Interobserver and Intraobserver Variability in the Detection of Glaucomatous Progression of the Optic Disc

Coleman, Anne L.; Enger, Cheryl; Knopf, Harry L S; Stamper, Robert L.; Minckler, Donald S.

doi:10.1097/00061198-199612000-00005

Cited by 60 publications

(40 citation statements)

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“…Therefore, in an eye with advanced disease and large CDR, it will be difficult to detect further changes in CDR unless the loss of RGCs is substantial. These results may explain the widely held belief, also supported by some studies, 2,20,38,39 that evaluation of the optic disc by biomicroscopy or photographs may be relatively insensitive to detect disease progression in moderate to advanced stages of damage.…”

Section: Discussionsupporting

confidence: 52%

The Relationship Between Cup-to-Disc Ratio and Estimated Number of Retinal Ganglion Cells

Tatham

Weinreb

Zangwill

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To investigate the relationship between cup-to-disc ratio (CDR) and estimates of retinal ganglion cell (RGC) number.METHODS. This cross-sectional study included 156 healthy eyes, 53 glaucoma suspects, and 127 eyes with glaucoma. All eyes had standard automated perimetry (SAP), Cirrus SD-OCT, and stereoscopic optic disc photography within 6 months. CDR was determined from stereoscopic photographs by two or more masked graders. The number of RGCs in each eye was estimated using a published model that combines estimates of RGC number from SAP sensitivity thresholds and SD-OCT retinal nerve fiber layer measurements.RESULTS. The mean estimated RGC count was 1,063,809 in healthy eyes; 828,522 in eyes with suspected glaucoma; and 774,200 in early, 468,568 in moderate, and 218,471 in advanced glaucoma. Healthy eyes had a mean vertical CDR of 0.45 6 0.15 vs. 0.80 6 0.16 in glaucomatous eyes. There was good correlation between stereophotographic vertical CDR and SD-OCT vertical CDR (R 2 ¼ 0.825; P < 0.001). The relationship between estimated RGCs and vertical CDR was best represented using a third degree polynomial regression model, including age and optic disc area, which accounted for 83.3% of the variation in estimated RGC counts. The nonlinear relationship between RGC estimates and CDRs indicated that eyes with a large CDR would require loss of large RGC numbers for a small increase in CDR. CONCLUSIONS.The relationship between estimated RGC counts and CDR suggests that assessment of change in CDR is an insensitive method for evaluation of progressive neural losses in glaucoma. Even relatively small changes in CDR may be associated with large losses of RGCs, especially in eyes with large CDRs. (ClinicalTrials.gov numbers, NCT00221923, NCT00221897.)

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Section: Discussionsupporting

confidence: 52%

The Relationship Between Cup-to-Disc Ratio and Estimated Number of Retinal Ganglion Cells

Tatham

Weinreb

Zangwill

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…However, a certain level of clinical inconsistency should be acknowledged. Coleman et al recently reported poor clinical agreement in detecting changes in the optic disc with non-simultaneous disc photographs (Coleman et al 1996). A variable stereo base could partially explain the poorer agreement.…”

Section: Discussionmentioning

confidence: 98%

“…Observer agreement has been suggested to be higher with stereoscopic photographs than with monoscopic images (Lichter 1976;Tielsch et al 1988;Varma et al 1992). However, the qualitative examination of the optic disc relies on the experience of the examiner, and some degree of variability has to be expected (Lichter 1976;Klein et al 1985Klein et al , 1987Tielsch et al 1988;Varma et al , 1992Odberg & Rise 1985;Abrams et al 1994;Coleman et al 1996). The reported intra-and inter-observer concordance in the evaluation of some features of the disc contour is high (Lichter 1976;Tielsch et al 1988;Varma et al , 1992.…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative or semiquantitative estimates of the optic nerve head by disc drawings or fundus photography (Lichter 1976;Klein et al 1985Klein et al , 1987Tielsch et al 1988;Varma et al , 1992Odberg & Rise 1985;Abrams et al 1994;Coleman et al 1996) and computerized quantitative techniques (Varma et al 1988;Dandona et al 1989;Dreher et al 1991;Burk et al 1993;Cioffi et al 1993;Weinreb et al 1993;Mikelberg et al 1993;Hoskins et al 1994;Varma et al 1994;Tezel et al 1996) can be used to record the appearance of the optic nerve head. Computerized disc analysis and laser scanning devices seem attractive but are expensive and their clinical utility has not been established yet in longitudinal studies.…”

mentioning

confidence: 99%

“…However, the clinical agreement in the evaluation of changes of the optic nerve head is not well established yet. A recent study reported that examination of sequential stereophotographs had poor specificity and sensitivity in detecting changes in the optic disc (Coleman et al 1996).…”

