Abstract
Purpose :
Optical coherence tomography (OCT) has become an essential tool to screen for glaucomatous optic neuropathy. Here we compare glaucoma referrals based on a customized one-page OCT report [1] with a more comprehensive community-based glaucoma screening protocol.[2]
Methods :
A community-based glaucoma screening study was conducted in a high-risk population in NYC from 2007–2014 using a mobile van. Each participant underwent visual acuity testing, OCT imaging, tonopen intraocular pressure assessment, frequency doubling testing, and optic nerve cup/disk ratio (C/D) funduscopic measurement. Trained ophthalmology residents/optometrists used all the data available to determine if ophthalmologic referral was needed based on suspicion for glaucoma. Topographic one-page OCT reports with RNFL and RGC thickness and probability plots were subsequently generated from volume scans of the optic disc and macula.[1] A report specialist judged each eye using these reports plus the commercially available OCT reports to similarly decide if a glaucoma referral was needed. The report specialist was blind to all other clinical data.
Results :
188 patients (438 eyes) were used for this analysis. The inter-grader agreement between the two methods was κ= 0.487. Of the 438 eyes, 329 (75.1%) had no evidence of glaucomatous damage per either screening methods and 43 (9.8%) were marked for referral by both. The 59 eyes referred by the van, but not the report specialist, were based on a combination of factors, the most prevalent being increased C/D (30/59) and increased IOP (20/59). 7 eyes had subtle defects picked up on the report, but not by the van screening protocol. Interestingly, circumpapillary RNFL quadrant analysis from the commercially available report picked up only 22 of the 43 eyes referred by both protocols.
Conclusions :
When comparing a community-based glaucoma screening protocol and a customized OCT report, a consensus was reached in 75% of cases (κ= 0.49). While this is comparable to the inter-grader agreement reported for interpreting disc photos, OCT, and parametric data,[3,4] it should be possible to increase agreement by training screeners to identify subtle abnormalities in a customized OCT report.
1. Hood et al., TVST, 2016; 2. Al-Aswad et al., Cogent Medicine, 2017; 3. Abrams et al., Ophthalmol, 1994; 4. Blumberg et al. IOVS 2016
This is a 2020 ARVO Annual Meeting abstract.