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: fundus images; glaucoma; health checkup; sensitivity; specificity.