Using optical coherence tomography (OCT) reading centers to determine glaucoma referability may decrease the number of unnecessary referrals and increase agreement between glaucoma specialists, according to research published in Ophthalmology Glaucoma.

Researchers enrolled 449 eyes of 239 patients (mean age 59.4±12.7 years, 50% women, 73% Black or Hispanic ethnicity) in the study. The team performed comprehensive eye examinations, OCT imaging, gonioscopy, intraocular pressure (IOP) measurement, frequency doubling testing, and funduscopic assessment.

A total of 3 glaucoma specialists reviewed the data and determined whether glaucoma referral, ophthalmologic pathology referral, or optometric referral for routine exam was most appropriate. Concurrently, 2 OCT report specialists interpreted quadrant analysis on OCT reports and a specialized customized report.


Continue Reading

The investigators noted that inter-grader agreement was 60% (k=0.42) among glaucoma specialists and 95% (k=0.77) among report specialists. An OCT report specialist and 2 of 3 glaucoma specialists agreed in 74% of cases (k=0.32), according to the report.

Glaucoma specialists determined that 25% of cases were referable, while report specialists recommended that 1% of eyes be referred for further care.

Once researchers evaluated the inter-grader agreement between both groups, they moved to phase 2 of the analysis and made the OCT specialists’ reports available to the glaucoma specialists. After accessing the reports, overall agreement increased to 85% (k=0.53).

“Careful interpretation of OCT imaging, by an OCT reading center, may influence glaucoma referral patterns even when other screening data is available,” according to the investigators. “Thus, it is possible that OCT reading centers can be leveraged in the design of screening protocols to decrease the numbers of unnecessary specialist referrals, while still maintaining a high level of quality comparable to more comprehensive screening strategies.”

Study limitations include a lack of stereoscopic analysis of the optic disk, failure to blind glaucoma specialists to the purpose of phase 2, the exclusion of patients with suspected anatomical narrow angle based on gonioscopy and anterior segment OCT, and the potential for geographical bias. 

Disclosure: This research was supported by multiple sources. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Ramachandran R, Joiner DB, Patel V, et al. Comparisons between the recommendations of glaucoma specialists and OCT report specialists for further ophthalmic evaluation in a community-based screening study. Ophthalmol Glaucoma. Published online June 7, 2022. doi:10.1016/j.ogla.2022.06.001