Provider Agreement in the Assessment of Glaucoma Progression Within a Team Model

Saumya M. Shah, Clara Choo, Jamie Odden, Bingying Zhao, Chengbo Fang, Muriel Schornack, Gina Stalboerger, Jeffrey R. Bennett, Cheryl L. Khanna

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Glaucoma specialists and optometrists who work in a team model at a single institution utilize a common definition of glaucoma progression and treatment algorithm. The purpose of this study was to assess the consistency of agreement in identifying glaucoma progression among glaucoma specialists and optometrists of 1 team. Methods: In total, 399 eyes of 200 patients age 18 or older with glaucoma were enrolled over 2 years. Clinical data, disc photographs, optical coherence tomography (OCT), and visual fields were independently reviewed by 2 masked optometrists and 2 masked fellowship-trained glaucoma specialists. Each eye was judged as progression or no progression of glaucomatous disease. The following were assessed: (1) agreement among optometrists; (2) agreement among glaucoma specialists; and (3) agreement among optometrists and glaucoma specialists. The frequency of use of testing modality to determine progression was also studied. κ statistics were used to evaluate agreements. Results: Optometrists agreed with each other for 74.2% of the eyes assessed (κ=0.42), whereas glaucoma specialists agreed with each other for 78.7% of eyes (κ=0.39). All 4 providers agreed with each other for 54.4% of the eyes evaluated (κ=0.37). Providers had the highest agreement when the progression decision was based on disc hemorrhage (92%) and the lowest agreement when based on OCT progression analysis (36%). Compared with optometrists, glaucoma specialists used OCT (P≤0.01) more frequently to determine disease progression. Conclusions: Fair to moderate agreement levels were found among providers in their assessment of glaucoma progression, suggesting that a team approach to glaucoma management may be effective. Further work is needed to investigate ways to optimize consistency within the glaucoma team.

Original languageEnglish (US)
Pages (from-to)691-698
Number of pages8
JournalJournal of glaucoma
Issue number8
StatePublished - Aug 1 2018


  • Key Words: team care
  • glaucoma monitoring
  • glaucoma practice
  • shared-care model

ASJC Scopus subject areas

  • Ophthalmology


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