Glaucomatous optic neuropathy evaluation project: a standardized internet system for assessing skills in optic disc examination.
BACKGROUND
Development of a standardized internet-based system to self-assess skills in optic disc examination for glaucoma risk assessment.


METHODS
Prospective internet-based observational study.


METHODS
Total of 197 participants (glaucoma subspecialists, general ophthalmologists and trainees) from 22 countries.


METHODS
Forty-two optic disc images demonstrating a range of features were selected from 2500 monoscopic disc photographs of normal and glaucomatous eyes. Images were presented to clinicians via website (http://www.gone-project.com). Participants were asked to assess nine topographic features and make a subjective assessment of glaucoma likelihood.


METHODS
Inter-observer agreement using kappa (κ) or weighted kappa (κ(w) ).


RESULTS
There was substantial level of inter-observer agreement between glaucoma subspecialists for assessment of glaucoma likelihood (κ(w) = 0.63). Inter-observer agreement was high for haemorrhage (κ= 0.83) and substantial for disc size, disc shape, cup:disc ratio, peripapillary atrophy and cup shape (κ(w) = 0.59-0.68). Subspecialists had stronger inter-observer agreement for glaucoma likelihood and for most disc characteristics than did trainees: the greatest difference being the assessment for retinal nerve fibre layer loss. Analysis of individual disc answers from ophthalmology trainees showed that discs leading to lower agreement of glaucoma likelihood tend to produce lower agreement for the assessment of cup:disc ratio, cup shape, cup depth and retinal nerve fibre layer. Discs with features of moderate to deep cup or cup:disc ratio between 0.6 and 0.8 also lead to lower agreement in glaucoma likelihood.


CONCLUSIONS
This internet-based system is a readily accessible and standardized tool, for clinicians globally, that permits self-assessment and benchmarking of skills in optic disc examination.
Centre for Eye Research Australia, University of Melbourne at The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Yu Xiang G
YX
Kong
Michael A
MA
Coote
Evelyn C
EC
O'Neill
Lulu U
LU
Gurria
Jing
J
Xie
David
D
Garway-Heath
Felipe A
FA
Medeiros
Jonathan G
JG
Crowston
D019985:Benchmarking; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D020407:Internet / Q000592:standards*; D007396:Internship and Residency; D016013:Likelihood Functions; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment