Grader agreement of ROTA retinal nerve fiber bundle defects in glaucoma

Abstract

Purpose : To investigate the grader agreement using retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) in glaucoma.

Methods : A total of 90 eyes (including 30 early [visual field mean deviation (VF MD) > -6 dB] primary open angle glaucoma (POAG), 30 moderate to advanced POAG [VF MD ≤ -6dB] and 30 healthy eyes) from 74 participants were enrolled. The dataset consists of a total of 180 ROTA images, each image being randomly presented twice for all eyes. The boundaries of RNFL defects were identified using ROTA, assessing the involvement of the arcuate, papillomacular, and papillofoveal bundles for each superior or inferior hemifield. Two medical trainees and two glaucoma specialists, masked to all clinical information except for ROTA images, diagnosed the presence or absence of RNFL defects. Glaucoma diagnosis was confirmed by an independent evaluator using ROTA images, 24-2 and 10-2 VF, and fundus photographs. The agreement with glaucoma diagnosis (percentage), and intra-rater agreement (Cohen's Kappa) were calculated.

Results : Mean (95% CI) age was 64.0 (60.9 to 67.1) years. The proportion of agreement to identify ROTA retinal nerve fiber bundle defects was 95.0% between glaucoma experts and 73.9% between medical trainees. The agreement with glaucoma diagnosis was 80.0-92.8% for medical trainees and 96.1-98.9% for glaucoma experts (Table 1). Both glaucoma experts (kappa=0.78-0.83) and medical trainees (kappa=0.70-0.74) exhibited good intra-rater agreement in determining the location of ROTA defects in glaucoma cases (Table 2).

Conclusions : Regardless of training level, there was good intra-rater agreement in identifying the location of ROTA defects in glaucoma cases. Notably, there was a high degree of agreement in the diagnosis of glaucoma using ROTA, underscoring its clinical utility in the identification of glaucoma.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.