Clinician versus Reading Center Assessment of Cytomegalovirus Retinitis Lesion Size
Received 19 October 2004; accepted 8 November 2004. published online 11 February 2005.
Purpose
To compare clinician and fundus photograph reading center assessments of the cytomegalovirus (CMV) retinitis area and change in the CMV retinitis area over time, and to investigate how these assessments correlate with the visual field (VF) of eyes with CMV retinitis.
Design
Analysis of pooled data from 2 multicenter randomized clinical trials and 1 prospective multicenter epidemiologic study.
Participants
Ninety-five eyes of 79 patients. At baseline, each eye had CMV retinitis restricted to zone 1 and/or zone 2 (approximately the photographable postequatorial retina), as assessed by the evaluating clinician.
Methods
Comparison of CMV retinitis area, change in area over time as assessed by clinicians and a fundus photograph reading center, and correlation of these assessments with VF measurement.
Main Outcome Measures
Cytomegalovirus retinitis area, change in CMV retinitis area over time, and VF score.
Results
Baseline assessments of the mean retinitis area were, by clinicians, 12.8% of the total retinal area and, by the reading center, 6.3% of the total retinal area (P<0.001). There was a positive correlation between clinician and reading center assessments of retinitis area at baseline (ρ = 0.77 and P<0.0001 by Pearson correlation and ρ = 0.54 and P<0.001 by concordance). Both clinician and reading center size measures correlated negatively with VF (Spearman correlation ρs = −0.38 and −0.52, respectively; P<0.001 each). Mean changes in area over a 3-month interval were, by clinicians, +1.2% and, by the reading center, +1.1% (P = 0.68). Regression analysis showed a positive concordance (ρ = 0.42, P<0.001). Change in VF over a 3-month interval did not correlate with change in retinitis area as assessed by clinicians or the reading center.
Conclusions
Awareness of the similarities and differences between clinician and reading center assessments of CMV retinitis area should permit clinicians to apply research data to clinical practice more effectively. Clinician assessment of retinitis area correlates negatively with VF, a clinically meaningful visual outcome in patients with CMV retinitis.
1Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
3Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
4Departments of Ophthalmology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
5Jules Stein Eye Institute, University of California, Los Angeles, California
Correspondence to Janet T. Holbrook, PhD, Johns Hopkins University, Bloomberg School of Public Health, 615 North Wolfe Street, Room W5010, Baltimore, MD 21205
Manuscript no. 2004-204.
Supported by the National Eye Institute, Bethesda, Maryland (cooperative agreement nos.: U10 EY08052 [The Johns Hopkins University School of Medicine], U10 EY08057 [The Johns Hopkins University Bloomberg School of Public Health], and U10 EY08067 [University of Wisconsin, Madison]). Additional support was provided by the National Center for Research Resources, Bethesda, Maryland (General Clinical Research Center grant nos.: 5MO1 RR00188 [Baylor College of Medicine], MO1 RR00052 [Johns Hopkins University School of Medicine], 5MO1 RR05096 [Louisiana State University], 5MO1 RR00865 [University of California, Los Angeles], 5MO1 RR05280 [University of Miami], 5M01 RR00046 [University of North Carolina], 5MO1 RR00043 [University of Southern California], and 5MO1 RR00047 [Weill Medical College of Cornell University]). Dr Jabs is the recipient of a Research to Prevent Blindness (New York, New York) Senior Scientific Investigator Award.
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ABSTRACT