title: Comparison of clinicians and an artificial neural network regarding accuracy and certainty in performance of visual field assessment for the diagnosis of glaucoma.
abstract: OBJECTIVE
  To compare clinicians and a trained artificial neural network (ANN) regarding accuracy and certainty of assessment of visual fields for the diagnosis of glaucoma.
  
  
  METHODS
  Thirty physicians with different levels of knowledge and experience in glaucoma management assessed 30-2 SITA Standard visual field printouts that included full Statpac information from 99 patients with glaucomatous optic neuropathy and 66 healthy subjects. Glaucomatous eyes with perimetric mean deviation values worsethan -10 dB were not eligible. The fields were graded on a scale of 1-10, where 1 indicated healthy with absolute certaintyand 10 signified glaucoma; 5.5 was the cut-off between healthy and glaucoma. The same fields were classified by a previously trained ANN. The ANN output was transformed into a linear scale that matched the scale used in the subjective assessments. Classification certainty was assessed using a classification error score.
  
  
  RESULTS
  Among the physicians, sensitivity ranged from 61% to 96% (mean 83%) and specificity from 59% to 100% (mean 90%). Our ANN achieved 93% sensitivity and 91% specificity, and it was significantly more sensitive than the physicians (p < 0.001) at a similar level of specificity. The ANN classification error score was equivalent to the top third scores of all physicians, and the ANN never indicated a high degree of certainty for any of its misclassified visual field tests.
  
  
  CONCLUSIONS
  Our results indicate that a trained ANN performs at least as well as physicians in assessments of visual fields for the diagnosis of glaucoma.
authors.affiliation: Department of Clinical Sciences, Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden. sabina.andersson@med.lu.se
authors.forename: Sabina
authors.initials: S
authors.lastname: Andersson
authors.forename: Anders
authors.initials: A
authors.lastname: Heijl
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bizios
authors.forename: Boel
authors.initials: B
authors.lastname: Bengtsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016571:Neural Networks, Computer; D012372:ROC Curve; D015203:Reproducibility of Results; D058609:Visual Field Tests / Q000379:methods; D014794:Visual Fields