Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.

Inter/intra-observer evaluation between radiographs and tomographies for proximal humerus fracture / Avaliação inter e intra-observador entre radiografias e tomografias para fratura de úmero proximal

ABSTRACT Objective: The use of images in 3D reconstruction is an instrument that facilitates the interpretation of the fracture, observations of deviations, rotations and articular surface. Objective: To evaluate the inter-observer and intra-observer reliability of the Neer x AO proximal humerus fracture classification on radiographs versus computed tomography with three-dimensional reconstruction (3D). Methods: We evaluated the digital radiographs (anteroposterior and profile) and computerized tomography with 3D reconstruction of patients presenting with a proximal humerus fracture, surgically treated at an Orthopedics and Traumatology Service. All radiographs and computed tomography were classified (Neer and AO) by eight (8) orthopedic surgeons, specialists in the upper limb and sent, following the pre-established numeration by the author, in a spreadsheet to the author of the study. Results: The Neer and AO scores were more reproducible when determined by computed tomography with 3D reconstruction, mainly in fractures of greater complexity (Neer 4 parts and AO group C). However, in absolute values, inter and intra-observer reproducibility and concordance still remain low. Conclusion: Computed tomography with 3D reconstruction allows a better analysis of fractures of group C and Neer 4 parts. However, the inter and intra-observer agreement does not increase significantly in comparison to the radiographs. Level of evidence III, Study of non-consecutive patients, without gold standard, applied uniformly.

RESUMO Objetivo: O uso de imagens em reconstrução 3D são um instrumento facilitador na interpretação da fratura, observações dos desvios, rotações e superfície articular. Objetivo: Avaliar a confiabilidade inter-observador e intra-observador da classificação da fratura de úmero proximal, descrita por Neer x AO, em radiografias versus tomografias computadorizadas com reconstrução tridimensional (3D). Métodos: Avaliamos as radiografias digitais (anteroposterior e perfil) e tomografias computadorizadas com reconstrução 3D de pacientes que apresentavam fratura de úmero proximal, tratados cirurgicamente em um Serviço de Ortopedia e Traumatologia. Todas as radiografias e tomografias computadorizadas foram classificadas (Neer e AO) por oito (8) cirurgiões ortopédicos especialistas em membro superior e enviadas, seguindo a numeração pré-estabelecida pelo autor, em uma planilha para o autor do trabalho. Resultados: A classificação de Neer e AO foram mais reprodutíveis quando determinadas pela tomografia computadorizada com reconstrução 3D, principalmente em fraturas de maior complexidade (Neer 4 partes e AO grupo C). Porém, em valores absolutos, a reprodutibilidade e concordância inter e intraobservador ainda permanecem baixas. Conclusão: A tomografia com reconstrução 3D, permite uma melhor análise das fraturas do grupo C e Neer 4 partes. Entretanto, não aumenta significativamente a concordância global inter e intraobservador em comparação as radiografias. Nível de Evidência III, Estudo de pacientes não consecutivos, sem padrão ouro, aplicados uniformemente.

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain / 대한소아소화기영양학회지

PURPOSE: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. METHODS: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. RESULTS: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. CONCLUSION: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

Reliability of the measurement of glenoid bone defect in anterior shoulder instability / 中华医学杂志(英文版)

Background@#The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability. However, the reliability of glenoid bone defect measurement is controversial. The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.@*Methods@#The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017. The glenoid bone defect was measured by three surgeons on 'self-confirmed’ and 'designated’ 3-D en-face views, and repeated after an interval of 3 months. Measurements included the ratio of the defect area to the best-fit circle area, and the ratio of the defect width to the diameter of the best-fit circle. The inter- and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients (ICCs). The maximum absolute inter- and intra-observer differences and the cumulative percentages of cases with inter- and intraobserver differences greater than these respective levels were calculated.@*Results@#Almost all linear defect values were bigger than the areal defect values. The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the 'self-confirmed’ group and 0.549 and 0.431 in the 'designated’ group. The inter-observer reliabilities for the linear defect were moderate or fair in the 'self-confirmed’ group (ICC = 0.446, 0.374) and 'designated’ group (ICC = 0.402, 0.327). The ICCs for intra-observer measurements were higher than those for inter-observer measurements. The respective maximum interand intra-observer absolute differences were 13.9% and 13.2% in the 'self-confirmed’ group, and 15.8% and 9.8% in the 'designated’ group.@*Conclusions@#The areal measurement of the glenoid bone defect is more reliable than the linear measurement. The reliability of the glenoid defect areal measurement is moderate or worse, suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination. Subjective factors affecting the glenoid bone loss measurement should be minimized.

