视乳头结构即时测量新法——+78D前置镜合并目镜刻度尺法

New Agreement in Assessing Vertical Cup: Disc Ratio Using a 78D Lens with Slit-lamp Eyepiece Measuring Graticule

目的:探讨+78D前置镜合并目镜刻度尺测量法作为新的视乳头结构即时测量方法的测量一致性,并和直接眼底镜进行测量一致性比较。方法:两名检查者分别使用直接检眼镜和+78D前置镜合并目镜刻度尺法对所有受检眼(477眼)测量视神经垂直杯盘比比值,计算仪器间的测量可重复性。对前100只眼,两名测量者均采用+78D前置镜合并目镜刻度尺法测量垂直杯盘比、视盘直径和视杯直径,均采用直接检眼镜测量垂直杯盘比,计算同一测量仪器的检查者间可重复性。结果:本研究受检者有257名(477眼)。两名检查者利用+78D前置镜合并目镜刻度尺法测量视盘直径、视杯直径和垂直杯盘比得出95%一致性区间分别为-4.3～+4.5、-7.2～+6.2和-2.2～+2.8,没有成比例偏倚,而直接检眼镜的95%一致性区间为-0.33～+0.38。两种测量方法进行比较发现直接眼底镜倾向于高估垂直杯盘比值,没有成比例偏倚。结论:+78D前置镜合并目镜刻度尺测量垂直杯盘比的检查者间一致性测量结果较好,测量值变异比直接检眼镜小,并且直接眼底镜倾向于高估垂直杯盘比值。建议+78D前置镜合并目镜刻度尺用于临床检查即时判断以及基层和社区青光眼筛查。

Aim： To determine the inter-observer agreement in assessing vertical cup： disc ratio （VCDR） by using 78D lens with slit-lamp eyepiece measuring graticule （SLMP） and direct ophthalmoscope with standard photo （DOSP）. Methods： Four hundred and seventy-seven eyes of 257 subjects form one random selected community districts were examined. Two observers performed clinical estimations of VCDR. The cup to disc ratio （CDR） was assessed by slit-lamp biomicroscopy using a 78D lens and measuring eyepiece graticule （SLMP） and also by direct ophthalmoscope with standard photo （DOSP）. Results： The 95% limits of agreement on VCDR between observers was -2.2-＋2.8 for SLMG, and -3.3-＋3.8 for DOSP. DOSP method consistently overestimates the VCDR compared with the SLMG. The inter-observer agreements on disc and cup diameter estimation using SLMP were -4.3 -＋4.5, -7.2 -＋6.2 units respectively. The bias was not proportional to VCDR level. Conclusion： 78D lens with slit-lamp eyepiece measuring graticule has a smaller interobserver variability compared with direct ophthalmoscope with standard photo. This method is a more repeatable and cost-effective method of optic disc estimation in clinical and screening assessment. Eye Science 2007;23：53-57.