Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial

Nicolaas J Reus; Hans G Lemij; David F Garway-Heath; P Juhani Airaksinen; Alfonso Anton; Alain M Bron; Christoph Faschinger; Gábor Holló; Michele Iester; Jost B Jonas; Andrea Mistlberger; Fotis Topouzis; Thierry G Zeyen

doi:10.1016/j.ophtha.2009.09.026

Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial

Nicolaas J Reus, Hans G Lemij, David F Garway-Heath, P Juhani Airaksinen, Alfonso Anton, Alain M Bron, Christoph Faschinger, Gábor Holló, Michele Iester, Jost B Jonas, Andrea Mistlberger, Fotis Topouzis, Thierry G Zeyen

Glaucoma

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: To determine the diagnostic accuracy of judging optic disc photographs for glaucoma by ophthalmologists.

DESIGN: Evaluation of diagnostic test and technology.

PARTICIPANTS: A total of 243 of 875 invited ophthalmologists in 11 European countries.

METHODS: We determined how well each participant classified 40 healthy eyes and 48 glaucomatous eyes with varying severity of the disease on stereoscopic slides. Duplicate slides were provided for determining intraobserver agreement. All eyes were also imaged with the GDx with variable corneal compensation (GDx-VCC) (Carl Zeiss Meditec AG, Jena, Germany) and the Heidelberg Retina Tomograph (HRT) I (Heidelberg Engineering GmbH, Heidelberg, Germany). Diagnostic accuracies of clinicians were compared with those of the best machine classifiers.

MAIN OUTCOME MEASURES: Accuracy of classification, expressed as sensitivity, specificity, and overall accuracy. Intraobserver agreement (kappa).

RESULTS: The overall diagnostic accuracy of ophthalmologists was 80.5% (standard deviation [SD], 6.8; range, 61.4%-94.3%). The machine classifiers outperformed most observers in diagnostic accuracy; the GDx-VCC nerve fiber indicator and the HRT's best classifier correctly classified 93.2% and 89.8% of eyes, respectively. The intraobserver agreement (kappa) varied between -0.13 and 1.0 and was on average good (0.7).

CONCLUSIONS: In general, ophthalmologists classify optic disc photographs moderately well for detecting glaucoma. There is, however, large variability in diagnostic accuracy among and agreement within clinicians. Common imaging devices outperform most clinicians in classifying optic discs.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Original language	English
Pages (from-to)	717-23
Number of pages	7
Journal	Ophthalmology
Volume	117
Issue number	4
DOIs	https://doi.org/10.1016/j.ophtha.2009.09.026
Publication status	Published - Apr 2010

Keywords

Adult
Aged
Aged, 80 and over
Europe
Female
Glaucoma/diagnosis
Health Personnel
Humans
Intraocular Pressure
Male
Middle Aged
Observer Variation
Ocular Hypertension/diagnosis
Ophthalmology
Ophthalmoscopy
Optic Disk/pathology
Photography/methods
Reproducibility of Results
Scanning Laser Polarimetry
Sensitivity and Specificity
Tomography/methods

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10.1016/j.ophtha.2009.09.026

Cite this

Reus, N. J., Lemij, H. G., Garway-Heath, D. F., Airaksinen, P. J., Anton, A., Bron, A. M., Faschinger, C., Holló, G., Iester, M., Jonas, J. B., Mistlberger, A., Topouzis, F., & Zeyen, T. G. (2010). Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial. Ophthalmology, 117(4), 717-23. https://doi.org/10.1016/j.ophtha.2009.09.026

@article{bae46edc97864e59b5b0dcdccff45f88,

title = "Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial",

abstract = "PURPOSE: To determine the diagnostic accuracy of judging optic disc photographs for glaucoma by ophthalmologists.DESIGN: Evaluation of diagnostic test and technology.PARTICIPANTS: A total of 243 of 875 invited ophthalmologists in 11 European countries.METHODS: We determined how well each participant classified 40 healthy eyes and 48 glaucomatous eyes with varying severity of the disease on stereoscopic slides. Duplicate slides were provided for determining intraobserver agreement. All eyes were also imaged with the GDx with variable corneal compensation (GDx-VCC) (Carl Zeiss Meditec AG, Jena, Germany) and the Heidelberg Retina Tomograph (HRT) I (Heidelberg Engineering GmbH, Heidelberg, Germany). Diagnostic accuracies of clinicians were compared with those of the best machine classifiers.MAIN OUTCOME MEASURES: Accuracy of classification, expressed as sensitivity, specificity, and overall accuracy. Intraobserver agreement (kappa).RESULTS: The overall diagnostic accuracy of ophthalmologists was 80.5% (standard deviation [SD], 6.8; range, 61.4%-94.3%). The machine classifiers outperformed most observers in diagnostic accuracy; the GDx-VCC nerve fiber indicator and the HRT's best classifier correctly classified 93.2% and 89.8% of eyes, respectively. The intraobserver agreement (kappa) varied between -0.13 and 1.0 and was on average good (0.7).CONCLUSIONS: In general, ophthalmologists classify optic disc photographs moderately well for detecting glaucoma. There is, however, large variability in diagnostic accuracy among and agreement within clinicians. Common imaging devices outperform most clinicians in classifying optic discs.FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.",

keywords = "Adult, Aged, Aged, 80 and over, Europe, Female, Glaucoma/diagnosis, Health Personnel, Humans, Intraocular Pressure, Male, Middle Aged, Observer Variation, Ocular Hypertension/diagnosis, Ophthalmology, Ophthalmoscopy, Optic Disk/pathology, Photography/methods, Reproducibility of Results, Scanning Laser Polarimetry, Sensitivity and Specificity, Tomography/methods",