Acuerdo intra-interobservador en las pruebas Minimental State Examination (MMSE) y Montreal Cognitive Assessment (MoCA test) aplicados por personal en entrenamiento / Intra and interrater reliability of the Minimental State Exmination (MMSE) and Montréal Cognitive Assessment (MoCA test) applied by health personnel in training

Introducción: en el proceso del diagnóstico neuropsicológico, los instrumentos de tamizaje cognitivo, son una herramienta útil en la identificación de cambios mentales del sujeto, en momentos puntuales o a través del tiempo. Su uso se fundamenta en el análisis psicométrico. Objetivo: determinar el acuerdo inter e intra-observador en el MoCA test y el MMSE, aplicado por profesores y estudiantes en procesos de entrenamiento de tamización cognitiva. Materiales y métodos: a los estudiantes y profesores en entrenamiento en la puntuación del MoCA test y el MMSE, se les presentó un video en dos sesiones, con un intervalo de 5 meses, mostrando el desempeño de dos adultos mayores, respondiendo el MoCA test y el MMSE, previo consentimiento informado. Se compararon los puntajes dados en las dos sesiones por los sujetos en entrenamiento, con los de ellos mismos (intra-observador), usando el coeficiente de concordancia y correlación de Lin(rho) y con los del grupo restante (inter-observador) usando el coeficiente de correlación intra-clase (ICC). Resultados: participaron 46 evaluadores. Se encontró alta confiabilidad inter-observador para el MoCA (ICC=0.86), pero baja para el MMSE (ICC=0.24) y baja confiabilidad intra-observador tanto para el MoCA (rho paciente 1=0.012 y rho paciente 2=0.152) como para el MMSE (rho paciente 1=0.008 y rho paciente 2=0.012). Aunque los puntajes difirieron, las clasificaciones diagnósticas realizadas por los evaluadores fueron similares a las del patrón de oro. Conclusión: la correcta aplicación del test, requiere varios entrenamientos, y aunque hubo pocas diferencias entre los puntajes, los errores cuando se está cerca del punto de corte propuesto, aumentan el riesgo de sesgo.

Introduction: The instruments for screening cognitive functions, applied to subjects in clinical settings and research, are useful for determining if this person has any trouble in cognition or show changes in the time. The usefulness of these instruments is defined with the evaluation of their psychometrics properties. Objective: This study allows to determine the intra and inter-observer agreement, when the MoCA test and MMSE were applied by a group in training process Materials and methods: The study group who attended two training sessions, with an interval of 5 months, scored the MoCA test and MMSE, from two patients which were filmed responding the tests, previous informed consent signature. We compared how close were the scores of participants among themselves by concordance correlation coefficient of Lin (rho) and with those given from the others by intra-class correlation coefficients (ICC). Results: In total, 46 participants were included. Intra-rater reliability was high for MoCA test (ICC = 0.86), but it was poor for MMSE (ICC=0.24). Inter-rater was poor for MoCA test (rho patient 1= 0.012, rho patient 2= 0.152) and MMSE (rho patient 1 = 0.008, rho patient 2 = 0.012). Although the scores between participants and gold standard were different, the diagnoses were similar. Conclusion:The correct scoring of the test, requires several trainings to clinical and research groups, and although they can be found few differences between scores applied by non-expert personnel, if the scores mistakenly given, are close to the cut-of point proposed for each test, the bias increases.

Impedance pH Monitoring: Intra-observer and Inter-observer Agreement and Usefulness of a Rapid Analysis of Symptom Reflux Association

