Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial

Steven E. Feldon, Lori Levin, Roberta W. Scherer, Anthony Arnold, Sophia M. Chung, Lenworth N. Johnson, Gregory Kosmorsky, Steven A. Newman, Joanne Katz, Patricia Langenberg, P. David Wilson, Shalom E. Kelman, Kay Dickersin, John Kennerdell, Anna Bruchis, Dawn Govreau, John Holds, John Selhorst, Mark Malton, Amy Rogers & 118 others Timothy Saunders, Karen King, Tami Fecko, Deborah Ross, Kerry Zimmerman, Kathy Friedberg, Nahid Sadaati, Nancy J. Newman, Donna Loupe, Ted Wojno, Barry Skarf, Mark Croswell, Wendy Gilroy Clements, George Ponka, Rosa Tang, Melissa Hamlin, Jewel Curtis, Kirk Mack, Portia Tello, Janet Buckley, Robert Goldberg, Lynn Gordon, Howard Krauss, Robert Stalling, Wayne Cornblath, Barbara Michael, Gaye Baker, Coy Cobb, Sharon Turner, Brian Younge, Jacqueline Leavitt, Rebecca Nielsen, Barbara Eickhoff, James Garrity, Jacqueline Ladsten, Kathleen Lebarron, Thomas Link, Jay Rostvold, Karen Weber, Warren Felton, Tammy Anderson, George Sanborn, David Kaufman, Eric Eggenberger, Suzanne Bickert, Robert Granadier, Sandra Holliday, Thomas Moore, Deborah Friedman, Patricia Jones, Thomas Bersani, Jonathan Horton, Maeve Chang, Lou Anne Aber, Stuart Seiff, John Guy, Z. Suzanne Zam, Revonda Burke, James Goodwin, Allen Putterman, Robert Baker, Judy Beck, Michael Hanson, Toni Scoggins, Charlotte Frank, Rani Kalsi, Kakarla Chalam, Shirley Hackett, Kathleen Digre, Jolyn Erickson, Terrell Blackburn, Richard Anderson, Paul Langer, Paula Morris, Sandra Osborn, Bhupendra Patel, Sandra Staker, Judith Warner, Christine Evans, Carolyn Harrell, Helen Overstreet, James Scott, Lillian Tyler, John Linberg, Brian Ellis, Charlene Campbell, Gordon McGregor, Edward Cohn, Kristi Cummings, Patricia Manatrey, Sara Casey, Virginia Regan, David Roehr, Patricia Streasick, Michael Elman, Frank Hooper, Barbara Crawley, Cheryl Hiner, Lucy Howard, Olga Lurye, Janet Masiero, Robert McCarter, Sara Riedel, Michelle Sotos, Laureen Spioch, Joann Starr, Judy Urban, Mark Waring, Jie Zhu, Qi Zhu, Donald Everett, Marian Fisher, Phil Aitken, Roy Beck, Andrea LaCroix, Simmons Lessell, Reverend Kenneth MacLean, Stuart R. Seiff

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. Methods: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuroophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel® software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). Results: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. Conclusion: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting.

Original languageEnglish (US)
Article number34
JournalBMC Ophthalmology
Volume6
DOIs
StatePublished - Nov 20 2006

