Influência da campimetria computadorizada, da tomografia de coerência óptica, ou ambas, no diagnóstico do glaucoma por oftalmologistas não especialistas em glaucoma
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2018-11-19
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Universidade Federal de Goiás
Resumo
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.
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Citação
FRANCO, Cláudia Gomide Vilela de Sousa. Influência da campimetria computadorizada, da tomografia de coerência óptica, ou ambas, no diagnóstico do glaucoma por oftalmologistas não especialistas em glaucoma. 2018. 65 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2018.