BACKGROUND/AIMS: Symptom reflux association analysis is especially helpful for evaluation and management of proton pump inhibitor (PPI) refractory patients. An accurate calculation requires manual editing of 24-hour multichannel intraluminal impedance-pH (MII-pH) tracings after automatic analysis. Intra- and inter-observer agreement as well as reliability of rapid editing confined to the time around symptomatic episodes are unknown. Aim of this study was to explore these topics in a prospective multicenter study. METHODS: Forty consecutive patients who were off PPI therapy underwent MII-pH recordings. After automatic analysis, their tracings were anonymized and randomized. Three experienced observers, each one trained in a different European center, independently performed manual editing of 24-hour tracings on 2 separate occasions. Values of symptom index and symptom association probability for acid and non acid reflux were transformed into binary response (i.e., positive or negative). RESULTS: Intra-observer agreement on symptom reflux association was 92.5% to 100.0% for acid and 85.0% to 97.5% for non-acid reflux. Inter-observer agreement was 100.0% for acid and 82.5% to 95.0% for non-acid reflux. Values for symptom index and symptom association probability were similar. Concordance between 24-hour and rapid (2 minutes-window before each symptomatic episode) editings for symptom reflux association occured in 39 to 40 patients (acid) and in 37 to 40 (non-acid), depending on the observer. CONCLUSIONS: Intra- and inter-observer agreement in classifying patients with or without symptom reflux association at manual editing of 24-hour tracings was high, especially for acid reflux. Classifying patients according to a rapid editing showed excellent concordance with the 24-hour one and can be adopted in clinical practice.

Variabilidad en la medición del índice acetabular / Variability in measurement of acetabular index

Introducción: La Displasia del desarrollo de la cadera (DDC) es un espectro de enfermedades que abarca desde la luxación franca de la cadera hasta la displasia acetabular leve. El screening de detección de DDC se realiza de rutina en nuestro país, mediante una radiografía de pelvis a los 3 meses. El índice acetabular medido en estas radiografías se utiliza para evaluar la cadera displásica, tanto en la presentación inicial como durante el seguimiento posterior. Objetivo: Evaluar la variabilidad tanto intra como inter observador en la medición del índice acetabular, entre profesionales médicos. Material y Métodos: Cuatro evaluadores (un cirujano-ortopédico infantil, un médico general, un pediatra y un radiólogo) realizaron la medición del índice acetabular en 100 radiografías de screening (200 caderas), en tres ocasiones, separadas por un mes cada una (600 mediciones totales). Un observador independiente evaluó la reproductibilidad en la medición. Se utilizó el coeficiente de correlación intraclase para determinar diferencias significativas. Resultados: La variabilidad intra observador fue menor que la interobservador. La variabilidad intra observador fue similar para los diferentes evaluadores, +/- 1,5°. La variabilidad inter observador fue de +/- 3,4°. Conclusiones: Demostramos una alta concordancia entre las mediciones, determinando una alta reproductibilidad del índice acetabular. El índice acetabular es un método seguro para el diagnóstico y seguimiento de displasia acetabular.

Developmental dysplasia of the hip (DDH) is a spectrum of diseases ranging from frank dislocation of the hip to mild acetabular dysplasia. DDH screening for detection is performed routinely in our country using pelvic x-ray at 3 months of age. The radiographic measured acetabular index is used to evaluate the dysplastic hip, at initial presentation and during follow-up. Objective: Evaluation of the intra- and inter-observer variability, among medical professionals, when measuring acetabular index. Methods: Four reviewers (a children orthopedic surgeon, a general practitioner, a pediatrician and a radiologist) performed acetabular index measurement in 100 radiographs (200 hips), on three occasions, separated each by one month (600 total measurements). An independent observer evaluated the measurement reproducibility. The intra-class correlation coefficient to determine significant differences was used. Results: The intra-observer variability was less than the inter-observer variability. The intra-observer variability was similar among the different assessors, +/- 1.5 degrees. The inter-observer variability was +/- 3.4 degrees. Conclusions: A high concordance among measurements was reported, evidencing a high reproducibility of the acetabular index; this index is a reliable method for the diagnosis and follow-up of acetabular dysplasia.

Inter-observer and intra-observer reliability of the Harris hip scoring system

OBJECTIVE: The Harris hip score (HHS) is a 100-point scale for rating pain, function, absence of deformity, and range of motion. The purpose of this study is to assess the inter-observer and intra-observer reliability of the Harris hip score among senior orthopedic residents at the Philippine General Hospital. METHODS: Twenty-four hips from 20 patients were evaluated using the Harris hip score by four senior residents from the Department of Orthopedics, Philippine General Hospital. All patients were interviewed twice in the clinic and the reliability of the HHS was evaluated. RESULTS: The inter-observer coefficient of concordance (Kendall coefficient of concordance W) was 0.9 for both groups of observers. The intra-observer coefficients of concordance were 0.8, 1.0, 0.9, and 0.9, for the four observers. A 0 value indicates no concordance among a set of raters while a score of 1 indicates perfect concordance. Obtaining a score greater than 0.75 represents excellent level of agreement. CONCLUSION: We conclude that the Harris hip score has high interobserver and inter-observer reliability among senior Orthopedic residents at the Philippine General Hospital.

