OCT Centers: Role in Glaucoma Screening?

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Could OCT reading centers be useful for determining glaucoma referability and increasing agreement among glaucoma specialists? The answer may be yes, according to recent research out of New York University.¹

In this retrospective exploratory study, researchers compared glaucoma referral patterns of three independent glaucoma specialists based upon a com­prehensive teleophthalmology screen­ing protocol.² They then compared these patterns to referrals made by two OCT report specialists on the sole basis of the OCT.

“The literature has demonstrated interobserver variability in glaucoma referral, approximately 15% on average,” said coauthor Lama Al-Aswad, MD, MPH, CEO of Visi Health Tech­nologies and EnVision Health Technol­ogies in New York City. “This is a prob­lem in community screening because, in general, we don’t want a lot of false positive or unnecessary referrals.”

Mobile screening project. The study included data on 243 individuals (483 eyes) who were evaluated during a mo­bile van community screening project that took place in 2017 in several New York City neighborhoods. The par­ticipants (mean age, 59.4 years) were predominantly Black or Hispanic, and 50% were female. They underwent comprehensive ophthalmic evaluations, including anterior segment OCT to evaluate the angle and posterior seg­ment OCT to evaluate the macula and optic nerve.

For this study, three glaucoma spe­cialists independently evaluated the col­lected data to determine whether they would recommend a further glaucoma workup. To simulate a reading center, two OCT report specialists evaluated only the OCT image for each eye using the commercial report and a specialized custom report. They then looked at the effect of making the OCT specialist custom reports available to the glauco­ma specialists.

Results. Intergrader agreement between glaucoma specialists and between OCT report specialists was 60% (k = 0.43) and 95% (k = 0.77), respectively. The glaucoma specialists determined that 25% of cases were referable for further workup, while the report specialists recommended that 1% be referred. With the availability of the OCT report specialist’s judgments in the second phase of the analysis, overall agreement increased to 85% (k = 0.53).

Surprising findings. “In our study, we showed that there is less variability in the interpretation when adding a customized OCT report,” Dr. Al-Aswad said. “These findings were unexpected.” Moreover, she said, “I personally did not think that having a customize report or an OCT specialist would differ from the glaucoma specialists’ decision, because we are experts in OCT readings. I didn’t think that would affect our de­cision-making or increase interobserver agreement.”

Future implications. Based on the findings, Dr. Al-Aswad said, “If you are going to use one tool for glaucoma screening in a large community screen­ing, OCT may be the tool to use.”

Dr. Al-Aswad said the findings “sug­gest a role for an OCT reading center, similar to a radiology reading center,” and she highlighted the importance of community glaucoma screening to de­crease the burden of eye disease. “There is still a lot of work to be done in this field,” she noted. “In addition, we really need to better define glaucoma as a dis­ease for us to be able to create protocols and standards for glaucoma referrals.”

—Patricia Weiser, PharmD

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1 Ramachandran R et al. Ophthalmol Glaucoma. 2023;6(1):602-613.

2 Al-Aswad L et al. Asia Pac J Ophthalmol. 2021;10(5):461-472.

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Relevant financial disclosures: Dr. Al-Aswad—New World Medical: S; Research to Prevent Blindness: S; Russell Barrie Foundation: S; Save Vision Foundation: S; Topcon: S.

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