The GONE Project

Despite major advances in imaging and automated analysis, careful examination of the optic nerve head remains the most important skill for detecting glaucoma early. This is also where many clinicians struggle. Key signs are often missed, not because they are rare, but because the way we learn to assess optic discs is inconsistent, unstructured, and hard to practise at scale.

The Glaucomatous Optic Neuropathy Evaluation (GONE) Project was created to fix this.

GONE was originally developed as an internal training tool at the Centre for Eye Research Australia and the Royal Victorian Eye and Ear Hospital in Melbourne. In 2008 it was released publicly as a free online platform so clinicians around the world could test and improve their optic nerve head assessment skills.

What started with fewer than 200 users has now grown into a global digital education platform with over 33,000 registered participants across more than 100 countries. It has been continuously available for more than 15 years.

What makes GONE different

GONE is not a passive learning resource. It is an active assessment and feedback system built around how experts actually examine optic discs.

The platform is based on a structured, stepwise framework using nine expert-defined optic disc characteristics, applied to a curated set of 42 high-quality disc images. Users are asked to identify these features systematically, rather than relying on vague pattern recognition or intuition.

By analysing how thousands of users assess the same discs, the project has been able to identify consistent patterns of error. These insights have been used to build targeted education and have informed a series of peer-reviewed publications.

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Education without barriers

GONE is privately hosted and maintained to ensure long-term stability and independence. It has always been free to access, with no commercial advertising and no subscription fees. It is a true open-access medical education tool designed to support trainees, clinicians, optometrists and educators worldwide.

The educational framework developed through GONE has also contributed to the creation of international glaucoma teaching modules focused on optic nerve head examination.

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Research impact

Data from the GONE Project has been used to study how clinicians examine optic discs, where mistakes occur, and how viewing conditions, gaze behaviour and experience level influence diagnostic accuracy.

Key Publications

1. Chan HH, Ong DN, Kong YXG, et al. Glaucomatous Optic Neuropathy Evaluation (GONE) Project: The Effect of Monoscopic versus Stereoscopic Viewing Conditions on Optic Nerve Evaluation. Am J Ophthalmol. 2014.
2. Kong YXG, Coote MA, O'Neill EC, et al. Glaucomatous optic neuropathy evaluation project: a standardized internet system for assessing skills in optic disc examination. Clin Experiment Ophthalmol. 39(4):308-317.
3. O'Neill EC, Danesh-Meyer H V, Kong GXY, et al. Optic disc evaluation in optic neuropathies: the optic disc assessment project. Ophthalmology. 2011;118(5):964-970.
4. O'Neill EC, Kong YXG, Connell PP, et al. Gaze behavior among experts and trainees during optic disc examination: does how we look affect what we see? Invest Ophthalmol Vis Sci. 2011;52(7):3976-3983.
5. O'Neill EC, Gurria LU, Pandav SS, et al. Glaucomatous optic neuropathy evaluation project: factors associated with underestimation of glaucoma likelihood. JAMA Ophthalmol. 2014;132(5):560-566.