Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening.
<h4>Purpose</h4>Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatabilit...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0220362 |
| _version_ | 1818834505623928832 |
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| author | Blake M Snyder Sang Min Nam Preeyanuch Khunsongkiet Sakarin Ausayakhun Thidarat Leeungurasatien Maxwell R Leiter Artem Sevastopolsky Ashlin S Joye Elyse J Berlinberg Yingna Liu David A Ramirez Caitlin A Moe Somsanguan Ausayakhun Robert L Stamper Jeremy D Keenan |
| author_facet | Blake M Snyder Sang Min Nam Preeyanuch Khunsongkiet Sakarin Ausayakhun Thidarat Leeungurasatien Maxwell R Leiter Artem Sevastopolsky Ashlin S Joye Elyse J Berlinberg Yingna Liu David A Ramirez Caitlin A Moe Somsanguan Ausayakhun Robert L Stamper Jeremy D Keenan |
| author_sort | Blake M Snyder |
| collection | DOAJ |
| description | <h4>Purpose</h4>Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment.<h4>Methods</h4>In this cross-sectional diagnostic accuracy study, 5 ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7.<h4>Results</h4>VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the 8 graders and the reference standard was higher for visual inspection (median ICC 0.65, interquartile range 0.57 to 0.82) than for software-assisted grading (median ICC 0.59, IQR 0.44 to 0.71); P = 0.02, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping.<h4>Conclusion</h4>The computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard. |
| first_indexed | 2024-12-19T02:35:53Z |
| format | Article |
| id | doaj.art-f436d599a4284ee88221c631bc04d64c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T02:35:53Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f436d599a4284ee88221c631bc04d64c2022-12-21T20:39:26ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01148e022036210.1371/journal.pone.0220362Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening.Blake M SnyderSang Min NamPreeyanuch KhunsongkietSakarin AusayakhunThidarat LeeungurasatienMaxwell R LeiterArtem SevastopolskyAshlin S JoyeElyse J BerlinbergYingna LiuDavid A RamirezCaitlin A MoeSomsanguan AusayakhunRobert L StamperJeremy D Keenan<h4>Purpose</h4>Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment.<h4>Methods</h4>In this cross-sectional diagnostic accuracy study, 5 ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7.<h4>Results</h4>VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the 8 graders and the reference standard was higher for visual inspection (median ICC 0.65, interquartile range 0.57 to 0.82) than for software-assisted grading (median ICC 0.59, IQR 0.44 to 0.71); P = 0.02, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping.<h4>Conclusion</h4>The computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard.https://doi.org/10.1371/journal.pone.0220362 |
| spellingShingle | Blake M Snyder Sang Min Nam Preeyanuch Khunsongkiet Sakarin Ausayakhun Thidarat Leeungurasatien Maxwell R Leiter Artem Sevastopolsky Ashlin S Joye Elyse J Berlinberg Yingna Liu David A Ramirez Caitlin A Moe Somsanguan Ausayakhun Robert L Stamper Jeremy D Keenan Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. PLoS ONE |
| title | Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. |
| title_full | Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. |
| title_fullStr | Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. |
| title_full_unstemmed | Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. |
| title_short | Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. |
| title_sort | accuracy of computer assisted vertical cup to disk ratio grading for glaucoma screening |
| url | https://doi.org/10.1371/journal.pone.0220362 |
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