Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study.

PURPOSE: To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. DESIGN: Retrospective, exploratory study. SUBJECTS: We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017. METHODS: All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURES: Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS: Intergrader agreement between glaucoma specialists was 60% (κ = 0.43) and between report specialists was 95% (κ = 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). CONCLUSIONS: There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.

ß-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study.

Importance: ß-zone parapapillary atrophy (ßPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of ßPPA differs between individuals of African descent (AD) and European descent (ED). Objective: To test whether the association between the presence and progression of ßPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants: In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of ßPPA at baseline and ßPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures: Disc stereophotographs. Main Outcomes and Measures: Progression of ßPPA in AD and ED individuals. Results: In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between ßPPA at baseline and visual field progression was not significantly different between AD and ED eyes (ß = 0.071; 95% CI, -0.016 to 0.158; P = .11), nor was the association between ßPPA progression and visual field progression (ß = 0.020; 95% CI, -0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline ßPPA progressed faster than did AD eyes with baseline ßPPA (ß = -0.124; 95% CI, -0.241 to -0.007; P = .04), although the association between ßPPA progression and visual field progression did not differ significantly between race groups (ß = -0.101; 95% CI, -0.323 to 0.119; P = .37). Conclusions and Relevance: Race had a significant effect on the association between baseline ßPPA and rates of visual field progression in eyes with GON. Progression of ßPPA was not associated with faster visual field progression in either racial group.