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Editors Selection IGR 21-1

Screening and Detection: Recommendations for Further Evaluation of Screening Hits

Comment by Aaron Carlisle & Augusto Azuara Blanco on:

104345 Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study, Ramachandran R; Joiner DB; Joiner DB; Patel V et al., Ophthalmology. Glaucoma, 2022; 5: 602-613

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Glaucoma screening can save many person-years of blindness in high-risk populations.¹ Optical Coherence Tomography (OCT) provides valuable topographic information on glaucomatous damage, but its efficacy as a glaucoma screening tool, both alone and in combination with other tests, has yet to be established. Allied health care professionals (e.g., OCT report specialists) can help provide efficient health care, particularly for triage or screening purposes, but the appropriateness of referral recommendations needs to be determined.

Ramachandran et al., in a retrospective, exploratory study compared the glaucoma referral patterns of 483 eyes (243 individuals) of three independent glaucoma specialists with those by two OCT report specialists on the basis of only the OCT.² Glaucoma specialists were asked to choose between the following options: (1) a glaucoma referral for a specialist glaucoma workup; (2) an ophthalmic referral for a workup for another ocular pathology; or (3) an optometric referral for a routine evaluation in two to three years. Intergrader agreement between glaucoma specialists was fair (60%) while agreement between report specialists was strong 95%.

The study's second phase, explored what impact, if any, a designated OCT reading would have on a glaucoma specialist's judgements. Each glaucoma specialist was instructed to re-evaluate all eyes where there was a disagreement with the primary OCT report specialist, this time with a customized OCT report and the report specialist's comments available. Interestingly, the level of agreement increased from fair to moderate between glaucoma experts. Among the differences between glaucoma specialists and OCT specialists, there was a propensity for glaucoma referrals to be moved to routine ophthalmic follow up or optometry follow-up. Having the report of the specialist's analysis of the OCT allowed the glaucoma specialist to feel more confident in not sending patients for specialist care.

According to the authors of this study, the use of OCT report specialists may reduce the number of potentially unnecessary specialist referrals. This is a valuable finding. OCT reading centers may be employed in the design of screening protocols to potentially reduce the number of unnecessary specialist referrals.³ This study justifies further research, e.g., a formal evaluation of the diagnostic accuracy of OCT tests interpreted by report specialists.

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