Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults

Aim: To quantify the observer variation in the sonographic measurement of optic nerve sheath diameter (ONSD) in normal adults. Materials and methods: Sixty-seven normal adult volunteers underwent ultrasound examination of each eye by three independent observers using a 7 MHz sector probe. Three measurements were made of each eye by each observer and a mean value calculated for each eye. Median and 5th–95th centile values for both intra- and inter-observer variation were calculated for the three observers. Results: The median intra-observer variation was ±0.1 mm, with 5th–95th centile values of ±0–0.4 mm. The median inter-observer variation was ±0.2–0.3 mm, with 5th–95th centile values of ±0–0.7 mm. Careful review of examination technique by the three observers after the first 17 examinations was shown to reduce both intra- and inter-observer variation. Conclusion: The sonographic measurement of ONSD is a readily learned, reproducible technique with low intra- and inter-observer variation. The average inter-observer variation (±0.2 mm) is comparable to the inherent variability of the ultrasound machine. The importance of standardisation of examination technique is stressed.