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Ischemic Optic Neuropathy
Expert Systems
Decompression
Visual Fields
Social Adjustment
Visual Acuity
Optic Nerve Diseases
Random Allocation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial. / Feldon, Steven E.; Levin, Lori; Scherer, Roberta W.; Arnold, Anthony; Chung, Sophia M.; Johnson, Lenworth N.; Kosmorsky, Gregory; Newman, Steven A.; Katz, Joanne; Langenberg, Patricia; Wilson, P. David; Kelman, Shalom E.; Dickersin, Kay; Kennerdell, John; Bruchis, Anna; Govreau, Dawn; Holds, John; Selhorst, John; Malton, Mark; Rogers, Amy; Saunders, Timothy; King, Karen; Fecko, Tami; Ross, Deborah; Zimmerman, Kerry; Friedberg, Kathy; Sadaati, Nahid; Newman, Nancy J.; Loupe, Donna; Wojno, Ted; Skarf, Barry; Croswell, Mark; Clements, Wendy Gilroy; Ponka, George; Tang, Rosa; Hamlin, Melissa; Curtis, Jewel; Mack, Kirk; Tello, Portia; Buckley, Janet; Goldberg, Robert; Gordon, Lynn; Krauss, Howard; Stalling, Robert; Cornblath, Wayne; Michael, Barbara; Baker, Gaye; Cobb, Coy; Turner, Sharon; Younge, Brian; Leavitt, Jacqueline; Nielsen, Rebecca; Eickhoff, Barbara; Garrity, James; Ladsten, Jacqueline; Lebarron, Kathleen; Link, Thomas; Rostvold, Jay; Weber, Karen; Felton, Warren; Anderson, Tammy; Sanborn, George; Kaufman, David; Eggenberger, Eric; Bickert, Suzanne; Granadier, Robert; Holliday, Sandra; Moore, Thomas; Friedman, Deborah; Jones, Patricia; Bersani, Thomas; Horton, Jonathan; Chang, Maeve; Aber, Lou Anne; Seiff, Stuart; Guy, John; Zam, Z. Suzanne; Burke, Revonda; Goodwin, James; Putterman, Allen; Baker, Robert; Beck, Judy; Hanson, Michael; Scoggins, Toni; Frank, Charlotte; Kalsi, Rani; Chalam, Kakarla; Hackett, Shirley; Digre, Kathleen; Erickson, Jolyn; Blackburn, Terrell; Anderson, Richard; Langer, Paul; Morris, Paula; Osborn, Sandra; Patel, Bhupendra; Staker, Sandra; Warner, Judith; Evans, Christine; Harrell, Carolyn; Overstreet, Helen; Scott, James; Tyler, Lillian; Linberg, John; Ellis, Brian; Campbell, Charlene; McGregor, Gordon; Cohn, Edward; Cummings, Kristi; Manatrey, Patricia; Casey, Sara; Regan, Virginia; Roehr, David; Streasick, Patricia; Elman, Michael; Hooper, Frank; Crawley, Barbara; Hiner, Cheryl; Howard, Lucy; Lurye, Olga; Masiero, Janet; McCarter, Robert; Riedel, Sara; Sotos, Michelle; Spioch, Laureen; Starr, Joann; Urban, Judy; Waring, Mark; Zhu, Jie; Zhu, Qi; Everett, Donald; Fisher, Marian; Aitken, Phil; Beck, Roy; LaCroix, Andrea; Lessell, Simmons; MacLean, Reverend Kenneth; Seiff, Stuart R.

In: BMC Ophthalmology, Vol. 6, 34, 20.11.2006.

