Non-physician grader reliability in measuring morphological features of the optic nerve head in stereo digital images

Addis, Victoria; Oyeniran, Enny; Daniel, Ebenezer; Salowe, Rebecca; Zorger, Richard; Lee, Roy; Pistilli, Maxwell; Maguire, Maureen G.; Cui, Qi N.; Miller-Ellis, Eydie; O’Brien, Joan M.; Sankar, Prithvi S.

doi:10.1038/s41433-018-0332-8

Cited by 12 publications

(17 citation statements)

References 23 publications

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“…It is possible that further training could have lead to higher accuracy and more agreement across graders, especially given other studies that have shown non-ophthalmologist graders to have higher inter-grader reliability with more extensive training. [19] Despite this, our findings suggest non-ophthalmologist graders might be trained to accurately estimate VCDR using simple visual inspection, although it is important to note that the non-experts with no clinical background did substantially worse than those with clinical experience and interest in ophthalmology, and in some cases, the non-clinical graders demonstrated unacceptable agreement with the reference standard. Indeed, these results provide evidence of the high variability in VCDR grading, especially when done by those with little clinical experience.…”

Section: Discussionmentioning

confidence: 62%

Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening

et al. 2019

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Purpose Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment. Methods In this cross-sectional diagnostic accuracy study, 5 ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7. Results VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the 8 graders and the reference standard was higher for visual inspection (median ICC 0.65, interquartile range 0.57 to 0.82) than for software-assisted grading (median ICC 0.59, IQR 0.44 to 0.71); P = 0.02, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping. Conclusion The computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard.

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Section: Discussionmentioning

confidence: 62%

Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening

et al. 2019

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“…The greater experience and training of glaucoma specialists in the evaluation of the optic disc could, in theory, make the suspicion of glaucoma more accurate. Other studies have seen good intra-and interobserver agreement among ophthalmologists, optometrists, and even nonmedical qualifiers [26][27][28]. In our case, we have models similar to other detection programs that evaluate the retina and also the optic disc, such as in Hong Kong or the UK, where glaucoma specialists [24,29] are not used.…”

Section: Discussionmentioning

confidence: 78%

Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers

Zapata¹,

Martin

Garcia-Arumí

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers. Methods Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24-48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex. Results A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50-59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092-1322). Conclusions Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.

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“…Qualitative phenotypes were obtained using a standardized grading form for 30-degree color stereo disc photos of study subjects, imaged with the Topcon TRC 50EX retinal camera (Topcon Corporation of America, Paramus, NJ, USA). Two non-physician graders were trained by glaucoma specialists to independently complete a standardized form for each pair of color stereo images [ 37 ]. Patients were excluded from analysis if they did not have disc photos or if the photos were deemed too low in quality.…”

Section: Methodsmentioning

confidence: 99%

Association of the SNP rs112369934 near TRIM66 Gene with POAG Endophenotypes in African Americans

Kim

Gudiseva

McGeehan

et al. 2021

Genes

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We investigated the association of the single nucleotide polymorphism (SNP) rs112369934 near the TRIM66 gene with qualitative and quantitative phenotypes of primary open-angle glaucoma (POAG) in African Americans (AA). AA subjects over 35 years old were recruited for the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study in Philadelphia, PA. Glaucoma cases were evaluated for phenotypes associated with POAG pathogenesis, and the associations between rs112369934 and phenotypes were investigated by logistic regression analysis and in gender-stratified case cohorts: The SNP rs112369934 was found to have a suggestive association with retinal nerve fiber layer (RNFL) thickness and cup-to-disc ratio (CDR) in 1087 male AA POAG cases, individuals with the TC genotype having thinner RNFL (95% CI 0.85 to 6.61, p = 0.01) and larger CDR (95% CI −0.07 to −0.01, p = 0.02) than those with wildtype TT. No other significant associations were found. In conclusion SNP rs112369934 may play a role in POAG pathogenesis in male AA individuals. However, this SNP has been implicated in higher POAG risk in both male and female AA POAG cases.

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Non-physician grader reliability in measuring morphological features of the optic nerve head in stereo digital images

Cited by 12 publications

References 23 publications

Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening

Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening

Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers

Association of the SNP rs112369934 near TRIM66 Gene with POAG Endophenotypes in African Americans

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