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Multirater Validation of Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS)
Axel Petzold1,2, Valerie Biousse3, Lulu Bursztyn4
1Moorfields Eye Hospital NHS Foundation Trust and the National Hospital for Neurology and Neurosurgery, Queen Square, Institute of Neurology, University College London, London, UK.
The 2018 definition for peripapillary hyperreflective ovoid mass-like structures (PHOMS) showed poor reliability. A refined definition, developed through expert consensus, significantly improved detection agreement for these new optical coherence tomography (OCT) findings.
Area of Science:
- Ophthalmology
- Medical Imaging
Background:
- Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a novel finding on optical coherence tomography (OCT).
- Previous recommendations in 2018 aimed to differentiate PHOMS from optic disc drusen (ODD).
- The diagnostic accuracy and inter-rater reliability of the 2018 PHOMS definition remain unassessed.
Purpose of the Study:
- To evaluate the reliability of the 2018 PHOMS definition.
- To develop a refined and consistent definition for PHOMS using a Delphi consensus process.
- To improve the diagnostic accuracy and inter-rater agreement for PHOMS detection.
Main Methods:
- A multi-rater study assessed the reliability of the 2018 PHOMS definition.
- A Delphi consensus process involving expert raters was conducted.
- Teaching slides and 50 OCT scans were used to refine the definition and train raters.
Main Results:
- The 2018 PHOMS definition yielded a poor multi-rater kappa of 0.356.
- The refined definition, developed through consensus and training, achieved a good inter-rater agreement (kappa 0.701).
- Fifty explanatory slides and 50 OCT scans facilitated high agreement among 21 expert raters.
Conclusions:
- The initial 2018 definition for PHOMS lacks sufficient reliability for clinical use.
- A refined definition, established via expert consensus and educational materials, significantly enhances diagnostic agreement.
- Adoption of the refined PHOMS definition is recommended for consistent identification in OCT imaging.