Reprodutibilidade intra e interobservadores no ângulo de cobb em indivíduos escolióticos / Intra-and interobserver reproducibility in the Cobb angle in scoliosis patients

O objetivo deste estudo é analisar a variabilidade intra e interobservador do método de Cobb em indivíduos escolióticos. Foram avaliadas trinta e quatro radiografias de sujeitos com escoliose para mensuração do ângulo de Cobb. A avaliação intraobservador foi realizada por um avaliador, enquanto a avaliação interobservador foi realizada por três avaliadores. Foram controlados possíveis erros intrínsecos e extrínsecos de mensuração, mas não houve a pré-seleção das vértebras que caracterizam a escoliose. A concordância intra e interobservador foi avaliada pelo coeficiente de correlação de Pearson (p < 0,05). Não houve diferenças significativas de julgamento na condição intra e interobservadores. A magnitude dos coeficientes de correlação oscilou de bom até excelente nos níveis torácico e tóraco-lombar. Na coluna lombar não houve correlação em ambas as condições

Inter- and Intra-observer Reliability of MRI for Lumbar Lateral Disc Herniation

BACKGROUND: The authors analyzed inter- and intra-observer agreement with respect to interpretation of simple magnetic resonance T1- and T2-weighted axial and sagittal images for the diagnosis of lumbar lateral disc herniation, including foraminal and extraforaminal disc herniations. METHODS: Forty-two patients in whom lumbar lateral disc herniation was suspected or confirmed by simple magnetic resonance imaging at one institute between May 2003 and December 2004 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. RESULTS: The kappa values for inter-observer agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-observer agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. CONCLUSIONS: The present study indicates that simple magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. Another imaging study with improved diagnostic values should be developed to diagnose this pathologic finding.

Fuentes de variabilidad en el diagnóstico de gastritis atrófica multifocal asociada con la infección por Helicobacter pylori / Source of variation in the diagnosis of Helicobacter pylori-associated multifocal atrophic gastritis

Introducción: El mapeo de las diferentes regiones del estómago y el número de fragmentos de mucosa gßstrica disponibles para evaluación histopatológica son fuentes importantes de variación en el momento de clasificar y hacer la gradación de la gastritis crónica. Objetivos: Estimar la sensibilidad del número de fragmentos de mucosa gßstrica necesarios para establecer los diagnósticos de gastritis atrófica con metaplasia intestinal (MI), displasia y estado de infección por Helicobacter pylori. Ademßs evaluar la variabilidad intra-observador en la clasificación de estas lesiones precursoras del cancer gastrico. Materiales y métodos: En una cohorte de 6 a±os de seguimiento se evaluaron 1,958 procedimientos de endoscopia realizados por dos gastroenterólogos. En cada procedimiento y de cada participante se obtuvieron 5 biopsias de mucosa gßstrica que representaban antro, incisura angularis y cuerpo. Un único patólogo hizo la interpretación histológica de las 5 biopsias y proporcionó un diagnóstico definitivo global que se utilizó como patrón de referencia. Cada fragmento de mucosa gßstrica examinado condujo a un diagnóstico individual para cada biopsia que se comparó con el patrón de referencia. La variabilidad intra-observador se evaluó en 127 personas que corresponden a una muestra aleatoria de 20% del total de endoscopias hechas a los 72 meses de seguimiento. Resultados: La sensibilidad del diagnóstico de MI y displasia gßstrica aumentó de manera significativa con el número de fragmentos de mucosa gßstrica evaluados El sitio anatómico de mayor sensibilidad para el diagnóstico de MI y displasia fue la incisura angularis. Para descubrir H. pylori se logró alta sensibilidad con el estudio de un solo fragmento de mucosa gastrica (95.9%) y fue independiente del sitio de obtención de la biopsia. El acuerdo intra-observador para el diagnóstico de gastritis crónica fue 86.1% con valor kappa de 0.79 IC 95% (0.76-0.85).

