title: Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of judging optic disc photographs for glaucoma by ophthalmologists.
  
  
  METHODS
  Evaluation of diagnostic test and technology.
  
  
  METHODS
  A total of 243 of 875 invited ophthalmologists in 11 European countries.
  
  
  METHODS
  We determined how well each participant classified 40 healthy eyes and 48 glaucomatous eyes with varying severity of the disease on stereoscopic slides. Duplicate slides were provided for determining intraobserver agreement. All eyes were also imaged with the GDx with variable corneal compensation (GDx-VCC) (Carl Zeiss Meditec AG, Jena, Germany) and the Heidelberg Retina Tomograph (HRT) I (Heidelberg Engineering GmbH, Heidelberg, Germany). Diagnostic accuracies of clinicians were compared with those of the best machine classifiers.
  
  
  METHODS
  Accuracy of classification, expressed as sensitivity, specificity, and overall accuracy. Intraobserver agreement (kappa).
  
  
  RESULTS
  The overall diagnostic accuracy of ophthalmologists was 80.5% (standard deviation [SD], 6.8; range, 61.4%-94.3%). The machine classifiers outperformed most observers in diagnostic accuracy; the GDx-VCC nerve fiber indicator and the HRT's best classifier correctly classified 93.2% and 89.8% of eyes, respectively. The intraobserver agreement (kappa) varied between -0.13 and 1.0 and was on average good (0.7).
  
  
  CONCLUSIONS
  In general, ophthalmologists classify optic disc photographs moderately well for detecting glaucoma. There is, however, large variability in diagnostic accuracy among and agreement within clinicians. Common imaging devices outperform most clinicians in classifying optic discs.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, The Netherlands. n.reus@oogziekenhuis.nl
authors.forename: Nicolaas J
authors.initials: NJ
authors.lastname: Reus
authors.forename: Hans G
authors.initials: HG
authors.lastname: Lemij
authors.forename: David F
authors.initials: DF
authors.lastname: Garway-Heath
authors.forename: P Juhani
authors.initials: PJ
authors.lastname: Airaksinen
authors.forename: Alfonso
authors.initials: A
authors.lastname: Anton
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bron
authors.forename: Christoph
authors.initials: C
authors.lastname: Faschinger
authors.forename: Gábor
authors.initials: G
authors.lastname: Holló
authors.forename: Michele
authors.initials: M
authors.lastname: Iester
authors.forename: Jost B
authors.initials: JB
authors.lastname: Jonas
authors.forename: Andrea
authors.initials: A
authors.lastname: Mistlberger
authors.forename: Fotis
authors.initials: F
authors.lastname: Topouzis
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Zeyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006282:Health Personnel; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009798:Ocular Hypertension / Q000175:diagnosis; D009885:Ophthalmology; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology*; D010781:Photography / Q000379:methods*; D015203:Reproducibility of Results; D057109:Scanning Laser Polarimetry; D012680:Sensitivity and Specificity; D014054:Tomography / Q000379:methods