June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Improving inter-individual diagnostic agreement in early glaucoma through better use of optical coherence tomography (OCT) scans.
Author Affiliations & Notes
  • Donald Hood
    Psychology and Ophthalmology, Columbia University, New York, NY
  • C Gustavo De Moraes
    Ophthalmology, Columbia University, New York, NY
  • Lola Grillo
    Psychology and Ophthalmology, Columbia University, New York, NY
  • Paula Alhadeff
    New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Ravivarn Jarukasetphon
    New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Rithambara Ramachandran
    Psychology, Columbia University, New York, NY
  • Diane Wang
    Psychology, Columbia University, New York, NY
  • Dana Blumberg
    Ophthalmology, Columbia University, New York, NY
  • Jeffrey M Liebmann
    New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Robert Ritch
    New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Footnotes
    Commercial Relationships Donald Hood, Topcon, Inc (F); C Gustavo De Moraes, None; Lola Grillo, None; Paula Alhadeff, None; Ravivarn Jarukasetphon, None; Rithambara Ramachandran, None; Diane Wang, None; Dana Blumberg, None; Jeffrey Liebmann, Topcon, Inc (F); Robert Ritch, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2060. doi:
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    • Get Citation

      Donald Hood, C Gustavo De Moraes, Lola Grillo, Paula Alhadeff, Ravivarn Jarukasetphon, Rithambara Ramachandran, Diane Wang, Dana Blumberg, Jeffrey M Liebmann, Robert Ritch; Improving inter-individual diagnostic agreement in early glaucoma through better use of optical coherence tomography (OCT) scans.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2060.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To test if individuals trained in a method integrating key visual field (VF) and optical coherence tomography (OCT) information without stereo disc photographs (SDP) would show better inter-individual agreement in diagnosing early glaucoma than glaucoma specialists using traditional commercial reports and SDP.

 
Methods
 

Two glaucoma fellows and two students were trained with a method [1] for interpreting spectral domain OCT scans and for comparing them to 24-2 VFs. The training involved learning to use a single-page report [1] containing inner retinal layer thickness information from OCT macular and disc cube scans, along with superimposed 24-2 VF (total deviation) and OCT probability plots (Fig. 1). They were then given reports for 50 eyes (50 patients) with 24-2 MDs better than -6 dB and suspicious discs based upon SDP. For each eye, they judged whether it had glaucomatous damage. The fellows were then given the commercial 24-2 VF reports and SDP, and could change their judgment. Inter-individual agreement (kappa statistic, k) was compared to that of 3 glaucoma specialists who judged these eyes based upon SDP and commercially available 24-2 VF and OCT reports.[2] A “reference standard” based upon the majority opinion of 3 glaucoma experts plus the referring specialist, consisted of 32 glaucomatous and 16 non-glaucomatous eyes (there was insufficient agreement for 2 eyes).[2]

 
Results
 

With the report alone, the agreement among the 4 graders (mean paired k of 0.93, range of 0.87 to 0.96) was substantially better than that among the 3 specialists (mean paired k of 0.53, range of 0.36 to 0.69) who used traditional diagnostic methodologies.[2] The estimated “sensitivity” and “specificity” were also good. Of the 32 eyes judged as abnormal by the specialists, only one was judged as normal by the 4 graders, and of the 16 eyes judged as normal by the specialists, between 0 and 2 were judged as abnormal by the graders. The students and fellows did equally well. Adding the full VFs and stereo-photographs only improved the agreement by one eye for one grader.

 
Conclusions
 

With training to read a report that integrates OCT and VF information, inter-individual agreement and diagnostic performance can be improved without the need for fundus photographs. 1. Hood, Raza (2014) BJO. 2. Hood, Raza, De Moraes et al. (2014) TVST.  

 
Fig. 1. A sample report [1]
 
Fig. 1. A sample report [1]

 
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