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Indian J Ophthalmol. 2019 Jul;67(7):1089-1094. doi: 10.4103/ijo.IJO_1509_18.

Clinical validation of RIA-G, an automated optic nerve head analysis software.

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Noble Eye Care; Narayana Superspecialty Hospital, Gurugram, Haryana, India.
Division of Ophthalmology, Medanta-The Medicity, Gurugram, Haryana, India.
SMS Medical College, Jaipur, Rajasthan, India.
Noble Eye Care, Gurugram, Haryana; IClinix-Advanced Eye Centre, New Delhi, India.



To clinically validate a new automated glaucoma diagnosis software RIA-G.


A double-blinded study was conducted where 229 valid random fundus images were evaluated independently by RIA-G and three expert ophthalmologists. Optic nerve head parameters [vertical and horizontal cup-disc ratio (CDR) and neuroretinal rim (NRR) changes] were quantified. Disc damage likelihood scale (DDLS) staging and presence of glaucoma were noted. The software output was compared with consensus values of ophthalmologists.


Mean difference between the vertical CDR output by RIA-G and the ophthalmologists was - 0.004 ± 0.1. Good agreement and strong correlation existed between the two [interclass correlation coefficient (ICC) 0.79; r = 0.77, P < 0.005]. Mean difference for horizontal CDR was - 0.07 ± 0.13 with a moderate to strong agreement and correlation (ICC 0.48; r = 0.61, P < 0.05). Experts and RIA-G found a violation of the inferior-superior NRR in 47 and 54 images, respectively (Cohen's kappa = 0.56 ± 0.07). RIA-G accurately detected DDLS in 66.2% cases, while in 93.8% cases, output was within ± 1 stage (ICC 0.51). Sensitivity and specificity of RIA-G to diagnose glaucomatous neuropathy were 82.3% and 91.8%, respectively. Overall agreement between RIA-G and experts for glaucoma diagnosis was good (Cohen's kappa = 0.62 ± 0.07). Overall accuracy of RIA-G to detect glaucomatous neuropathy was 90.3%. A detection error rate of 5% was noted.


RIA-G showed good agreement with the experts and proved to be a reliable software for detecting glaucomatous optic neuropathy. The ability to quantify optic nerve head parameters from simple fundus photographs will prove particularly useful in glaucoma screening, where no direct patient-doctor contact is established.


Disc damage likelihood scale; RIA-G; fundus photograph; glaucoma; optic nerve head; screening; software

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