TY - JOUR
T1 - Agreement Among Glaucoma Specialists in Assessing Progressive Disc Changes From Photographs in Open-Angle Glaucoma Patients
AU - Jampel, Henry D.
AU - Friedman, David
AU - Quigley, Harry
AU - Vitale, Susan
AU - Miller, Rhonda
AU - Knezevich, Frederick
AU - Ding, Yulan
N1 - Funding Information:
This study was supported by The National Eye Institute/National Institutes of Health, Baltimore, Maryland, Grant R01 EY 12295 and unrestricted support from Livingston and Saranne Kosberg, Houston, Texas. Dr Quigley is receiving consulting fees (per year) from Pfizer ($25,000); Allergan ($3,000), and Alcon ($5,000). His current grant support is from Alcon for $150 000. Involved in design and conduct of study (H.D.J., D.F., H.Q., S.V., R.M., F.K., Y.D.); collection of data (H.D.J., R.M., F.K.); analysis, management, and interpretation of data (H.D.J., D.F., H.Q., S.V.); writing the article (H.D.J., D.F., H.Q., S.V., R.M., F.K., Y.D.); and review and preparation of manuscript (H.D.J., D.F., H.Q., S.V., R.M., F.K., Y.D.). This study was approved by Johns Hopkins University, School of Medicine, Institutional Review Boards (IRBs). The study was in accordance with the Declaration of Helsinki and HIPAA.
PY - 2009/1
Y1 - 2009/1
N2 - Purpose: To determine the agreement among glaucoma specialists in assessing progressive disc changes from photographs in a cohort of patients with glaucomatous visual field loss. Design: Retrospective cohort study. Methods: Three glaucoma specialists, masked to chronological sequence, examined pairs of optic disc stereophotographs to determine whether the appearance of the optic disc had changed. Eyes for which the observers disagreed were adjudicated to reach a consensus about which discs had changed over time. Results: Sequential stereophotographs, separated in time by a median of 26 months (range, five to 50), from 164 eyes of 111 patients were analyzed. Among the three observers, the number of interpretable discs judged to have changed was 11 of 155 (7%) for Observer 1, 17 of 155 (11%) for Observer 2, and 44 of 155 (28%) for Observer 3 (κ = 0.20). Sixty-six eyes (43%) required adjudication. After adjudication, the consensus was that 10 discs had changed, six eyes in which the disc was worse in the later photograph and four eyes in which the disc was judged to appear more glaucomatous in the earlier photograph. Conclusion: Interobserver agreement among glaucoma specialists in judging progressive optic disc change from stereophotographs was slight to fair. After masked adjudication, in 40% of the cases in which the optic disc appeared to have progressed in glaucoma severity, the photograph of the "worse" optic disc was in fact taken at the start of the study. Caution must be exercised when using disc change on photographs as the "gold standard" for diagnosing open-angle glaucoma or determining its progression.
AB - Purpose: To determine the agreement among glaucoma specialists in assessing progressive disc changes from photographs in a cohort of patients with glaucomatous visual field loss. Design: Retrospective cohort study. Methods: Three glaucoma specialists, masked to chronological sequence, examined pairs of optic disc stereophotographs to determine whether the appearance of the optic disc had changed. Eyes for which the observers disagreed were adjudicated to reach a consensus about which discs had changed over time. Results: Sequential stereophotographs, separated in time by a median of 26 months (range, five to 50), from 164 eyes of 111 patients were analyzed. Among the three observers, the number of interpretable discs judged to have changed was 11 of 155 (7%) for Observer 1, 17 of 155 (11%) for Observer 2, and 44 of 155 (28%) for Observer 3 (κ = 0.20). Sixty-six eyes (43%) required adjudication. After adjudication, the consensus was that 10 discs had changed, six eyes in which the disc was worse in the later photograph and four eyes in which the disc was judged to appear more glaucomatous in the earlier photograph. Conclusion: Interobserver agreement among glaucoma specialists in judging progressive optic disc change from stereophotographs was slight to fair. After masked adjudication, in 40% of the cases in which the optic disc appeared to have progressed in glaucoma severity, the photograph of the "worse" optic disc was in fact taken at the start of the study. Caution must be exercised when using disc change on photographs as the "gold standard" for diagnosing open-angle glaucoma or determining its progression.
UR - http://www.scopus.com/inward/record.url?scp=57549088895&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=57549088895&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2008.07.023
DO - 10.1016/j.ajo.2008.07.023
M3 - Article
C2 - 18790472
AN - SCOPUS:57549088895
SN - 0002-9394
VL - 147
SP - 39-44.e1
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 1
ER -