Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study

Abstract

To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. Retrospective, exploratory study. We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October2017. All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. Intergrader agreement between glaucoma specialists was 60% (κ= 0.43) and between report specialists was 95% (κ= 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.