Research output: Contribution to journalArticle

Feldon, SE, Levin, L, Scherer, RW, Arnold, A, Chung, SM, Johnson, LN, Kosmorsky, G, Newman, SA, Katz, J, Langenberg, P, Wilson, PD, Kelman, SE, Dickersin, K, Kennerdell, J, Bruchis, A, Govreau, D, Holds, J, Selhorst, J, Malton, M, Rogers, A, Saunders, T, King, K, Fecko, T, Ross, D, Zimmerman, K, Friedberg, K, Sadaati, N, Newman, NJ, Loupe, D, Wojno, T, Skarf, B, Croswell, M, Clements, WG, Ponka, G, Tang, R, Hamlin, M, Curtis, J, Mack, K, Tello, P, Buckley, J, Goldberg, R, Gordon, L, Krauss, H, Stalling, R, Cornblath, W, Michael, B, Baker, G, Cobb, C, Turner, S, Younge, B, Leavitt, J, Nielsen, R, Eickhoff, B, Garrity, J, Ladsten, J, Lebarron, K, Link, T, Rostvold, J, Weber, K, Felton, W, Anderson, T, Sanborn, G, Kaufman, D, Eggenberger, E, Bickert, S, Granadier, R, Holliday, S, Moore, T, Friedman, D, Jones, P, Bersani, T, Horton, J, Chang, M, Aber, LA, Seiff, S, Guy, J, Zam, ZS, Burke, R, Goodwin, J, Putterman, A, Baker, R, Beck, J, Hanson, M, Scoggins, T, Frank, C, Kalsi, R, Chalam, K, Hackett, S, Digre, K, Erickson, J, Blackburn, T, Anderson, R, Langer, P, Morris, P, Osborn, S, Patel, B, Staker, S, Warner, J, Evans, C, Harrell, C, Overstreet, H, Scott, J, Tyler, L, Linberg, J, Ellis, B, Campbell, C, McGregor, G, Cohn, E, Cummings, K, Manatrey, P, Casey, S, Regan, V, Roehr, D, Streasick, P, Elman, M, Hooper, F, Crawley, B, Hiner, C, Howard, L, Lurye, O, Masiero, J, McCarter, R, Riedel, S, Sotos, M, Spioch, L, Starr, J, Urban, J, Waring, M, Zhu, J, Zhu, Q, Everett, D, Fisher, M, Aitken, P, Beck, R, LaCroix, A, Lessell, S, MacLean, RK & Seiff, SR 2006, 'Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial', BMC Ophthalmology, vol. 6, 34. https://doi.org/10.1186/1471-2415-6-34
Feldon, Steven E. ; Levin, Lori ; Scherer, Roberta W. ; Arnold, Anthony ; Chung, Sophia M. ; Johnson, Lenworth N. ; Kosmorsky, Gregory ; Newman, Steven A. ; Katz, Joanne ; Langenberg, Patricia ; Wilson, P. David ; Kelman, Shalom E. ; Dickersin, Kay ; Kennerdell, John ; Bruchis, Anna ; Govreau, Dawn ; Holds, John ; Selhorst, John ; Malton, Mark ; Rogers, Amy ; Saunders, Timothy ; King, Karen ; Fecko, Tami ; Ross, Deborah ; Zimmerman, Kerry ; Friedberg, Kathy ; Sadaati, Nahid ; Newman, Nancy J. ; Loupe, Donna ; Wojno, Ted ; Skarf, Barry ; Croswell, Mark ; Clements, Wendy Gilroy ; Ponka, George ; Tang, Rosa ; Hamlin, Melissa ; Curtis, Jewel ; Mack, Kirk ; Tello, Portia ; Buckley, Janet ; Goldberg, Robert ; Gordon, Lynn ; Krauss, Howard ; Stalling, Robert ; Cornblath, Wayne ; Michael, Barbara ; Baker, Gaye ; Cobb, Coy ; Turner, Sharon ; Younge, Brian ; Leavitt, Jacqueline ; Nielsen, Rebecca ; Eickhoff, Barbara ; Garrity, James ; Ladsten, Jacqueline ; Lebarron, Kathleen ; Link, Thomas ; Rostvold, Jay ; Weber, Karen ; Felton, Warren ; Anderson, Tammy ; Sanborn, George ; Kaufman, David ; Eggenberger, Eric ; Bickert, Suzanne ; Granadier, Robert ; Holliday, Sandra ; Moore, Thomas ; Friedman, Deborah ; Jones, Patricia ; Bersani, Thomas ; Horton, Jonathan ; Chang, Maeve ; Aber, Lou Anne ; Seiff, Stuart ; Guy, John ; Zam, Z. Suzanne ; Burke, Revonda ; Goodwin, James ; Putterman, Allen ; Baker, Robert ; Beck, Judy ; Hanson, Michael ; Scoggins, Toni ; Frank, Charlotte ; Kalsi, Rani ; Chalam, Kakarla ; Hackett, Shirley ; Digre, Kathleen ; Erickson, Jolyn ; Blackburn, Terrell ; Anderson, Richard ; Langer, Paul ; Morris, Paula ; Osborn, Sandra ; Patel, Bhupendra ; Staker, Sandra ; Warner, Judith ; Evans, Christine ; Harrell, Carolyn ; Overstreet, Helen ; Scott, James ; Tyler, Lillian ; Linberg, John ; Ellis, Brian ; Campbell, Charlene ; McGregor, Gordon ; Cohn, Edward ; Cummings, Kristi ; Manatrey, Patricia ; Casey, Sara ; Regan, Virginia ; Roehr, David ; Streasick, Patricia ; Elman, Michael ; Hooper, Frank ; Crawley, Barbara ; Hiner, Cheryl ; Howard, Lucy ; Lurye, Olga ; Masiero, Janet ; McCarter, Robert ; Riedel, Sara ; Sotos, Michelle ; Spioch, Laureen ; Starr, Joann ; Urban, Judy ; Waring, Mark ; Zhu, Jie ; Zhu, Qi ; Everett, Donald ; Fisher, Marian ; Aitken, Phil ; Beck, Roy ; LaCroix, Andrea ; Lessell, Simmons ; MacLean, Reverend Kenneth ; Seiff, Stuart R. / Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial. In: BMC Ophthalmology. 2006 ; Vol. 6.
