{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:39:30Z","timestamp":1791895170796,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,11,3]],"date-time":"2024-11-03T00:00:00Z","timestamp":1730592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Program for Zhejiang Leading Talent of S&amp;T Innovation","award":["2021R52012"],"award-info":[{"award-number":["2021R52012"]}]},{"name":"Program for Zhejiang Leading Talent of S&amp;T Innovation","award":["2022C03112"],"award-info":[{"award-number":["2022C03112"]}]},{"name":"Key Research and Development Projects of Zhejiang Province","award":["2021R52012"],"award-info":[{"award-number":["2021R52012"]}]},{"name":"Key Research and Development Projects of Zhejiang Province","award":["2022C03112"],"award-info":[{"award-number":["2022C03112"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: The study aimed to evaluate the interobserver agreement among glaucoma subspecialists in diagnosing glaucoma and to explore the causes of diagnostic discrepancies. Methods: Three experienced glaucoma subspecialists independently assessed frequency domain optical coherence tomography, fundus color photographs, and static perimetry results from 464 eyes of 275 participants, adhering to unified glaucoma diagnostic criteria. All data were collected from the Wenzhou Glaucoma Progression Study between August 2014 and June 2021. Results: The overall interobserver agreement among the three experts was poor, with a Fleiss\u2019 kappa value of 0.149. The kappa values interobserver agreement between pairs of experts ranged from 0.133 to 0.282. In 50 cases, or approximately 10.8%, the three experts reached completely different diagnoses. Agreement was more likely in cases involving larger average cup-to-disc ratios, greater vertical cup-to-disc ratios, more severe visual field defects, and thicker retinal nerve fiber layer measurements, particularly in the temporal and inferior quadrants. High myopia also negatively impacted interobserver agreement. Conclusions: Despite using unified diagnostic criteria for glaucoma, significant differences in interobserver consistency persist among glaucoma subspecialists. To improve interobserver agreement, it is recommended to provide additional training on standardized diagnostic criteria. Furthermore, for cases with inconsistent diagnoses, long-term follow-up is essential to confirm the diagnosis of glaucoma.<\/jats:p>","DOI":"10.3390\/diagnostics14212460","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T05:41:23Z","timestamp":1730698883000},"page":"2460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating Diagnostic Concordance in Primary Open-Angle Glaucoma Among Academic Glaucoma Subspecialists"],"prefix":"10.3390","volume":"14","author":[{"given":"Chenmin","family":"Wang","sequence":"first","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-4598","authenticated-orcid":false,"given":"Xiao","family":"Shang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Wang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xizhong","family":"Chu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengju","family":"Hu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiangjie","family":"Huang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gangwei","family":"Cheng","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5785-2165","authenticated-orcid":false,"given":"Ruiyi","family":"Ren","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanbo","family":"Liang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/S2214-109X(13)70113-X","article-title":"Causes of vision loss worldwide, 1990\u20132010: A systematic analysis","volume":"1","author":"Bourne","year":"2013","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1016\/j.ophtha.2014.05.013","article-title":"Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis","volume":"121","author":"Tham","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1136\/bjo.2005.081224","article-title":"The number of people with glaucoma worldwide in 2010 and 2020","volume":"90","author":"Quigley","year":"2006","journal-title":"Br. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"AGIS Investigators (2000). The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am. J. Ophthalmol., 130, 429\u2013440.","DOI":"10.1016\/S0002-9394(00)00538-9"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"CNTGS Group (1998). The effectiveness of intraocular pressure reduction in the treatment of Normal-tension glaucoma. Collaborative Normal tension glaucoma study group. Am. J. Ophthalmol., 126, 498\u2013505.","DOI":"10.1016\/S0002-9394(98)00272-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.ajo.2013.05.027","article-title":"Lifetime risk of blindness in open-angle glaucoma","volume":"156","author":"Peters","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1016\/S0161-6420(98)91133-2","article-title":"The probability of blindness from open-angle glaucoma","volume":"105","author":"Hattenhauer","year":"1998","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/aos.12203","article-title":"Factors associated with lifetime risk of open-angle glaucoma blindness","volume":"92","author":"Peters","year":"2013","journal-title":"Acta Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1097\/IJG.0b013e318163bdd1","article-title":"Depression and quality of life in patients with glaucoma: A cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision, and the Glaucoma Quality of Life-15","volume":"17","author":"Skalicky","year":"2008","journal-title":"J. Glaucoma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1097\/OPX.0b013e31822f4d6a","article-title":"Inferior field loss increases rate of falls in older adults with