Refractive Surgery Evaluation and Risk for Corneal Ectasia, Inter-Rater Agreement, and Comparison With New Software: Score Analyzer

Cabot, Florence

Refractive Surgery Evaluation and Risk for Corneal Ectasia, Inter-Rater Agreement, and Comparison With New Software: Score Analyzer

Tuesday, April 29, 2014: 8:01 AM

Room 151A (Boston Convention and Exhibition Center)

Florence Cabot, MD, Bascom Palmer Eye Institute, Miami, Florida, USA

Alain Saad, MD, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France

George D. Kymionis, MD, PhD, University of Crete, Heraklion, Greece

Ana Paula Fraga Santini Canto, MD, Bascom Palmer Eye Institute, Curitiba, Parana, Brazil

Sonia H. Yoo, MD, Bascom Palmer Eye Institute, Miami, FL, USA

Damien Gatinel, MD, Fondation Rothschild, Paris, France

Narrative Responses:

Purpose
To assess the level of agreement between 5 refractive surgeons and a new software in detecting corneal ectasia risk during refractive surgery evaluation.

Methods
Three attending ophthalmologists subspecializing in refractive surgery and 2 cornea fellows reviewed 168 Orbscan (Bausch and Lomb, Rochester, NY) topographic quadmaps. They rated the maps and determined whether a refractive surgery (LASIK or PRK) was advisable or not. Topographic maps were divided in 3 different groups: LASIK or PRK (group 1), PRK only (group 2), no surgery (group 3). The same maps were also screened by a new corneal ectasia risk detection software combined with Orbscan: the SCORE analyzer (Technolas Perfect Vision). Multirater kappa statistics were used to assess innter-rater agreement.

Results
43.1% and 58.9% of topographic maps were classified in group 1; 37.1% and 2.9% in group 3 by cornea fellows. 75.6%, 46.2% and 55% of topographic maps were classified in group 1 ; 13.2%, 18.7% in group 3 by subspecialized attending ophthalmologists. 57.7% of topographic maps were classified in group 1 and 9.6% in group 3 by the SCORE analyzer. Inter-rater agreement was slight to fair compared with that expected by chance: the overall rate of agreement was 56% and the fixed marginal kappa coefficient was 0.24.

Conclusion
Using the SCORE analyzer as an objective assessment in determining the patient's candidacy for refractive surgery is valuable. Age,
refraction, symmetry between eyes and familiy history are other factors that may be incorporated into the SCORE analysis in the future to make the assessment more robust.