title: The effect of education on the assessment of optic nerve head photographs for the glaucoma diagnosis.
abstract: BACKGROUND
  To evaluate the effect of one lesson of continuing medical education (CME) of subjective assessment of optic nerve head appearance on sensitivity and specificity for the diagnosis of glaucoma.
  
  
  METHODS
  Ophthalmologists and residents in ophthalmology attending an international glaucoma meeting arranged at Malmö University Hospital, Malmö, Sweden, were asked to grade optic nerve head (ONH) photographs of healthy and glaucomatous subjects at two sessions separated by a lecture on glaucoma diagnosis by ONH assessment. Each grader had access to an individual portfolio of 50 ONH photographs randomly selected from a web-based data bank including ONH photographs of 73 glaucoma patients and 123 healthy subjects. The individual portfolio of photographs was graded before and after the lecture, but in different randomized order.
  
  
  RESULTS
  Ninety-six doctors, 91% of all attending the meeting, completed both assessment sessions. The number of correct classifications increased from 69 to 72% on the average. Diagnostic sensitivity increased significantly (p < 0.0001) from 70% to 80%, and the number of photographs classified as uncertain decreased significantly (p < 0.0001) from 22% to 13%. Specificity remained at 68%, and intra-grader agreement decreased.
  
  
  CONCLUSIONS
  CME had only a small effect on the assessment of ONH for the glaucoma diagnosis. Sensitivity increased and the amount of uncertain classifications decreased, while specificity was unchanged.
authors: Department of Clinical Sciences, Ophthalmology, Malmö, Lund University, Sweden. sabina.andersson@med.lu.se
authors: Sabina
authors: S
authors: Andersson
authors: Anders
authors: A
authors: Heijl
authors: Andreas G
authors: AG
authors: Boehm
authors: Boel
authors: B
authors: Bengtsson
references: Arch Ophthalmol. 1967 Jul;78(1):35-43
references: 6067496
references: Ophthalmology. 2005 May;112(5):855-62
references: 15878066
references: Ophthalmology. 2000 Dec;107(12):2272-7
references: 11097609
references: Ophthalmology. 2004 Jan;111(1):125-32
references: 14711724
references: J Gen Intern Med. 1989 Jul-Aug;4(4):296-9
references: 2760698
references: Ophthalmology. 2003 Aug;110(8):1540-4
references: 12917169
references: Optometry. 2005 Nov;76(11):661-8
references: 16298320
references: Graefes Arch Clin Exp Ophthalmol. 1988;226(6):522-30
references: 3209079
references: Trans Ophthalmol Soc U K. 1973;93(0):213-42
references: 4526444
references: Acta Ophthalmol (Copenh). 1993 Feb;71(1):122-9
references: 8475706
references: Acta Ophthalmol (Copenh). 1976 Dec;54(6):804-18
references: 990030
references: Ophthalmology. 2004 Oct;111(10):1873-9
references: 15465549
references: Acta Ophthalmol Scand. 1999 Feb;77(1):13-8
references: 10071140
references: Invest Ophthalmol Vis Sci. 2006 Aug;47(8):3374-80
references: 16877405
references: Diabet Med. 1997 Nov;14(11):970-3
references: 9400922
references: Acta Ophthalmol Scand. 1998 Apr;76(2):170-5
references: 9591947
references: Br J Ophthalmol. 1976 Nov;60(11):778-85
references: 1009058
references: Ophthalmology. 1992 Feb;99(2):215-21
references: 1553210
references: Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5667-74
references: 20505199
references: Ophthalmology. 2003 Aug;110(8):1499-505
references: 12917163
references: Ophthalmology. 2007 Sep;114(9):1748-54
references: 17368543
references: Graefes Arch Clin Exp Ophthalmol. 2001 Jun;239(5):342-50
references: 11482337
references: Am J Ophthalmol. 1964 Dec;58:958-64
references: 14233720
references: Ophthalmology. 2010 Apr;117(4):717-23
references: 20045571
references: Trans Am Acad Ophthalmol Otolaryngol. 1974 Mar-Apr;78(2):OP255-74
references: 4825055
references: Ophthalmology. 1990 Sep;97(9):1211-5
references: 2234855
references: Acta Ophthalmol (Copenh). 1981 Oct;59(5):627-41
references: 7315218