author = "Reus, {Nicolaas J} and Lemij, {Hans G} and Garway-Heath, {David F} and Airaksinen, {P Juhani} and Alfonso Anton and Bron, {Alain M} and Christoph Faschinger and G{\'a}bor Holl{\'o} and Michele Iester and Jonas, {Jost B} and Andrea Mistlberger and Fotis Topouzis and Zeyen, {Thierry G}",

year = "2010",

month = apr,

doi = "10.1016/j.ophtha.2009.09.026",

language = "English",

volume = "117",

pages = "717--23",

number = "4",

}

Reus, NJ, Lemij, HG, Garway-Heath, DF, Airaksinen, PJ, Anton, A, Bron, AM, Faschinger, C, Holló, G, Iester, M, Jonas, JB, Mistlberger, A, Topouzis, F & Zeyen, TG 2010, 'Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial', Ophthalmology, vol. 117, no. 4, pp. 717-23. https://doi.org/10.1016/j.ophtha.2009.09.026

TY - JOUR

T1 - Clinical assessment of stereoscopic optic disc photographs for glaucoma

T2 - the European Optic Disc Assessment Trial

AU - Reus, Nicolaas J

AU - Lemij, Hans G

AU - Garway-Heath, David F

AU - Airaksinen, P Juhani

AU - Anton, Alfonso

AU - Bron, Alain M

AU - Faschinger, Christoph

AU - Holló, Gábor

AU - Iester, Michele

AU - Jonas, Jost B

AU - Mistlberger, Andrea

AU - Topouzis, Fotis

AU - Zeyen, Thierry G

PY - 2010/4

Y1 - 2010/4

N2 - PURPOSE: To determine the diagnostic accuracy of judging optic disc photographs for glaucoma by ophthalmologists.DESIGN: Evaluation of diagnostic test and technology.PARTICIPANTS: A total of 243 of 875 invited ophthalmologists in 11 European countries.METHODS: We determined how well each participant classified 40 healthy eyes and 48 glaucomatous eyes with varying severity of the disease on stereoscopic slides. Duplicate slides were provided for determining intraobserver agreement. All eyes were also imaged with the GDx with variable corneal compensation (GDx-VCC) (Carl Zeiss Meditec AG, Jena, Germany) and the Heidelberg Retina Tomograph (HRT) I (Heidelberg Engineering GmbH, Heidelberg, Germany). Diagnostic accuracies of clinicians were compared with those of the best machine classifiers.MAIN OUTCOME MEASURES: Accuracy of classification, expressed as sensitivity, specificity, and overall accuracy. Intraobserver agreement (kappa).RESULTS: The overall diagnostic accuracy of ophthalmologists was 80.5% (standard deviation [SD], 6.8; range, 61.4%-94.3%). The machine classifiers outperformed most observers in diagnostic accuracy; the GDx-VCC nerve fiber indicator and the HRT's best classifier correctly classified 93.2% and 89.8% of eyes, respectively. The intraobserver agreement (kappa) varied between -0.13 and 1.0 and was on average good (0.7).CONCLUSIONS: In general, ophthalmologists classify optic disc photographs moderately well for detecting glaucoma. There is, however, large variability in diagnostic accuracy among and agreement within clinicians. Common imaging devices outperform most clinicians in classifying optic discs.FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

AB - PURPOSE: To determine the diagnostic accuracy of judging optic disc photographs for glaucoma by ophthalmologists.DESIGN: Evaluation of diagnostic test and technology.PARTICIPANTS: A total of 243 of 875 invited ophthalmologists in 11 European countries.METHODS: We determined how well each participant classified 40 healthy eyes and 48 glaucomatous eyes with varying severity of the disease on stereoscopic slides. Duplicate slides were provided for determining intraobserver agreement. All eyes were also imaged with the GDx with variable corneal compensation (GDx-VCC) (Carl Zeiss Meditec AG, Jena, Germany) and the Heidelberg Retina Tomograph (HRT) I (Heidelberg Engineering GmbH, Heidelberg, Germany). Diagnostic accuracies of clinicians were compared with those of the best machine classifiers.MAIN OUTCOME MEASURES: Accuracy of classification, expressed as sensitivity, specificity, and overall accuracy. Intraobserver agreement (kappa).RESULTS: The overall diagnostic accuracy of ophthalmologists was 80.5% (standard deviation [SD], 6.8; range, 61.4%-94.3%). The machine classifiers outperformed most observers in diagnostic accuracy; the GDx-VCC nerve fiber indicator and the HRT's best classifier correctly classified 93.2% and 89.8% of eyes, respectively. The intraobserver agreement (kappa) varied between -0.13 and 1.0 and was on average good (0.7).CONCLUSIONS: In general, ophthalmologists classify optic disc photographs moderately well for detecting glaucoma. There is, however, large variability in diagnostic accuracy among and agreement within clinicians. Common imaging devices outperform most clinicians in classifying optic discs.FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Europe

KW - Female

KW - Glaucoma/diagnosis

KW - Health Personnel

KW - Humans

KW - Intraocular Pressure

KW - Male

KW - Middle Aged

KW - Observer Variation

KW - Ocular Hypertension/diagnosis

KW - Ophthalmology

KW - Ophthalmoscopy

KW - Optic Disk/pathology

KW - Photography/methods

KW - Reproducibility of Results

KW - Scanning Laser Polarimetry

KW - Sensitivity and Specificity

KW - Tomography/methods

U2 - 10.1016/j.ophtha.2009.09.026

DO - 10.1016/j.ophtha.2009.09.026

M3 - Article

C2 - 20045571

SN - 0161-6420

VL - 117

SP - 717

EP - 723

JO - Ophthalmology

JF - Ophthalmology

IS - 4

ER -

Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial

Abstract

Keywords

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