Background/aims The objective of this study is to evaluate the accuracy and speed of trainees and experienced glaucoma specialists using the MatchedFlicker software against the manual examination of stereoscopic disc photographs for detecting glaucomatous optic disc change.
Methods Three experienced glaucoma specialists, two resident ophthalmologists and one glaucoma fellow from multiple institutions independently evaluated the same 140 image pairs from 100 glaucomatous/ocular hypertensive eyes using a handheld stereo viewer and the MatchedFlicker programme. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and endpoint committee, and 50 more were negative controls for progression with photos taken a few minutes apart. Twenty photo pairs from each of the two groups were duplicated for reviewer variability analysis. The initial viewing method was randomised and then alternated for each group of 70 image pairs. Reviewer accuracy and evaluation time for each method were measured.
Results Evaluators averaged 8.6 s faster per image pair (26%) with the MatchedFlicker programme than with the stereo viewer (p=0.0007). Evaluators correctly identified more image pairs when using the MatchedFlicker software over the stereo viewer (p=0.0003). There was no significant difference between the expert and trainee group in speed or overall accuracy for either method. Experts were significantly more consistent than trainees with the duplicate image pairs (p=0.029). Trainees appeared more reluctant to designate eyes as showing glaucoma progression than experts.
Conclusions Both expert glaucoma specialists and ophthalmologists in various stages of training had greater accuracy and speed with the MatchedFlicker programme than with a handheld stereoscopic viewer.
- optic disc change
- diagnostic technology
- stereoscopic disc viewing
- electronic medical record
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Contributors All the authors have provided substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work, as described for each author below. JLS developed methodology to be used in experiment, managed execution of research project, provided the study materials and conducted experiments and performed data collection. AMM managed execution of research project and coordinated data analysis. CDR and NCR coordinated data analysis. AJL, ZLL, ABG, LJK and JS conducted experiments and performed data collection. GMM developed methodology to be used in experiment, provided the study materials and analyzed the data. BZ and JJS analyzed the data. MAK provided the study materials. MBS conceptualised the research idea, analyzed data, developed methodology to be used in experiment, managed execution of research project, provided the study materials, conducted experiments and performed data collection. All the authors have participated in drafting the work or revising it criticallyfor important intellectual content, as described for each author below. JLS, AMM,GMM, BZ, JJS and MBS were involved in writing the initial draft and preparing data tables and criticalreview and commentary for editing. CDR, NCR, AJL, ZLL, ABG, LJK, JS and MAK did the criticalreview and commentary for editing. All the authors have given final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This study was supported in part by an unrestricted grant from Research to Prevent Blindness (New York City, New York, USA), to the Department of Ophthalmology, University of Florida.
Competing interests None declared.
Patient consent A full waiver of informed consent was granted for the use of de-identified patient optic nerve photographs from patient records and from the Bascom Palmer Eye Institute optic disc reading center because no risk was posed to any patient with their use.
Ethics approval The University of Florida’s Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
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