Research on agreement among clinicians on evaluation of optic disc damage in early glaucoma / 眼科

ABSTRACT

Objective To determine the agreement of interobserver and intraobserver in diagnosing early glaucoma by optic disc morphology,and to explore the efficacy of established methods for evaluating glaucomatous optic discs.Design Prospective study. Participants Clinicians and evaluating methods for glaucomatous optic discs.Methods 120 digital fundus photographs were enrolled including early glaucoma eyes(67 cases)and non-glaucoma eyes but with glaucomatous appearance(53 cases),which were collected in Tongren Hospital.Thirteen ophthalmologists as observers were divided into three groupsGroupⅠ(5 clinicians)were trained with stan- dardized methods for evaluating glaucomatous optic disc damage recently.GroupⅡ(4 clinicians)were ophthalmologists majoring in glaucoma.GroupⅢwere ophthalmologists not specializing in glaucoma.In general groupⅡandⅢ,none had been trained with the es- tablished criteria.Observers evaluated the photos 3 times,with an interval time of 3 days.Kappa statistics were used to evaluate agree- ment between the intraobserver and interobserver.Main Outcome Measures Interobserver and intraobserver agreement,kappa value. Results In GroupⅠ,4 clinicians were in almost perfect agreement,1 clinician was in substantial agreement,kappa value ranging from 0.779(90.0%)to 0.966(98.3%).In GroupⅡ,almost perfect agreement occurred in 2 clinicians,substantial in 1 clinician and moderate in 1 clinician,kappa value ranging from 0.506(82.5%)to 0.866(93.3%).In GroupⅢ,the agreements in 4 clinicians were substantial, moderate,fair,and slight,respectively,kappa value ranging from 0.094(54.2%)to 0.778(89.2%).In term of interobserver agreement for glaucoma diagnosis,kappa values in GroupⅠranged from 0.768 to 0.983,in GroupⅡ0.354-0.834,in GroupⅢ0.335-0.737,respec- tively.Conclusions Intraobserver and interobserver agreement rates in early glaucoma diagnosis are substantially improved through training on optic disc morphologic evaluation methods.Establishing the diagnosis criteria for glaucomatous optic disc damage can raise the correct rate of diagnosis.