Purpose To report on concordance of optical coherence tomography (OCT) grading in the Network of Ophthalmic Reading Centres UK (NetwORC UK). The present study looks at concordance of OCT gradings across the network for patients enrolled in the UK IVAN Study. Methods A set of 5 patient scans (6 radial line scans and one 7mm offset scan using the Stratus OCT III (Zeiss, UK)) were graded by accredited graders at all three centres. Scans were exported as JPEG images with a corresponding PDF. Measurements for the Outer High Reflectivity Band (OHRB), Sub Retinal Fluid (SRF), Pigment Epithelial Detachment (PED), maximum height of largest cyst, maximum retinal thickenss (MRT) and foveal retinal thickness (FRT) were taken, if present. Results In all cases an acceptable level of concordance was achieved. One case proved more problematic than the others and results were more varied. For OHRB, SRF, PED, cyst, MRT and FRT the measurements by individual graders were consistent in 4 out of 5 cases. One case showed wider‐ranging measurements with the range for OHRB varying by 0.25mm (mean thickness 0.22mm). Conclusion The present study shows an acceptable level of concordance for OCT grading across NetwORC UK. In difficult cases, the complexity of AMD grading explained the lack of total concordance when an abnormal thickening of the OHRB is present. The most problematic case had an area of moderate hyperreflectivity anterior to the OHRB which caused difficulty and highlighted a specific area for further training and a protocol amendment. The exercise was useful in highlighting both individual and overall training needs which are currently being addressed in each of the RCs. The concordance study is being extended to include a larger dataset.
Purpose: To report on the identification of Retinal Angiomatous Proliferation (RAP) in the Network of Ophthalmic Reading Centres UK (NetwORC) for the Verteporfin Photodynamic Therapy (VPDT) cohort study. RAP tends to be bilateral and although it is accepted to be part of the spectrum of age‐related macular degeneration (AMD), no treatment has yet proved to be as successful as in other types of AMD. A diagnosis of RAP is therefore instrumental to the success of treatment decisions to be made. Methods: The VPDT study involves the grading of more than 5000 angiograms per annum at the network of Reading Centres (RC) with regular training and concordance activities being performed. The grading database was queried for RAP lesions identified on a monthly basis between Nov 2005 and Oct 2006. Expert training on identification of RAP was given at 3 successive meetings during this period. Results: In this 12‐month period, 5402 angiograms were graded (including both primary and quality assurance gradings). RAP was identified in 264 cases, with a step‐wise increase in the identification of RAP during this one year period. Using a simple chi‐squared for trend test, there is a highly significant increasing trend over the 12 months (p<0.0001) following training sessions at all three RCs, highlighting the benefit of structured training. Conclusions: The present study has shown that consistent concordance and training exercises across the RC network improves the identification of specific lesion components such as RAP. With improved education, other clinical and grading staff can be trained to recognise RAP lesions and better identification may lead to improved treatment outcomes.
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