A Statistical Model to Analyze Clinician Expert Consensus on Glaucoma Progression using Spatially Correlated Visual Field Data

We developed a statistical model to improve the detection of glaucomatous visual field (VF) progression as defined by the consensus of expert clinicians

Scleral rupture during retinal detachment repair with primary scleral buckle and cryoretinopexy in a patient with microspherophakia

Purpose: The purpose of this report is to describe a case of a patient with microspherophakia (MSP) who had a scleral rupture during a retinal detachment (RD) repair with primary scleral buckle and cryoretinopexy. Observations: A 48-year-old woman with MSP presented with six days of expanding loss of vision and photopsias. Examination revealed a superior retinal detachment involving the macula associated with two superior retinal tears. The patient underwent successful placement of a segmental buckle. During cryoretinopexy treatment of the tears, a 4 mm full-thickness scleral rupture occurred. The sclera was immediately closed with interrupted 8-0 nylon sutures and reinforced with a processed pericardium allograft. Subsequent combined phacoemulsification with capsulectomy, zonulectomy, and pars plana vitrectomy with retinal reattachment was performed nine days post buckle placement. Conclusions and importance: This case illustrates that a patient with MSP, even observed in the absence of a genetic syndrome or familial condition, may be at increased risk of scleral rupture during RD repair. Though future investigations are necessary to confirm this association, surgeons should take a conservative approach by having a high clinical suspicion for compromised scleral integrity in patients with MSP and proceeding with caution in procedures that may pose a risk of scleral rupture. A pericardium allograft can be an effective adjunct for scleral rupture repair

A Statistical Model to Analyze Clinician Expert Consensus on Glaucoma Progression using Spatially Correlated Visual Field Data

PURPOSE: We developed a statistical model to improve the detection of glaucomatous visual field (VF) progression as defined by the consensus of expert clinicians. METHODS: We developed new methodology in the Bayesian setting to properly model the progression status of a patient (as determined by a group of expert clinicians) as a function of changes in spatially correlated sensitivities at each VF location jointly. We used a spatial probit regression model that jointly incorporates all highly correlated VF changes in a single framework while accounting for structural similarities between neighboring VF regions. RESULTS: Our method had improved model fit and predictive ability compared to competing models as indicated by the deviance information criterion (198.15 vs. 201.29–213.38), a posterior predictive model selection metric (130.08 vs. 142.08–155.59), area under the receiver operating characteristic curve (0.80 vs. 0.59–0.72; all P values < 0.018), and optimal sensitivity (0.92 vs. 0.28–0.82). Simulation study results suggest that estimation (reduction of mean squared errors) and inference (correct coverage of 95% credible intervals) for the model parameters are improved when spatial modeling is incorporated. CONCLUSIONS: We developed a statistical model for the detection of VF progression defined by clinician expert consensus that accounts for spatially correlated changes in visual sensitivity over time, and showed that it outperformed competing models in a number of areas. TRANSLATIONAL RELEVANCE: This model may easily be incorporated into routine clinical practice and be useful for detecting glaucomatous VF progression defined by clinician expert consensus

Interobserver Agreement and Intraobserver Reproducibility of the Subjective Determination of Glaucomatous Visual Field Progression

To determine the extent of interobserver agreement and intraobserver reproducibility of the subjective determination of visual field progression with achromatic automated static perimetry in eyes with glaucoma, and to determine the impact of access to Glaucoma Progression Analysis (GPA) data on interobserver agreement. Retrospective, observational case series. Five glaucoma subspecialists from 5 different academic medical centers. Five visual field tests from each of 100 eyes of 83 patients being monitored for glaucoma were retrospectively identified and subjectively and independently evaluated by the 5 glaucoma subspecialists. Each set of visual fields was classified regarding progression as “none,” “questionable,” “probable,” or “definite.” More than 1 month later, the same expert observers reevaluated the same sets of visual field tests to allow determination of intraobserver reproducibility. A final subjective evaluation regarding progression was performed 3 months later, at which time the expert observers had access to the GPA printout. The level of interobserver agreement and intraobserver reproducibility was estimated using kappa statistics on the raw classification data and also on dichotomized data in which “none” and “questionable” progression were reclassified together as nonprogressed and “ probable” and “definite” were reclassified as progressed. Intraobserver reproducibility was good to excellent (kappa = 0.62–0.78) for the raw data and moderate to good (kappa = 0.58–0.71) for the dichotomized data. Interobserver agreement was moderate (kappa = 0.45; 95% confidence interval [CI], 0.35–0.55) for the raw classification data and also for dichotomized data (kappa = 0.55; 95% CI, 0.46–0.64). Access to the GPA printout did not significantly change the level of interobserver agreement. Five glaucoma experts had good to excellent reproducibility of the determination of visual field progression compared with earlier evaluation of the same field sets. Agreement among the experts with each other was only moderate, and did not improve when each had access to GPA results. Proprietary or commercial disclosure may be found after the references

Glaucoma Progression Analysis Software Compared with Expert Consensus Opinion in the Detection of Visual Field Progression in Glaucoma

To compare the results of Glaucoma Progression Analysis (GPA, Carl Zeiss Meditec, Dublin, CA) to subjective expert consensus in the detection of glaucomatous visual field progression. Retrospective, observational case series. We included 100 eyes of 83 glaucoma patients. Five serial Humphrey visual fields from 100 eyes of 83 glaucoma patients were evaluated by 5 masked glaucoma subspecialists for determination of progression. Four months later, with a randomly reordered patient sequence, the same visual field series were reevaluated by the same graders, at which time they had access to the Glaucoma Progression Analysis (GPA) printout. The level of agreement between majority expert consensus and GPA, both before and after access to GPA data, was assessed using kappa statistics. On initial review and on reevaluation with access to the GPA printout, the level of agreement between majority expert consensus and GPA was fair (kappa = 0.52, 95% confidence interval [CI], 0.35–0.69 and kappa = 0.62; 95% CI, 0.46–0.78, respectively). Expert consensus was more likely to classify a series of fields as showing progression than was GPA (P≤0.002). There was good agreement between expert consensus on initial review and reevaluation 4 months later (kappa = 0.77; 95% CI, 0.65–0.90). The level of agreement between majority expert consensus of subjective determination of visual field progression and GPA is fair. In cases of disagreement with GPA, the expert consensus classification was usually progression. Access to the results of GPA did not significantly change the level of agreement between expert consensus and the GPA result; however, expert consensus did change in 11 of 100 cases. Proprietary or commercial disclosure may be found after the references

78 year old male with primary open angle glaucoma (POAG) with peripapillary retinoschisis.

<p>(1A) Optic nerve photograph shows glaucomatous optic neuropathy (1B) There is mild visual field damage with a mean deviation of -2.19 dB. (1C, 1D and 1E) Three horizontal OCT raster scans through three different sections of the optic nerve demonstrating peripapillary retinal splitting (retinoschisis) with adherent vitreous in the region of retinoschisis (yellow arrow), splitting in the nerve fiber layer (yellow star), and inner plexiform layer (white star) and outer plexiform layer with a likely outer nuclear layer component as well (white arrows). (1F) Circumpapillary retinal nerve fiber layer (RNFL) thickness map shows retinoschisis nasally within the RNFL segmentation (yellow star), causing a small area of artifactual thickening on the RNFL thickness profile.</p