title: Agreement among spectral-domain optical coherence tomography, standard automated perimetry, and stereophotography in the detection of glaucoma progression.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the agreement among spectral-domain optical coherence tomography, standard automated perimetry (SAP), and optic disc stereo photography in the detection of glaucomatous progression.
  
  
  METHODS
  This was an observational cohort study enrolling 246 eyes (148 patients) followed for an average of 31.8 ± 9 months. Images were obtained every 6 to 12 months with optical coherence tomography (OCT), visual field test, and optic disc stereo photography. Progression was determined with OCT using guided progression analysis (GPA) software, in perimetry with Humphrey field analyzer GPA, and by masked assessment of stereo photograph series. Agreement among methods was reported using the κ coefficient, prevalence-adjusted bias-adjusted κ (PABAK), Gwet's first-order agreement coefficient (AC1), overall percentage agreement (OPA), percentage of positive agreement (Ppos), and percentage of negative agreement (Pneg).
  
  
  RESULTS
  Progression by stereo photos, SAP, and OCT was found in 17 eyes (6.9%), 37 eyes (15%), and 63 eyes (25.6%), respectively. Most cases with detectable changes were only identified by one examination method, resulting in low Ppos (<33%). On the contrary, 147 eyes (59.7%) were identified as nonprogressing cases by all three methods, showing high OPA (72.8-89.8) and high Pneg (83.8-94.5). PABAK and AC1 between methods reached 0.67 to 0.88. Measurements of agreement showed a trend toward better agreement between photos and visual field (VF) than between photos and OCT. Spectral-domain OCT parameters reflected a tendency toward better agreement with stereo photos than with VF.
  
  
  CONCLUSIONS
  Methods obtained acceptable agreement outcomes in terms of PABAK, AC1, and OPA. However, most cases with detectable changes were identified only by one examination method, resulting in low Ppos.
authors: Institut Oftalmòlògic Quirón Barcelona, Spain.
authors: Sebastián A
authors: SA
authors: Banegas
authors: Institut Català de Retina, Universidad Internacional de Cataluña, Parc Salut Mar, Barcelona, Spain.
authors: Alfonso
authors: A
authors: Antón
authors: Institut Català de Retina, Universidad Internacional de Cataluña, Parc Salut Mar, Barcelona, Spain.
authors: Antonio
authors: A
authors: Morilla-Grasa
authors: Institut Català de Retina, Universidad Internacional de Cataluña, Parc Salut Mar, Barcelona, Spain.
authors: Marco
authors: M
authors: Bogado
authors: Institut Català de Retina, Universidad Internacional de Cataluña, Parc Salut Mar, Barcelona, Spain.
authors: Eleonora M
authors: EM
authors: Ayala
authors: Clínica Universidad de Navarra, Pamplona, Spain.
authors: Javier
authors: J
authors: Moreno-Montañes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D010781:Photography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields / Q000502:physiology*
keywords: agreement; glaucoma; optical coherence tomography; progression