.39), the difference among groups being statistically significant (p<0.001). Statistically significant difference was found regarding correct diagnoses among groups, GIII being higher (15.8 ± 1.82) in comparison with GI (12.95 ± 1.46), (p<0.001); and higher for GII (16.25 ± 2.02) when compared to GI and GIV (14.10 ± 2.24), for both p<0.001. We found higher values for GII and GIII (p<0.001) regarding correct diagnoses of slides with glaucomatous patients single-handedly. Sensitivity and Specificity for each group were respectively: GI (59% and 70.5%); GII (86.5% and 76%); GIII (86.5% and 71.5%); GIV (68.5% and 72.5%). Accuracy was higher for GII 81.3% (95% CI,77.1-84.8), followed by GIII 79% (95% CI,74.7-82.7), GIV 70,5% (95% CI,65.9-74.8) and lower for GI 64.8% (95% CI, 60.0-69.3). We concluded that isolated assessment of CR by non-glaucoma specialists failed to properly differentiate glaucomatous patients from those with increased physiological cupping. We detected a significant increase in diagnostic accuracy and inter-rater agreement when either VF or OCT is employed. Increase for Sensitivity and Specificity was not detected for both.