Original articleAgreement Among Glaucoma Specialists in Assessing Progressive Disc Changes From Photographs in Open-Angle Glaucoma Patients
Section snippets
Methods
Annual photographs of the optic discs of subjects enrolled in the GILS study were taken with a Zeiss fundus camera (Zeiss Inc, Jena, Germany) as 30-degree images and printed on color transparencies. The photographer captured a stereopair by aligning the camera at the maximal separation possible between two sequential photographs. All eyes with at least two sets of stereophotographs were selected for inclusion. For each eye, the pairs of optic disc photographs most separated in time were
Results
Stereophotographs from at least two different time points were available for 164 eyes of 111 subjects from the entire GILS cohort of 312 eyes of 205 patients. The quality of at least one of the two stereopairs of nine (5.5%) of the 164 eyes was deemed insufficient for analysis by at least two of the three readers, leaving 155 eyes of 103 subjects that were graded by the three glaucoma specialists.
The age of the subjects whose disc photographs were analyzed was 68 ± 12 years with a range of 36
Discussion
We found a lack of agreement among three glaucoma experts when they independently assessed disc change over time in a cohort of OAG patients with established VF loss. Not only was the κ value for agreement poor, but the proportion of discs deemed changed varied widely among the three observers. With adjudication, many discs that one or more observers had considered changed were classified as unchanged, suggesting that many of the changes observed were “soft calls.” It should be noted that,
Henry D. Jampel, MD, MHS, is the Odd Fellows and Rebekahs Professor of Ophthalmology at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine. Dr Jampel is the Associate Editor-in-Chief of Ophthalmology, serves on the Glaucoma Preferred Practice Pattern committee of the American Academy of Ophthalmology, and is Co-Director of the Glaucoma Subspecialty Day 2008 at the annual meeting of the Academy.
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Henry D. Jampel, MD, MHS, is the Odd Fellows and Rebekahs Professor of Ophthalmology at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine. Dr Jampel is the Associate Editor-in-Chief of Ophthalmology, serves on the Glaucoma Preferred Practice Pattern committee of the American Academy of Ophthalmology, and is Co-Director of the Glaucoma Subspecialty Day 2008 at the annual meeting of the Academy.