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title = "Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial",
abstract = "Background: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. Methods: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuroophthalmologists ({"}expert panel{"}) described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel{\circledR} software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). Results: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6{\%} (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. Conclusion: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting.",
author = "Feldon, {Steven E.} and Lori Levin and Scherer, {Roberta W.} and Anthony Arnold and Chung, {Sophia M.} and Johnson, {Lenworth N.} and Gregory Kosmorsky and Newman, {Steven A.} and Joanne Katz and Patricia Langenberg and Wilson, {P. David} and Kelman, {Shalom E.} and Kay Dickersin and John Kennerdell and Anna Bruchis and Dawn Govreau and John Holds and John Selhorst and Mark Malton and Amy Rogers and Timothy Saunders and Karen King and Tami Fecko and Deborah Ross and Kerry Zimmerman and Kathy Friedberg and Nahid Sadaati and Newman, {Nancy J.} and Donna Loupe and Ted Wojno and Barry Skarf and Mark Croswell and Clements, {Wendy Gilroy} and George Ponka and Rosa Tang and Melissa Hamlin and Jewel Curtis and Kirk Mack and Portia Tello and Janet Buckley and Robert Goldberg and Lynn Gordon and Howard Krauss and Robert Stalling and Wayne Cornblath and Barbara Michael and Gaye Baker and Coy Cobb and Sharon Turner and Brian Younge and Jacqueline Leavitt and Rebecca Nielsen and Barbara Eickhoff and James Garrity and Jacqueline Ladsten and Kathleen Lebarron and Thomas Link and Jay Rostvold and Karen Weber and Warren Felton and Tammy Anderson and George Sanborn and David Kaufman and Eric Eggenberger and Suzanne Bickert and Robert Granadier and Sandra Holliday and Thomas Moore and Deborah Friedman and Patricia Jones and Thomas Bersani and Jonathan Horton and Maeve Chang and Aber, {Lou Anne} and Stuart Seiff and John Guy and Zam, {Z. Suzanne} and Revonda Burke and James Goodwin and Allen Putterman and Robert Baker and Judy Beck and Michael Hanson and Toni Scoggins and Charlotte Frank and Rani Kalsi and Kakarla Chalam and Shirley Hackett and Kathleen Digre and Jolyn Erickson and Terrell Blackburn and Richard Anderson and Paul Langer and Paula Morris and Sandra Osborn and Bhupendra Patel and Sandra Staker and Judith Warner and Christine Evans and Carolyn Harrell and Helen Overstreet and James Scott and Lillian Tyler and John Linberg and Brian Ellis and Charlene Campbell and Gordon McGregor and Edward Cohn and Kristi Cummings and Patricia Manatrey and Sara Casey and Virginia Regan and David Roehr and Patricia Streasick and Michael Elman and Frank Hooper and Barbara Crawley and Cheryl Hiner and Lucy Howard and Olga Lurye and Janet Masiero and Robert McCarter and Sara Riedel and Michelle Sotos and Laureen Spioch and Joann Starr and Judy Urban and Mark Waring and Jie Zhu and Qi Zhu and Donald Everett and Marian Fisher and Phil Aitken and Roy Beck and Andrea LaCroix and Simmons Lessell and MacLean, {Reverend Kenneth} and Seiff, {Stuart R.}",
year = "2006",
month = "11",
day = "20",
doi = "10.1186/1471-2415-6-34",
language = "English (US)",
volume = "6",
journal = "BMC Ophthalmology",
issn = "1471-2415",
publisher = "BioMed Central",

