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Abstract #45773 Published in IGR 13-2
Agreement and accuracy of non-expert ophthalmologists in assessing glaucomatous changes in serial stereo optic disc photographs
Breusegem C; Fieuws S; Stalmans I; Zeyen TOphthalmology 2011; 118: 742-746
See also comment(s) by Kouros Nouri-Mahdavi •
Purpose: To compare the interobserver agreement in detecting glaucomatous optic disc changes using serial stereophotography between a large group of non-expert ophthalmologists and glaucoma specialists; to assess the accuracy of non-experts; to investigate whether the interobserver agreement and the accuracy of non-experts changed after a training session. Design: Masked interobserver agreement study. Participants: Serial optic disc stereophotos from 40 patients with glaucoma. Methods: Three independent experienced glaucoma specialists (readers of the European Glaucoma Prevention Study) evaluated a set of 2 serial optic disc color stereo-slides for glaucomatous change, obtained with a delay varying from 2 to 7 years of 40 patients, masked from the temporal sequence of the slides. Each patient was graded as changed or stable by agreement of 2 of 3 of the experts (the reference standard). Thirty-seven non-expert ophthalmologists independently evaluated the same set of serial optic disc stereo-slides twice, with the second evaluation on the same day, masked from the results of the previous evaluation, after a training session on a separate slide set. Main Outcome Measures: Interobserver agreement of non-experts and experts in detecting glaucomatous optic disc changes (expressed as kappa coefficient); agreement of non-experts with the reference standard (accuracy) before and after a training session. Results: The interobserver kappa coefficient ((kappa)) of the non-experts and experts was 0.20 (95% confidence interval [CI], 0.19-0.21) and 0.51 (95% CI, 0.33-0.69), respectively (P < 0.0001). The mean (kappa) of the non-experts with the reference standard was 0.33 (95% CI, 0.27-0.39). After a training session, the interobserver agreement of the non-experts increased from 0.20 to 0.27 (95% CI, 0.26-0.28) (P < 0.0001). The percentage agreement of the non-experts with the reference standard improved from 68.5% before to 71.4% after the training session (Wilcoxon signed-rank test, P=0.034). Conclusions: The interobserver agreement of non-expert ophthalmologists in detecting glaucomatous optic disc changes using serial stereophotos was significantly lower than that of experts, which was moderate. After a training session, the interobserver agreement and the accuracy of the non-experts showed a small but statistically significant improvement.
T. Zeyen. Leuven University Hospitals, Department of Ophthalmology, Campus St.-Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. Email: thierry.zeyen@uzleuven.be
Classification:
15 Miscellaneous
6.8.2 Posterior segment (Part of: 6 Clinical examination methods > 6.8 Photography)
