When looking at glaucoma suspects, some metrics may vary depending on the doctor, according to research published in the American Journal of Ophthalmology. The study asked five clinicians—three full-time attending glaucoma specialists, one visiting clinician-scientist specializing in glaucoma and one glaucoma fellow—at the Devers Eye Institute in Portland, Oregon, to provide optic disc margin (DM), rim margin (RM) and rim width (RW) estimates for 214 subjects. The research shows “discordance was frequent and substantial” in all three.

The investigators in this case attribute the discordance to “a lack of agreement on the anatomic landmarks underlying DM and RM.” Additionally, the study notes speculation about the educational foundation of the doctors, alleging that “there is little consistency in the way clinicians are taught how to identify the disc and rim margins.”

Although the study did not note the accuracy of each clinician, it did say that each individual clinician consistently ranked the measurements. For instance, one clinician was consistently logging the smallest DM, RM and RWs, while another consistently marked the largest. A follow-up study is planned to determine each clinician’s accuracy.

Hong S, Koenigsman H, Ren R, et al. Glaucoma specialist optic disc margin, rim margin, and rim width discordance in glaucoma and glaucoma suspect eyes. Am J Ophthalmol. 2018;192(8):65-76.