title: Assessment of optic disc photographs for glaucoma by UK optometrists: the Moorfields Optic Disc Assessment Study (MODAS).
abstract: OBJECTIVE
  To assess the ability of UK optometrists to accurately discriminate between stereoscopic photographs of healthy and glaucomatous optic discs.
  
  
  METHODS
  An online survey, including questions relating to qualification, practice environment, and diagnostic methods was completed by 1256 optometrists. Based on their responses, 208 (17%) were selected to undertake an online disc assessment exercise. Optometrists evaluated the same disc images previously assessed by European ophthalmologists as part of the European Optic Disc Assessment Trial (EODAT); the task was to state if the disc appeared healthy or glaucomatous. There were 110 stereoscopic disc images, of which 40 were healthy, 48 glaucomatous, and six ocular hypertensive, with 16 duplicates images. Sensitivity, specificity and overall accuracy were calculated and compared between optometrist groups and with the EODAT ophthalmologists using permutation analysis.
  
  
  RESULTS
  Median sensitivity was 0.92 (95% CI: 0.70, 1.00) and median specificity was 0.74 (95% CI: 0.62, 0.88). Median overall accuracy was 80% (95% CI: 67%, 88%). Agreement between optometrists was moderate (Fleiss' κ: 0.57). Optometrists with higher qualifications did not have overall higher sensitivity than those without (p = 0.23), but had higher specificity (p = 0.001) and higher overall accuracy (p < 0.001). Optometrists displayed higher sensitivity but lower specificity than the EODAT ophthalmologists.
  
  
  CONCLUSIONS
  UK optometrists displayed a high sensitivity and moderate specificity when assessing optic discs for the presence of glaucoma, in the context of this study.
authors: Optometry Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK. shonahadwin@hotmail.com
authors: Shona E
authors: SE
authors: Hadwin
authors: Tony
authors: T
authors: Redmond
authors: David F
authors: DF
authors: Garway-Heath
authors: Hans G
authors: HG
authors: Lemij
authors: Nicolaas J
authors: NJ
authors: Reus
authors: Gavin
authors: G
authors: Ward
authors: Roger S
authors: RS
authors: Anderson
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009898:Optic Disk / Q000473:pathology*; D009907:Optometry / Q000592:standards*; D010781:Photography / Q000592:standards*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: diagnosis; diagnostic imaging; glaucoma; optic disc; optometrist; stereoscopic images