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TY - JOUR

T1 - Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial

AU - Feldon, Steven E.

AU - Levin, Lori

AU - Scherer, Roberta W.

AU - Arnold, Anthony

AU - Chung, Sophia M.

AU - Johnson, Lenworth N.

AU - Kosmorsky, Gregory

AU - Newman, Steven A.

AU - Katz, Joanne

AU - Langenberg, Patricia

AU - Wilson, P. David

AU - Kelman, Shalom E.

AU - Dickersin, Kay

AU - Kennerdell, John

AU - Bruchis, Anna

AU - Govreau, Dawn

AU - Holds, John

AU - Selhorst, John

AU - Malton, Mark

AU - Rogers, Amy

AU - Saunders, Timothy

AU - King, Karen

AU - Fecko, Tami

AU - Ross, Deborah

AU - Zimmerman, Kerry

AU - Friedberg, Kathy

AU - Sadaati, Nahid

AU - Newman, Nancy J.

AU - Loupe, Donna

AU - Wojno, Ted

AU - Skarf, Barry

AU - Croswell, Mark

AU - Clements, Wendy Gilroy

AU - Ponka, George

AU - Tang, Rosa

AU - Hamlin, Melissa

AU - Curtis, Jewel

AU - Mack, Kirk

AU - Tello, Portia

AU - Buckley, Janet

AU - Goldberg, Robert

AU - Gordon, Lynn

AU - Krauss, Howard

AU - Stalling, Robert

AU - Cornblath, Wayne

AU - Michael, Barbara

AU - Baker, Gaye

AU - Cobb, Coy

AU - Turner, Sharon

AU - Younge, Brian

AU - Leavitt, Jacqueline

AU - Nielsen, Rebecca

AU - Eickhoff, Barbara

AU - Garrity, James

AU - Ladsten, Jacqueline

AU - Lebarron, Kathleen

AU - Link, Thomas

AU - Rostvold, Jay

AU - Weber, Karen

AU - Felton, Warren

AU - Anderson, Tammy

AU - Sanborn, George

AU - Kaufman, David

AU - Eggenberger, Eric

AU - Bickert, Suzanne

AU - Granadier, Robert

AU - Holliday, Sandra

AU - Moore, Thomas

AU - Friedman, Deborah

AU - Jones, Patricia

AU - Bersani, Thomas

AU - Horton, Jonathan

AU - Chang, Maeve

AU - Aber, Lou Anne

AU - Seiff, Stuart

AU - Guy, John

AU - Zam, Z. Suzanne

AU - Burke, Revonda

AU - Goodwin, James

AU - Putterman, Allen

AU - Baker, Robert

AU - Beck, Judy

AU - Hanson, Michael

AU - Scoggins, Toni

AU - Frank, Charlotte

AU - Kalsi, Rani

AU - Chalam, Kakarla

AU - Hackett, Shirley

AU - Digre, Kathleen

AU - Erickson, Jolyn

AU - Blackburn, Terrell

AU - Anderson, Richard

AU - Langer, Paul

AU - Morris, Paula

AU - Osborn, Sandra

AU - Patel, Bhupendra

AU - Staker, Sandra

AU - Warner, Judith

AU - Evans, Christine

AU - Harrell, Carolyn

AU - Overstreet, Helen

AU - Scott, James

AU - Tyler, Lillian

AU - Linberg, John

AU - Ellis, Brian

AU - Campbell, Charlene

AU - McGregor, Gordon

AU - Cohn, Edward

AU - Cummings, Kristi

AU - Manatrey, Patricia

AU - Casey, Sara

AU - Regan, Virginia

AU - Roehr, David

AU - Streasick, Patricia

AU - Elman, Michael

AU - Hooper, Frank

AU - Crawley, Barbara

AU - Hiner, Cheryl

AU - Howard, Lucy

AU - Lurye, Olga

AU - Masiero, Janet

AU - McCarter, Robert

AU - Riedel, Sara

AU - Sotos, Michelle

AU - Spioch, Laureen

AU - Starr, Joann

AU - Urban, Judy

AU - Waring, Mark

AU - Zhu, Jie

AU - Zhu, Qi

AU - Everett, Donald

AU - Fisher, Marian

AU - Aitken, Phil

AU - Beck, Roy

AU - LaCroix, Andrea

AU - Lessell, Simmons

AU - MacLean, Reverend Kenneth

AU - Seiff, Stuart R.

PY - 2006/11/20

Y1 - 2006/11/20

N2 - Background: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. Methods: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuroophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel® software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). Results: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. Conclusion: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting.

AB - Background: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. Methods: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuroophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel® software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). Results: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. Conclusion: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting.

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U2 - 10.1186/1471-2415-6-34

DO - 10.1186/1471-2415-6-34

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