目的研究青光眼盘沿形态分析方法的强化训练在青光眼早期诊断一致性评价中的作用。设计前瞻性研究。研究对象临床医生与青光眼视神经诊断方法。方法选取早期青光眼及类似青光眼视神经改变的数码眼底照片共120张,其中早期青光眼眼底照片67张,易混淆为青光眼的眼底照片53张。眼底照片观察者分三组。Ⅰ组为接受过青光眼盘沿形态分析强化训练者,共5人;Ⅱ组为青光眼医生4人,未强化训练;Ⅲ组为非青光眼医生4人,未强化训练。重复阅片3次,每次间隔3天。主要指标观察者自身及观察者间的评价一致率,Kappa值。结果观察者自身一致性评价,Ⅰ组Kappa值(一致率)为0．779～0．966 (90．0%～98．3%);Ⅱ组为0．506～0．866(82．5%～93．3%);Ⅲ组为0．094～0．778(54．2%～89．2%)。观察者间正确评估眼底照片的一致性分析结果,Ⅰ组Kappa值0．768～0．983,Ⅱ组0．354～0．834,Ⅲ组0．335～0．737。结论盘沿形态分析的强化训练可提高观察者对早期青光眼视神经损害评估的一致性,建立青光眼视神经诊断标准可提高青光眼的正确诊断率。(眼科,2007,16:20-23) Objective To study the role of glaucoma tracing along the morphological analysis in the early diagnosis of glaucoma. Design prospective studies. Study object Clinicians and glaucomatous optic nerve diagnostic methods. Methods A total of 120 digital fundus photographs of early glaucoma and glaucomatous optic nerve changes were selected, of which 67 were early glaucoma fundus photographs and 53 were easily confused with glaucoma fundus photographs. Fundus photo observers divided into three groups. Group Ⅰ received traumatic glaucoma morphology analysis intensive training, a total of 5; Ⅱ group of glaucoma doctors 4, not intensive training; Ⅲ group of non-glaucoma doctors 4, not intensive training. Repeat the reading 3 times, each interval of 3 days. The main indicators of observers themselves and between observers evaluation of the agreement rate, Kappa value. The results of observer self-consistency evaluation, Ⅰ group Kappa value (consistency rate) was 0.779 ~ 0.966 (90.0% ~ 98.3%); Ⅱ group was 0.506 ~ 0.866 (82.5 % ~ 93.3%); group Ⅲ was 0.094 ~ 0.778 (54.2% ~ 89.2%). Observations Correct assessment of fundus photographs of the consistency analysis results, Ⅰ group Kappa value of 0.768 ~ 0.983, Ⅱ group 0.354 ~ 0.834, Ⅲ group 0.335 ~ 0.737. Conclusions Intensive training of disc morphology analysis can improve the observer’s assessment of optic nerve damage in early glaucoma. Establishing the diagnostic criteria of glaucomatous optic nerve can improve the correct diagnosis rate of glaucoma. (Ophthalmology, 2007,16: 20-23)