Introduction: Multiple sampling from different sites of the stomach as well as the number of fragments of gastric mucosa available for histopathologic evaluation are important sources of variation when classifying and grading chronic gastritis. Objective: To estimate the sensitivity of the number of fragments of gastric mucosa necessary to establish the diagnosis of atrophic gastritis with intestinal metaplasia, gastric dysplasia and H. pylori infection. In addition, this study will attempt to assess the intra-observer variability in the classification of these premalignant gastric lesions. Methods: This is a 6 year-cohort study, wherein 1958 gastric endoscopic procedures performed by two gastroenterologists were reviewed. Five gastric biopsy samples were obtained from the antrum, body and lesser curvature during each procedure. One pathologist was in charge of reviewing the five histopathology samples for each subject and providing a definitive diagnosis which was used as the gold standard. Each gastric mucosa sample reviewed led to an individual diagnosis for that sample which was compared with the gold standard. Intra-observer variability was assessed in 127 individuals who correspond to a random sample of 20% of the total endoscopic procedures performed during the 72 month-follow-up. Results: The sensitivity of the diagnosis of intestinal metaplasia (IM) and gastric dysplasia increased proportionally with the number of gastric mucosa samples reviewed. The lesser curvature of the stomach had the highest sensitivity for the diagnosis of IM and dysplasia, among all the stomach regions studied. Just one sample of gastric mucosa attained a sensitivity of 95.9% for the detection of H. pylori infection. The intra-observer agreement for the diagnosis of multifocal atrophic gastritis was 86.1% and the kappa value was 0.79 (95% CI 0.76-0.85). Alcohol-fixed biopsy specimens were inadequate to diagnose H. pylori infection and to assess dysplasia.

Variabilidade intra-avaliador e inter-avaliadores de medidas antropométricas / Intra-observer and inter-observers variability of anthropometric measures

O objetivo do estudo foi avaliar a variabilidade intra e inter-avaliadores de medidas antropométricas realizadas por três antropometristas considerados experientes mediante o cálculo dos erros técnicos de medida (ETM). Para esse fim, foi selecionada uma amostra de 21 voluntários (25,7 ± 7,5 anos), sendo 12 homens e 9 mulheres. Foram consideradas as medidas de peso corporal (kg), estatura (cm), circunferências (cm) do braço direito relaxado, abdômen, quadril e coxa, e da espessura das dobras cutâneas (mm) tricipital, subescapular, suprailíaca, abdômen, coxa e panturrilha medial. As medidas foram realizadas em 2 dias consecutivos, sempre no período da tarde, envolvendo os mesmos equipamentos e os mesmos voluntários. Os resultados apontaram a ocorrência de ETMs acima dos recomendados para aceitabilidade, tanto a variabilidade intra-avaliador como inter-avaliadores, sugerindo, portanto, a importância e a necessidade de treinamento específico dos antropometristas.

The aim of this study was to evaluate the intra and inter-observer reliability in the anthropometric measures of three expert observers through the technical error of measure (TEM). For this end, 21 healthy volunteers (25.7 ± 7.5 years) took part in the study, being 12 males and 9 females. The following aspects were analyzed: body weigh (kg), stature (cm), circumferences (cm) of relaxed right arm, abdomen, hip and thigh, and skinfold thickness (mm) of triceps, subescapular, supra-iliac, abdomen, thigh and calf medial. The measures were made in 2 different days, always in the afternoon, with the same equipments and in the same volunteers. The results pointed the occurrence of TEMs out of the recommended patterns, in both intra-observer and inter-observers variability. This fact showed the importance and need of specific training of the observers.

Reproducibility Among Residents in Evaluating Cup-disc Ratio Using Computer-aided Planimetry

PURPOSE: To investigate the intra-observer agreement and inter-observer agreement among observers assessing optic disc cup-disc ratio of glaucoma patients. METHODS: Fifty stereoscopic optic disc photographs of patients with glaucoma were digitized and five ophthalmology residents drew optic disc and cup margin in a masked random fashion. It was performed twice on same photographs weekly under monoscopic and stereoscopic conditions. The agreement was estimated by Pearson correlation coefficient r. RESULTS: Intra-observer agreement for estimating linear cup-disc ratio (LCDR) under monoscopic (0.84) and stereoscopic conditions (0.86) were high and inter-observer agreement was also high under monoscopic (0.81) and stereoscopic conditions (0.83) showing more perfect agreement under stereoscopic condition. The observers estimated smaller cup-disc ratio when evaluating under stereoscopic condition than under monoscopic condition. CONCLUSIONS: Evaluating optic disc stereoscopically with computer-aided planimetry can be clinically useful when managing patients with glaucoma since it has a high reproducibility.