Can an inexperienced observer accurately plot disc contours using Heidelberg retinal Tomograph?

OBJECTIVE: To examine the reliability of inexperienced observers in plotting optic disc contours on Heidelberg retinal tomography images before and after training. DESIGN: Observational study. PARTICIPANTS: One hundred eyes that were randomly selected from the Singapore Indian Eye Study. METHODS: Both eyes of subjects were imaged with Heidelberg Retina Tomograph 3 (HRT-3; Heidelberg Engineering, Heidelberg, Germany). Optic disc contours were plotted on the same images by 2 new observers on 2 separate occasions, before and after 2-hour standardized training on the skills and tools available to accurately identify and delineate optic disc contours. These plottings were compared with an experienced, trained glaucoma expert (gold standard). Agreement and variability were analyzed by interclass correlation tests and Bland-Altman plots. RESULTS: A total of 182 images (18 excluded because of poor quality) from 89 Indian subjects were included. The mean age was 53.27 ± 7.25 years and 54.8% were male. There was moderate-to-high agreement between pretraining (both new observers) and experienced observer's results (interclass correlation values range, 0.76-0.99). The interclass correlation improved for all the HRT-3 parameters after the 2 new observers were adequately trained. Comparing the interclass correlation values before and after training, the differences for mean retinal nerve fibre layer thickness for Observer 1 and all the HRT-3 parameters for Observer 2 were statistically significant. CONCLUSIONS: This study shows that it is easy to train a new inexperienced observer to plot optic disc contours on HRT images, which translates into improved and acceptable interobserver variability and agreement.

Duke Scholars

Author Tien Yin Wong Ophthalmology