glaucoma","volume":"88","author":"Black","year":"2011","journal-title":"Optom. Vis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ophtha.2020.10.023","article-title":"Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern\u00ae","volume":"128","author":"Gedde","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bjophthalmol-2021-egsguidelines","article-title":"European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition","volume":"105","author":"Spaeth","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Watanabe, T., Hiratsuka, Y., Kita, Y., Tamura, H., Kawasaki, R., Yokoyama, T., Kawashima, M., Nakano, T., and Yamada, M. (2022). Combining Optical Coherence Tomography and Fundus Photography to Improve Glaucoma Screening. Diagnostics, 12.","DOI":"10.3390\/diagnostics12051100"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5935\/0004-2749.20210016","article-title":"Use of computerized campimetry and\/or optical coherence tomography for glaucoma diagnosis by non-glaucoma specialists","volume":"84","author":"Franco","year":"2021","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1097\/OPX.0000000000000394","article-title":"Visual fields and OCT role in diagnosis of glaucoma","volume":"91","author":"Bae","year":"2014","journal-title":"Optom. Vis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0161-6420(94)31118-3","article-title":"Agreement among optometrists, ophthalmologists, and residents in evaluating the optic disc for glaucoma","volume":"101","author":"Abrams","year":"1994","journal-title":"Ophthalmology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1167\/tvst.3.6.8","article-title":"Evaluation of a One-Page Report to Aid in Detecting Glaucomatous Damage","volume":"3","author":"Hood","year":"2014","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"OCT80","DOI":"10.1167\/iovs.15-18931","article-title":"Technology and the Glaucoma Suspect","volume":"57","author":"Blumberg","year":"2016","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/S0002-9394(01)01254-5","article-title":"Agreement among clinicians in the recognition of patterns of optic disk damage in glaucoma","volume":"132","author":"Nicolela","year":"2001","journal-title":"Am. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ophtha.2010.06.036","article-title":"Ability of cirrus HD-OCT optic nerve head parameters to discriminate normal from glaucomatous eyes","volume":"118","author":"Mwanza","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5882","DOI":"10.1167\/iovs.16-20104","article-title":"Diagnostic Performance of Peripapillary Retinal Nerve Fiber Layer Thickness for Detection of Glaucoma in an Elderly Population: The ALIENOR Study","volume":"57","author":"Schweitzer","year":"2016","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1007\/s00417-018-4011-z","article-title":"Prevalence of glaucoma in Germany: Results from the Gutenberg Health Study","volume":"256","author":"Nickels","year":"2018","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1136\/bjo.86.2.238","article-title":"The definition and classification of glaucoma in prevalence surveys","volume":"86","author":"Foster","year":"2002","journal-title":"Br. J. Ophthalmol."},{"key":"ref_24","first-page":"1641","article-title":"The prevalence of primary open-angle glaucoma in Japanese: The Tajimi Study","volume":"111","author":"Iwase","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1097\/IJG.0000000000002248","article-title":"A Systematic Review of Glaucoma Diagnosis in Prevalence Studies and Quality of Reporting","volume":"32","author":"Keay","year":"2023","journal-title":"J. Glaucoma"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1167\/iovs.65.3.28","article-title":"Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma","volume":"65","author":"Chen","year":"2024","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0161-6420(02)01754-2","article-title":"Reproducibility of evaluation of optic disc change for glaucoma with stereo optic disc photographs","volume":"110","author":"Zeyen","year":"2003","journal-title":"Ophthalmology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0161-6420(92)31990-6","article-title":"Expert agreement in evaluating the optic disc for glaucoma","volume":"99","author":"Varma","year":"1992","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1136\/bjo.2010.186569","article-title":"Agreement of visual field interpretation among glaucoma specialists and comprehensive ophthalmologists: Comparison of time and methods","volume":"95","author":"Lin","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.ophtha.2010.08.019","article-title":"Agreement and accuracy of non-expert ophthalmologists in assessing glaucomatous changes in serial stereo optic disc photographs","volume":"118","author":"Breusegem","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1167\/iovs.05-1133","article-title":"Influence of Disease Severity and Optic Disc Size on the Diagnostic Performance of Imaging Instruments in Glaucoma","volume":"47","author":"Medeiros","year":"2006","journal-title":"Investig. Opthalmology Vis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ophtha.2020.06.036","article-title":"Explaining the Rationale of Deep Learning Glaucoma Decisions with Adversarial Examples","volume":"128","author":"Chang","year":"2021","journal-title":"Ophthalmology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/21\/2460\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:48Z","timestamp":1760113668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/21\/2460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,3]]},"references-count":32,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["diagnostics14212460"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14212460","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,3]]}}}