Abstract
Background A number of orbital diseases may be evaluated based on the degree of exophthalmos, but there is still no gold standard method for the measurement of this parameter. In this study we compare two exophthalmometry measurement methods (digital photography and clinical) with regard to reproducibility and the level of correlation and agreement with measurements obtained with Computerized Tomography (CT) measurements. Methods Seventeen patients with bilateral proptosis and 15 patients with normal orbits diseases were enrolled. Patients underwent orbital CT, Hertel exophthalmometry (HE) and standardized frontal and side facial photographs by a single trained photographer. Exophthalmometry measurements with HE, the digital photographs and axial CT scans were obtained twice by the same examiner and once by another examiner. Pearson correlation coefficient (PCC) was used to assess correlations between methods. Validity between methods was assessed by mean differences, interintraclass correlation coefficients (ICC's), and Bland–Altman plots. Results Mean values were significantly higher in the proptosis group (34 orbits) than in the normal group (30 orbits), regardless of the method. Within each group, mean digital exophthalmometry measurements (24.32 ± 5.17 mm and 18.62 ± 3.87 mm) were significantly greater than HE measurements (20.87 ± 2.53 mm and 17.52 ± 2.67 mm) with broader range of standard deviation. Inter-/intraclass correlation coefficients were 0.95/0.93 for clinical, 0.92/0.74 for digital, and 0.91/0.95 for CT measurements. Correlation coefficients between HE and CT scan measurements in both groups of subjects (r = 0.84 and r = 0.91, p < 0.05) were greater than those between digital and CT scan measurements (r = 0.61 and r = 0.75, p < 0.05). On the Bland–Altman plots, HE showed better agreement to CT measurements compared to the digital photograph method in both groups studied. Conclusions Although photographic digital exophthalmometry showed strong correlation and agreement with CT scan measurements, it still performs worse than and is not as accurate as clinical Hertel exophthalmometry. This trail is registered with NCT01999790.
Highlights
A number of orbital diseases may be evaluated based on the degree of exophthalmos, but there is still no gold standard method for the measurement of this parameter
Photographic techniques have been used to evaluate palpebral position, [9, 10] but to our knowledge, only one previous study has compared the methods of photography, clinical exophthalmometry, and Computerized Tomography (CT) in the measurement of exophthalmos. e authors found the correlation between the methods to be weak, possibly due to the fact that the study was multicentric and involved different photographers and evaluators, compromising reliability and reproducibility [8]
Pearson correlations coefficient was used to evaluate the association between the different modalities, while the agreement between clinical and digital to radiological exophthalmometry was assessed with Bland–Altman plots. e level of statistical significance was set at 5% (p < 0.05)
Summary
Exophthalmometry is the assessment of the anteroposterior position of the globe in the orbit relative to the orbital rim. Photographic techniques have been used to evaluate palpebral position, [9, 10] but to our knowledge, only one previous study has compared the methods of photography, clinical exophthalmometry, and CT in the measurement of exophthalmos. E data generated with the three methods of exophthalmometry (clinical, radiological, and digital) in both groups (normal and proptosis) were compared with paired t tests. Pearson correlations coefficient was used to evaluate the association between the different modalities, while the agreement between clinical and digital to radiological exophthalmometry was assessed with Bland–Altman plots. Clinical measurements showed better agreement to CT especially in the normal orbits group (Figure 3)
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