Centre for Eye Research Australia, University of Melbourne at The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Clin Exp Ophthalmol. 2011 May-Jun;39(4):308-17. doi: 10.1111/j.1442-9071.2010.02462.x. Epub 2011 Jan 14.
Development of a standardized internet-based system to self-assess skills in optic disc examination for glaucoma risk assessment.
Prospective internet-based observational study.
Total of 197 participants (glaucoma subspecialists, general ophthalmologists and trainees) from 22 countries.
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.
Inter-observer agreement using kappa (κ) or weighted kappa (κ(w) ).
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.
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.
开发一种标准化的互联网系统，用于自我评估青光眼风险评估中视盘检查的技能。
前瞻性互联网观察研究。
来自 22 个国家的共 197 名参与者（青光眼专家、普通眼科医生和受训者）。
从 2500 张正常和青光眼眼的眼底照片中选择了 42 张展示各种特征的视盘图像。通过网站（http://www.gone-project.com）向临床医生展示图像。参与者被要求评估九个地形特征并对青光眼可能性进行主观评估。
使用κ（κ）或加权κ（κ(w)）评估观察者间一致性。
青光眼专家对青光眼可能性的评估具有相当程度的观察者间一致性（κ(w) = 0.63）。出血的观察者间一致性很高（κ= 0.83），而视盘大小、视盘形状、杯盘比、视盘周围萎缩和杯形的观察者间一致性较高（κ(w) = 0.59-0.68）。与受训者相比，专家对青光眼可能性和大多数视盘特征的观察者间一致性更强：最大的差异在于视网膜神经纤维层损失的评估。对眼科受训者的个别视盘回答进行分析表明，导致青光眼可能性的一致性较低的视盘往往会导致杯盘比、杯形、杯深和视网膜神经纤维层的评估一致性较低。具有中度至深杯或杯盘比在 0.6 到 0.8 之间的特征的视盘也会导致青光眼可能性的一致性降低。
这个基于互联网的系统是一种易于访问和标准化的工具，可供全球临床医生使用，可自我评估和基准测试视盘检查技能。
