Interobserver Agreement in the Interpretation of Single-Field Digital Fundus Images for Diabetic Retinopathy Screening

Ruamviboonsuk, Paisan; Teerasuwanajak, Khemawan; Tiensuwan, Montip; Yuttitham, Kanokwan

doi:10.1016/j.ophtha.2005.11.021

Cited by 59 publications

(53 citation statements)

References 35 publications

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“…Overall agreement in grading DR among readers was poor (J = 0.34) with the most interobserver agreement occurring between retina specialists with a J of 0.58 and the least agreement occurring between nurses with a J of 0.26. 22 Our study meets and/or exceeds these previously published values. The grading of DR is a common activity for all three graders in this study, and there are published, wellestablished guidelines for the grading of DR. 15,16,26,27 Although grading vessel tortuosity is common in retinopathy of prematurity, it follows a clinical scale of mild, moderate, severe, or extreme.…”

Section: Discussionsupporting

confidence: 82%

“…22Y25 Vujosevic et al compared interobserver agreement between two retina specialists with different photograph screening protocols; the best agreement occurred when using the Early Treatment Diabetic Retinopathy Study protocol with seven fields of 30-degree stereoscopic photographs (J = 0.92), and substantial agreement occurred when using 45-degree nonmydriatic photographs, as was used in this study, with J values of 0.83 and 0.81 comparing three fields and one field, respectively. Ruamviboonsuk et al 22 used a five-stage grading system; in their study, DR severity was graded by different health care professionals: three retina specialists, three general ophthalmologists, three retinal photographers, and three nurses. Overall agreement in grading DR among readers was poor (J = 0.34) with the most interobserver agreement occurring between retina specialists with a J of 0.58 and the least agreement occurring between nurses with a J of 0.26.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Arteriole Tortuosity Associated with Diabetic Retinopathy and Cholesterol

Weiler¹,

Engelke²,

Moore³

et al. 2015

Optometry and Vision Science

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First, RVT, particularly for venules, is difficult to grade consistently; therefore, future studies examining tortuosity should focus on arterioles. Second, the model indicates that there is an association between vessel changes, DR, and systemic cholesterol levels. Although DR and RVT are readily available to assess concurrently on a photograph, the addition of cholesterol to this model indicates that patients with RVT may warrant further follow-up on health factors, such as cholesterol levels.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Arteriole Tortuosity Associated with Diabetic Retinopathy and Cholesterol

Weiler¹,

Engelke²,

Moore³

et al. 2015

Optometry and Vision Science

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“…Several studies have demonstrated the limited sensitivity and specificity of retinal photography for detecting referable retinopathy: some referable disease is missed before the eye is even graded[7]–[9]. Furthermore, image grading is not a trivial task and other studies have reported wide disagreement between graders[10]–[13]. The ROC plot in figure 1 indicates the range of performance that may be expected from different levels of grader within a screening service.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Automated Disease Detection in Diabetic Retinopathy Screening Using Two-Field Photography

et al. 2011

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AimTo assess the performance of automated disease detection in diabetic retinopathy screening using two field mydriatic photography.MethodsImages from 8,271 sequential patient screening episodes from a South London diabetic retinopathy screening service were processed by the Medalytix iGrading™ automated grading system. For each screening episode macular-centred and disc-centred images of both eyes were acquired and independently graded according to the English national grading scheme. Where discrepancies were found between the automated result and original manual grade, internal and external arbitration was used to determine the final study grades. Two versions of the software were used: one that detected microaneurysms alone, and one that detected blot haemorrhages and exudates in addition to microaneurysms. Results for each version were calculated once using both fields and once using the macula-centred field alone.ResultsOf the 8,271 episodes, 346 (4.2%) were considered unassessable. Referable disease was detected in 587 episodes (7.1%). The sensitivity of the automated system for detecting unassessable images ranged from 97.4% to 99.1% depending on configuration. The sensitivity of the automated system for referable episodes ranged from 98.3% to 99.3%. All the episodes that included proliferative or pre-proliferative retinopathy were detected by the automated system regardless of configuration (192/192, 95% confidence interval 98.0% to 100%). If implemented as the first step in grading, the automated system would have reduced the manual grading effort by between 2,183 and 3,147 patient episodes (26.4% to 38.1%).ConclusionAutomated grading can safely reduce the workload of manual grading using two field, mydriatic photography in a routine screening service.

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“…The higher number of respondents using fundus photography could be due to it being the NICE recommended modality for documenting the optic disc (NICE, 2009); however, this could also be seen as surprising, considering that the modality is thought to have drawbacks as a diagnostic tool due to its subjectivity (Guttman Krader, 2013) and the need for an expert interpreter (Guttman Krader, 2013;Ruamviboonsuk, Teerasuwanajak, Tiensuwan & Yuttitham, 2006). This could be impracticable in departments with limited staff and could explain why it is used only occasionally by two of the respondents.…”

Section: Current Practicementioning

confidence: 99%

Imaging in glaucoma care pathways in the UK

Lee

2016

Journal of Visual Communication in Medicine

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Glaucoma is an incurable disease of the eye that affects 2% of over 40s in the United Kingdom and 5% of those over 80. The National Institute for Health and Care Excellence (NICE) estimates that the disease affects around 480,000 people in the United Kingdom, with over a million glaucoma-related hospital outpatient appointments each year. This paper aims to establish the care pathways for glaucoma across the United Kingdom and the perceived value of imaging. A questionnaire was distributed to members of the Ophthalmic Imaging Association to identify imaging protocols with glaucoma; results indicated that there was variation between hospitals. The perceived clinical value of imaging from staff involved in the pathway was also explored.

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Interobserver Agreement in the Interpretation of Single-Field Digital Fundus Images for Diabetic Retinopathy Screening

Cited by 59 publications

References 35 publications

Arteriole Tortuosity Associated with Diabetic Retinopathy and Cholesterol

Arteriole Tortuosity Associated with Diabetic Retinopathy and Cholesterol

Assessment of Automated Disease Detection in Diabetic Retinopathy Screening Using Two-Field Photography

Imaging in glaucoma care pathways in the UK

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