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confidence: 99%

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Detection of changes of the optic disc in glaucomatous eyes: Clinical examination and image analysis with the Topcon Imagenet system

Azuara‐Blanco

Katz

Spaeth

et al. 2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: This study was designed to evaluate the clinical agreement in the detection of optic disc changes and the ability of computerized image analysis to detect glaucomatous deterioration of the optic disc. Methods: Pairs of stereophotographs of 35 glaucomatous optic discs taken 5 years apart and of 5 glaucomatous discs photographed twice on the same day. Two glaucoma specialists examined the pairs of stereophotographs (35 cases and 5 controls) in a masked manner and judged whether the optic disc showed changes in the optic disc compatible with progression of glaucomatous damage. The stereophotographs of the five optic discs photographed twice on the same day (which by definition did not change) and of five cases judged to have deteriorated by both glaucoma specialists were analyzed by computerized image analysis with the Topcon ImageNet system. Intra-and inter-observer agreement in the detection of optic disc changes (evaluated using kappa statistic), and changes in the rim area to disc area ratio (evaluated using descriptive statistics and paired t-test). Results: Intra-observer agreement had a kappa value of 0.75 for observer 1 and 0.60 for the observer 2. Inter-observer agreement between the glaucoma specialists had a kappa value of 0.60. The image analyzer did not discriminate between controls and cases with clinically apparent glaucomatous change of the optic disc. Conclusion: Clinical agreement in detecting changes in the optic disc was moderate to substantial. Computerized image analysis with the Topcon ImageNet system appeared not to be useful in detecting glaucomatous changes of the optic disc.

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Short-Wavelength Automated Perimetry and Standard Perimetry in the Detection of Progressive Optic Disc Cupping

Girkin

Emdadi²,

Sample³

et al. 2000

Arch Ophthalmol

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Objective: To compare progression in shortwavelength automated perimetry (SWAP) and white-onwhite (standard) perimetry in eyes with progressive glaucomatous changes of the optic disc detected by serial stereophotographs. Methods: Forty-seven glaucoma patients with at least 2 disc stereophotographs more than 2 years apart, along with standard perimetry and SWAP examinations within 6 months of each disc photo of the same eye, were included in the study. The mean follow-up time was 4.1 years (range, 2.0-8.9 years). Baseline and follow-up stereophotographs were then graded and compared for the presence of progression. Progression in standard perimetry and SWAP, using the Advanced Glaucoma Intervention Study scoring system and a clinical scoring system, was compared between eyes with progressive change on stereophotographs and those without. Results: Twenty-two of 47 eyes showed progressive change by stereophotographs. There was a statistically significant difference in the mean change in Advanced Glaucoma Intervention Study scores for both standard perimetry (PϽ.004) and SWAP (PϽ.001) between the progressed and nonprogressed groups. The sensitivity, specificity, and area under the receiver operator characteristic curve were higher using SWAP than standard perimetry when evaluated by either algorithm. This was statistically significant only in the area under the receiver operator characteristic curve for the Advanced Glaucoma Intervention Study scoring system (P=.04). Conclusions: Short-wavelength automated perimetry identified more patients than standard perimetry as having progressive glaucomatous changes of the optic disc. Compared with standard perimetry, SWAP may improve the detection of progressive glaucoma.

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Interobserver and Intraobserver Variability in the Detection of Glaucomatous Progression of the Optic Disc

Cited by 60 publications

References 0 publications

The Relationship Between Cup-to-Disc Ratio and Estimated Number of Retinal Ganglion Cells

The Relationship Between Cup-to-Disc Ratio and Estimated Number of Retinal Ganglion Cells

Detection of changes of the optic disc in glaucomatous eyes: Clinical examination and image analysis with the Topcon Imagenet system

Short-Wavelength Automated Perimetry and Standard Perimetry in the Detection of Progressive Optic Disc Cupping

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