title: Agreement of flicker chronoscopy for structural glaucomatous progression detection and factors associated with progression.
abstract: OBJECTIVE
  To evaluate agreement of flicker chronoscopy for structural glaucomatous progression detection and factors associated with progression.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two glaucoma fellowship-trained ophthalmologists, masked to temporal sequence, independently graded serial flicker chronoscopy images from 1 eye of a cohort of glaucoma patients for features of structural progression. Agreement between graders was determined, as was accuracy for determining the temporal order of images. After adjudication, simple and multiple logistic models were constructed to determine baseline variables associated with increased odds of progression.
  
  
  RESULTS
  Fifty of 103 included eyes/patients (48.5%) had at least 1 sign of structural progression. Temporal sequence was incorrectly determined in 14 of 206 cases (6.4%). Interobserver agreements for identifying baseline photographs (κ = 0.9), global progression (κ = 0.7), parapapillary atrophy (PPA) progression (κ = 0.7), disc hemorrhages (κ = 0.7), neuroretinal rim loss (κ = 0.5), and retinal nerve fiber layer (RNFL) loss (κ = 0.2) were calculated. Age was significantly associated with global (1.8; 1.3-2.6, P < .001) (odds ratio; 95% confidence interval, significance) and PPA progression (1.7; 1.2-2.4, P = .002). Lower corneal hysteresis was associated with global progression (0.78; 0.56-0.99, P = .049) and RNFL loss (0.5; 0.3-0.9, P = .02). Goldmann-correlated intraocular pressure (1.0, 0.7-1.4, P = .9), visual field mean deviation (1.0, 0.9-1.0, P = .2), and central corneal thickness (0.9, 0.8-1.0, P = .1) were not significantly associated with progression. On multivariable analysis, only age was associated with global progression (1.8; 1.2-2.5, P = .002).
  
  
  CONCLUSIONS
  Flicker chronoscopy demonstrated acceptable interobserver agreement in structural progression detection. Corneal hysteresis and age were both associated with progression, but age was the only significant factor on multivariable analysis.
authors: Department of Ophthalmology, Weill Cornell Medical College, New York, New York 10021, USA.
authors: Ru-Ik
authors: RI
authors: Chee
authors: Fabiana Q
authors: FQ
authors: Silva
authors: Joshua R
authors: JR
authors: Ehrlich
authors: Nathan M
authors: NM
authors: Radcliffe
mesh_terms: D000368:Aged; D003315:Cornea / Q000502:physiology; D003941:Diagnostic Techniques, Ophthalmological; D018450:Disease Progression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D015588:Observer Variation; D009798:Ocular Hypertension / Q000175:diagnosis; D009896:Optic Atrophy / Q000175:diagnosis; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D014794:Visual Fields