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Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one\u2013to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age of DR graders (32.6\u00b15.5 years) did not differ from ophthalmologists (32.3\u00b17.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders\u2019 mean baseline score (33.3%\u00b114.3%) improved significantly after training (55.8%\u00b112.6%, p&lt;0.001), and post-training score did not differ from ophthalmologists (58.7\u00b115.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p&lt;0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p&lt;0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one\u2013to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076623","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T10:33:43Z","timestamp":1699526023000},"page":"e076623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-8924","authenticated-orcid":false,"given":"Olusola Oluyinka","family":"Olawoye","sequence":"first","affiliation":[{"name":"School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK"},{"name":"Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, 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