June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
A systematic OCT-based approach can improve ophthalmology residents’ performance in glaucoma detection
Author Affiliations & Notes
  • Sitara Hanif Hirji
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Ari Leshno
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Emmanouil Tsamis
    Psychology, Columbia University, New York, New York, United States
  • Alexis Kassotis
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Anna J Sun
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Gabriel Gomide
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Sol La Bruna
    Psychology, Columbia University, New York, New York, United States
  • Noga Harizman
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • George Cioffi
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Jeffrey M Liebmann
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Donald C Hood
    Psychology, Columbia University, New York, New York, United States
  • Footnotes
    Commercial Relationships   Sitara Hirji None; Ari Leshno None; Emmanouil Tsamis None; Alexis Kassotis None; Anna Sun None; Gabriel Gomide None; Sol La Bruna None; Noga Harizman None; George Cioffi None; Jeffrey Liebmann Advancesight, Code C (Consultant/Contractor), Alcon, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Carl Zeiss Meditech, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor), Johnson & Johnson, Inc, Code C (Consultant/Contractor), ONL Therapeutics, Inc., Code C (Consultant/Contractor), Thea, Inc., Code C (Consultant/Contractor); Donald Hood Novartis, Code F (Financial Support), Topcon, Inc, Code F (Financial Support), Heidelberg Engineering, Inc, Code F (Financial Support), Topcon, Inc, Code R (Recipient), Heidelberg Engineering, Inc, Code R (Recipient)
  • Footnotes
    Support  Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2015. doi:
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    • Get Citation

      Sitara Hanif Hirji, Ari Leshno, Emmanouil Tsamis, Alexis Kassotis, Anna J Sun, Gabriel Gomide, Sol La Bruna, Noga Harizman, George Cioffi, Jeffrey M Liebmann, Donald C Hood; A systematic OCT-based approach can improve ophthalmology residents’ performance in glaucoma detection. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2015.

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

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Abstract

Purpose : To determine if a systematic OCT-based approach can improve residents’ performance in identifying glaucomatous optic neuropathy (GON) seen on OCT scans in a real-world clinical setting.

Methods : One hundred eyes from consecutive patients in a glaucoma practice had both a 24-2 visual field (VF) and OCT imaging within 6 months. Six ophthalmology residents classified each eye as “glaucoma”, “suspect”, or “not glaucoma” in two phases of grading. In the first phase, each resident was presented with a combination of disc photo, VF, and the Zeiss Cirrus retinal nerve fiber layer (RNFL) analysis report for each eye (Fig. 1A); these were the tests they were typically using in the clinic. Then, residents underwent 4 hours of training on the Columbia University OCT-based method (CU-method),[1,2] as well as on how to identify structure-function correlation between OCT elements and VF. In the second phase of grading, residents classified eyes based on disc photo, VF, and a modified OCT report. The report included the RNFL and ganglion cell layer (GCL) thickness maps, combined RNFL/GCL deviation map, and circumpapillary RNFL thickness plot taken from commercial reports (Fig. 1B). The same information was graded by two masked OCT experts. Agreement among residents, confidence of grading, speed, and residents' agreement with OCT experts was compared between the phases of grading.

Results : Residents’ agreement with one another as measured by the kappa statistic increased after training from 0.38 to 0.57 (p<0.02). The residents were 14% more confident in diagnosing GON from phase 1 to phase 2 (p=0.001; 95% CI [5.7, 22.3]). On average, residents were able to complete the gradings 12 seconds faster from phase 1 to phase 2 (p<0.001; 95% CI [8.0, 15.6]). Lastly, agreement with OCT experts increased by 19.5% from phase 1 to phase 2 (p<0.001; 95% CI [14.7, 24.2]).

Conclusions : A training program based upon the CU-OCT method increased residents’ performance in diagnosing GON, with a significant increase in their agreement with one another, their level of confidence, and their agreement with OCT experts. A relatively short, systematic educational program focused on OCT information can significantly improve residents’ ability to diagnose glaucoma.

1. Liebmann et al, JOG 2022; 2. Hood et al. PRER, 2022.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

A. Phase 1 combination of disc photo, VF, and RNFL analysis report. B. Phase 2 modified OCT report

A. Phase 1 combination of disc photo, VF, and RNFL analysis report. B. Phase 2 modified OCT report

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