Optic nerve evaluation among optometrists.

Area of Science:

• Ophthalmology and Optometry
• Glaucoma Diagnosis
• Optic Nerve Imaging

Background:

• Accurate assessment of optic nerve head (ONH) features is crucial for glaucoma diagnosis.
• Cup-to-disk (C/D) ratio estimation and identification of glaucomatous damage are key diagnostic steps.
• Variability in ONH assessment among clinicians can impact patient care.

Purpose of the Study:

• To evaluate agreement among optometrists in assessing optic nerve C/D ratios and glaucomatous damage.
• To analyze how residency training, practice setting, and glaucoma patient experience influence these assessments.
• To determine interobserver and intraobserver agreement levels.

Main Methods:

• Fifty-six optometrists evaluated 33 stereoscopic optic nerve photographs.
• Participants estimated vertical C/D ratios and determined glaucomatous status.
• Interobserver and intraobserver agreement were calculated using kappa statistics.

Main Results:

• Optometrists' C/D ratio estimations and glaucoma damage interpretations varied significantly based on training, practice setting, and experience.
• Higher interobserver agreement for C/D ratios and glaucomatous damage was observed among residency-trained optometrists and those in clinical settings.
• Agreement was notably higher for optometrists with residency training and those practicing in clinical settings (e.g., optometry schools, medical centers).

Conclusions:

• Intraobserver agreement exceeded interobserver agreement for both C/D ratio estimation and glaucomatous damage assessment.
• Residency training, practice environment, and the volume of glaucoma patient encounters significantly influence optometrists' optic nerve evaluations.
• Standardization of ONH assessment criteria may be beneficial to improve diagnostic consistency.