Comparative Evaluation of Fundus Image Interpretation Accuracy in Glaucoma Screening Among Different Physician Groups

Abstract

Purpose

To examine the variability in glaucoma screening using fundus images among physicians, including non-ophthalmologists.

Patients and Methods

Sixty-nine eyes from 69 patients, including 25 eyes with glaucoma, were included from the Jikei University Hospital from July 2019 to December 2022. Fundus images were captured using TRC-NW8 (Topcon Corporation, Tokyo, Japan), and were interpreted by 10 non-ophthalmologists, 10 non-specialist ophthalmologists, and 9 specialists for diagnostic accuracy. We analyzed differences in diagnostic accuracy among the three groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa coefficient were compared, using the Kruskal–Wallis test followed by a post hoc Dunn’s test.

Results

The sensitivity and specificity were 0.22 and 0.92 for non-ophthalmologists, 0.49 and 0.83 for non-specialist ophthalmologists, and 0.68 and 0.87 for specialists, respectively. Both specialists and non-specialist ophthalmologists showed significantly higher sensitivity than non-ophthalmologists (Dunn’s test, P<0.001 and P=0.031). There was no significant difference in specificity among the three groups (Kruskal–Wallis test, P=0.086). The PPV did not differ significantly between the groups (Kruskal–Wallis test, P=0.108), while the NPV was significantly higher in specialists compared to non-ophthalmologists (Dunn’s test, P<0.001). Specialists also had a significantly higher Kappa coefficient than non-ophthalmologists and non-specialist ophthalmologists (Dunn’s test, P<0.001 and P=0.024).

Conclusion

Diagnostic accuracy varied significantly based on the physician’s background.

Keywords:

• glaucoma
• fundus images
• sensitivity
• specificity
• health checkup

Acknowledgments

We would like to thank all the physicians who provided their expertise in the interpretation of fundus image examinations.

Disclosures

The authors have made the following disclosure: R.T., E.N.: grant - Carl Zeiss, outside the submitted work. T.Na.: grants - Crewt Medical Systems, Kyowa Medical, Kuribara Medical Instruments, Tomey, MSD, Pfizer, Alcon Japan, NIDEK, AMO Japan, Bayer, IOL Medical, All Nippon Airway, Japan Airlines Nitto Medic, Nikon; grants and personal fees - Kowa, Otsuka Pharmaceutical, Senju Pharmaceutical, Santen Pharmaceutical, Carl Zeiss, outside the submitted work. The other authors report that they have no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Ministry of Health, Labor and Welfare (MHLW) Sciences Research Grant (Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus, 20FA1021, PI: Dr. Takashi WADA).