Combining Optical Coherence Tomography and Fundus Photography to Improve Glaucoma Screening

Abstract

We aimed to evaluate the accuracy of glaucoma screening using fundus photography combined with optical coherence tomography and determine the agreement between ophthalmologists and ophthalmology residents. We used a comprehensive ophthalmologic examination dataset obtained from 503 cases (1006 eyes). Of the 1006 eyes, 132 had a confirmed glaucoma diagnosis. Overall, 24 doctors, comprising two groups (ophthalmologists and ophthalmology residents, 12 individuals/group), analyzed the data presented in three screening strategies as follows: (1) fundus photography alone, (2) fundus photography + optical coherence tomography, and (3) fundus photography + optical coherence tomography + comprehensive examination. We investigated the diagnostic accuracy (sensitivity and specificity). The respective sensitivity and specificity values for the diagnostic accuracy obtained by 24 doctors, 12 ophthalmologists, and 12 ophthalmology residents were as follows: (1) fundus photography: sensitivity, 55.4%, 55.4%, and 55.4%; specificity, 91.8%, 94.0%, and 89.6%; (2) fundus photography + OCT: sensitivity, 80.0%, 82.3%, and 77.8%; specificity, 91.7%, 92.9%, and 90.6%; and (3) fundus photography + OCT + comprehensive examination: sensitivity 78.4%, 79.8%, and 77.1%; specificity, 92.7%, 94.0%, and 91.3%. The diagnostic accuracy of glaucoma screening significantly increased with optical coherence tomography. Following its addition, ophthalmologists could more effectively improve the diagnostic accuracy than ophthalmology residents. Screening accuracy is improved when optical coherence tomography is added to fundus photography.

Applications of Artificial Intelligence and Deep Learning in Glaucoma

“…High-quality images from eyes with media opacities, with movement artifacts, or anterior segment pathology can be difficult to obtain. Another fundamental challenge is that clinical glaucoma evaluation generally requires integrated analysis of multiple modalities (eg, clinical examination, ONH imaging, and VF testing) to determine the glaucoma subtypes and any progression, not only fundus photo findings 37,38. Groups have attempted to address this by developing algorithms utilizing multimodal imaging, which will be discussed later in this paper.…”

Innovations in Diabetic Macular Edema Management: A Comprehensive Review of Automated Quantification and Anti-vascular Endothelial Growth Factor Intervention

“…OCT proves particularly beneficial in diagnosing and monitoring conditions such as DME, ARMD, and glaucoma. Notably, OCT surpasses fundus photography in glaucoma screening by enabling the precise quantification of retinal structures, thereby enhancing diagnostic accuracy [ 18 , 19 ]. Recognizing the complementary strengths of both techniques is crucial in ophthalmic practice.…”

Comparative Evaluation of Fundus Image Interpretation Accuracy in Glaucoma Screening Among Different Physician Groups

“…To address the challenges identified, establishing a remote interpretation support system accessible to specialist ophthalmologists and building an AI-assisted diagnostic system 13 might be effective methods to mitigate variability in reading accuracy. Additionally, incorporating new ophthalmic examinations such as optical coherence tomography (OCT) 10,14 and visual field perimeters 7,15,16 might elevate the overall accuracy of image interpretation.…”

“…In countries like Japan, where non-ophthalmologists are involved in glaucoma screening, it is imperative to ascertain the level of accuracy with which these practitioners can evaluate fundus images. Previous reports have highlighted a variance in accuracy among ophthalmologists utilizing fundus photography for glaucoma assessment; [8][9][10] yet these studies exclusively focused on ophthalmologists, leaving the evaluation of nonophthalmologists who routinely interpret fundus images unexplored. We anticipate that the findings of this study will clearly delineate the obstacles inherent in glaucoma screening and spur further research aimed at refining the accuracy of glaucoma screening techniques.…”