Agreement on the evaluation of glaucomatous optic nerve head findings by ophthalmology residents and a glaucoma specialist

Abstract

Objectives

To assess agreement among ophthalmology residents and a glaucoma expert in the evaluation of cross-sectional glaucomatous optic nerve head characteristics using stereoscopic photographs.

Methods

Twenty stereo photographs were analyzed by ophthalmology residents just after completion of their first (First-Year Group) or third (Third-Year Group) year of residency and by a glaucoma expert. The agreement was assessed using the kappa statistic (κ) and limits of agreement.

Results

Agreement among resident groups and the expert ranged from poor to moderate. Agreement between Third Years and the expert seems to be better than that between First Years and the expert, especially in the evaluation of “nasal cupping”, “barring circumlinear vessel,” “notching”, and “retinal nerve fiber layer defect” criteria. However, no improvement was seen in the agreement with the expert regarding glaucomatous optic neuropathy, which was 64% (κ=0.19) for First Years and 63% (κ=0.20) for Third Years.

Conclusion

Agreement between residents and the expert was poor to moderate and similar when comparing both groups. This may suggest that the residents learn how to identify glaucoma signals during the first year of training, and the results of this study may facilitate the creation of targeted teaching tools in residency training.

Keywords:

• optic disk
• residency and internship
• medical education
• glaucoma

Author contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.