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Open Access Research article

The Effect of Education on the Assessment of Optic Nerve Head Photographs for the Glaucoma Diagnosis

Sabina Andersson1*, Anders Heijl1, Andreas G Boehm23 and Boel Bengtsson1

Author Affiliations

1 Department of Clinical Sciences, Ophthalmology, Malmö, Lund University, Sweden

2 Department of Ophthalmology, Elblandklinikum Radebeul, Radebeul, Germany

3 Department of Ophthalmology, University of Dresden, Dresden, Germany

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BMC Ophthalmology 2011, 11:12  doi:10.1186/1471-2415-11-12

Published: 19 May 2011



To evaluate the effect of one lesson of continuing medical education (CME) of subjective assessment of optic nerve head appearance on sensitivity and specificity for the diagnosis of glaucoma.


Ophthalmologists and residents in ophthalmology attending an international glaucoma meeting arranged at Malmö University Hospital, Malmö, Sweden, were asked to grade optic nerve head (ONH) photographs of healthy and glaucomatous subjects at two sessions separated by a lecture on glaucoma diagnosis by ONH assessment. Each grader had access to an individual portfolio of 50 ONH photographs randomly selected from a web-based data bank including ONH photographs of 73 glaucoma patients and 123 healthy subjects. The individual portfolio of photographs was graded before and after the lecture, but in different randomized order.


Ninety-six doctors, 91% of all attending the meeting, completed both assessment sessions. The number of correct classifications increased from 69 to 72% on the average. Diagnostic sensitivity increased significantly (p < 0.0001) from 70% to 80%, and the number of photographs classified as uncertain decreased significantly (p < 0.0001) from 22% to 13%. Specificity remained at 68%, and intra-grader agreement decreased.


CME had only a small effect on the assessment of ONH for the glaucoma diagnosis. Sensitivity increased and the amount of uncertain classifications decreased, while specificity was unchanged.