Abstract
Objective
To examine the inter-observer agreement between two retina specialists in grading diabetic retinopathy (DR) severity in ultra-wide-field fundus photographs.
Methods
Two hundred and seventy patients with diabetes, who visited the vitreoretinal specialty at a tertiary eye care hospital, with or without DR underwent comprehensive ophthalmic examination, dilated retinal exam and Optos ultra-wide-field (UWF) retinal photography. Optos images were graded for DR severity based on the International Clinical Diabetic Retinopathy Disease Severity Scale by two retina specialists with same number of years of experience, masked to the clinical details of the participants.
Results
The two graders showed agreement in 229/270 images (84.8%) and disagreement in 41/270 images (15.2%). The unweighted kappa for agreement between graders was k = 0.715, SE = 0.037 and the weighted kappa was k = 0.838, SE = 0.022. No DR was identified in 170/270 (62.9%) patients, mild NPDR in 15/270 (5.6%) patients, moderate NPDR in 35/270 (12.9%) patients, severe NPDR in 4/270 (1.48%) patient and PDR in 5/270 (1.85%) patients by both graders. Disagreement was neither related to the learning curve of graders nor with the patient’s age (p = 0.574), gender (p = 0.169), duration of diabetes (0.660) or the lens being phakic or pseudophakic (p = 0.171) on logistic regression.
Conclusions
The impact of disagreement noted between observers in grading DR on UWF fundus photographs should be considered when utilizing UWF system in clinical studies.
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Data availability
Data are available from the corresponding author upon reasonable request.
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Author contributions
SS, RRN designed the study for the funding; SS screened and examined patients, obtained data and images, performed statistical analysis; SRS, CCN, VJP graded optos images; SS, SSD, MB interpreted the results; SS wrote the paper; all authors provided critical scientific comments and approved the content of the manuscript.
Funding
This work was supported by the DBT/Wellcome Trust India Alliance Fellowship [grant number IA/CPHE/16/1/502670] awarded to Dr Sangeetha Srinivasan as per funder’s guidelines.
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Srinivasan, S., Suresh, S., Chendilnathan, C. et al. Inter-observer agreement in grading severity of diabetic retinopathy in wide-field fundus photographs. Eye 37, 1231–1235 (2023). https://doi.org/10.1038/s41433-022-02107-1
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DOI: https://doi.org/10.1038/s41433-022-02107-1
