Inter-observer concordance in grading retinopathy in cerebral malaria

Beare, Nicholas A. V.; Southern, Caroline L.; Lochhead, Jonathan; Molyneux, Malcolm E.; Lewallen, Susan; Harding, Simon

doi:10.1179/000349802125000565

Cited by 24 publications

(29 citation statements)

References 5 publications

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“…All children were examined by direct and indirect ophthalmoscopy after pupil dilatation with tropicamide 1% and phenylephrine 2.5%, and the retinal findings recorded and graded for severity on standardised charts. 10 Macular whitening is generally centred on the fovea, with sparing of the foveola, and the extent to which the fovea was involved was graded separately as foveal whitening. Ophthalmoscopy was performed on admission and daily thereafter subject to the depth of coma and cooperation.…”

Section: Methodsmentioning

confidence: 99%

Visual outcomes in children in Malawi following retinopathy of severe malaria

Beare

Southern

Kayira

et al. 2004

British Journal of Ophthalmology

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Aim: To investigate whether retinal changes in children with severe malaria affect visual acuity 1 month after systemic recovery. Methods: All children with severe malaria admitted to a research ward in Malawi during one malaria season were examined by direct and indirect ophthalmoscopy. Visual acuity was tested in those attending follow up by Cardiff cards, Sheridan-Gardiner single letters, or Snellen chart. Results: 96 (68%) children attended follow up, of whom 83 (86%) had visual acuity measured. Cardiff cards were used in 47 (57%) children, and Sheridan-Gardiner letters or Snellen chart in 29 (35%). There was no significant difference in the mean logMAR visual acuity between groups with or without macular whitening (0.14 versus 0.16, p = 0.55). There was no trend for worse visual acuity with increasing severity of macular whitening (p = 0.52) including patients in whom the fovea was involved (p = 0.32). Six (4.2%) children had cortical blindness after cerebral malaria, and all six had other neurological sequelae. Ophthalmoscopy during the acute illness revealed no abnormalities in four of these children. Conclusion: Retinal changes in severe malaria, in particular macular whitening, do not appear to affect visual acuity at 1 month. This supports the hypothesis that retinal whitening is due to reversible intracellular oedema in response to relative hypoxia, caused by sequestered erythrocytes infected by Plasmodium falciparum. Impaired visual functioning after cerebral malaria is not attributable to retinal changes and appears to be a cortical phenomenon.

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Section: Methodsmentioning

confidence: 99%

Visual outcomes in children in Malawi following retinopathy of severe malaria

Beare

Southern

Kayira

et al. 2004

British Journal of Ophthalmology

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“…To estimate

F D R

and

F O R

, we use data from Beare et al, 2002 who compared two ophthalmologists’ concordance in grading malarial retinopathy. As described in the next section, we obtain point estimates of .07 and .05 and upper bound estimates of .30 and .11 for

F D R

and

F O R

respectively; the main analyses use the point estimates and additional analyses use the upper bound estimates.…”

Section: Methodsmentioning

confidence: 99%

“…We use data on 65 patients at Queen Elizabeth Central Hospital in Blantyre, Malawi who were each examined by two ophthalmologists (Beare et al, 2002). Malarial retinopathy is diagnosed if any of the following six signs are present: retinal hemorrhages (RH), macular whitening (MW), foeval whitening (FW), peripheral whitening (PW), vessel changes (VC) and capillary whitening (CW).…”

Section: Methodsmentioning

confidence: 99%

“…Malarial retinopathy is diagnosed if any of the following six signs are present: retinal hemorrhages (RH), macular whitening (MW), foeval whitening (FW), peripheral whitening (PW), vessel changes (VC) and capillary whitening (CW). RH, VC and CW require little observer judgement if they are seen, but they may not be seen, depending on the degree of pupillary dilation and the presence/absence of spontaneous eye movements; for these consider the specificity to be 1 (Beare et al, 2002). Identifying MW, FW and PW requires more experience on the part of the observer; MW and FW are more reproducible, and PW is less so (Beare et al, 2002).…”

Section: Methodsmentioning

confidence: 99%

“…To find a conservative upper bound on the false discovery rate, we consider ophthalmologist 1 and found the 95% Wilson binomial confidence interval (Wilson, 1927) based on 6 out of 39 false discoveries, resulting in an 95% confidence interval of (0.07, 0.30), so resulting in an upper bound of 0.30 for the false discovery rate. To find a point estimate for the false discovery rate, we assume that there was true malarial retinopathy if RH, VC or CW was detected by either ophthalmologist or if FW was detected by both ophthalmologists or if MW was detected by both ophthalmologists since FW and MW were found to be reproducible by Beare et al, 2002, and then we averaged the resulting point estimates for the false discovery rate for the two ophthalmologists ((4/39 + 1/36)/2), to obtain an estimate of .07.…”

Section: Methodsmentioning

confidence: 99%

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Evidence from a natural experiment that malaria parasitemia is pathogenic in retinopathy-negative cerebral malaria

Small

Taylor

Postels

et al. 2017

eLife

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Cerebral malaria (CM) can be classified as retinopathy-positive or retinopathy-negative, based on the presence or absence of characteristic retinal features. While malaria parasites are considered central to the pathogenesis of retinopathy-positive CM, their contribution to retinopathy-negative CM is largely unknown. One theory is that malaria parasites are innocent bystanders in retinopathy-negative CM and the etiology of the coma is entirely non-malarial. Because hospitals in malaria-endemic areas often lack diagnostic facilities to identify non-malarial causes of coma, it has not been possible to evaluate the contribution of malaria infection to retinopathy-negative CM. To overcome this barrier, we studied a natural experiment involving genetically inherited traits, and find evidence that malaria parasitemia does contribute to the pathogenesis of retinopathy-negative CM. A lower bound for the fraction of retinopathy-negative CM that would be prevented if malaria parasitemia were to be eliminated is estimated to be 0.93 (95% confidence interval: 0.68, 1).DOI: http://dx.doi.org/10.7554/eLife.23699.001

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Prognostic Significance and Course of Retinopathy in Children WithSevere Malaria

Beare¹

2004

Arch Ophthalmol

150

156

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Objectives: To relate retinal findings in children treated for severe malaria to disease outcome and to determine the course of changes in the fundus. Methods: A prospective study of children with cerebral malaria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria seasons. Indirect and direct ophthalmoscopy were performed on admission and daily, subject to the patient's cooperation. Results: Threehundredtwenty-sixpatients(91%)withcomplicated malaria were recruited. Two hundred seventy-eight patients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia hadretinopathy.InCM,retinopathywasassociatedwithsubsequent death (relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema conferred the highest risk (rela-tive risk, 4.5; 95% confidence interval, 2.7-7.6). Increasing severity of retinal signs was related to increasing risk of a fatal outcome (PϽ.05), independent of papilledema. In survivors, retinal signs were associated with prolonged time to recover consciousness (PϽ.001). Patients with severe malarial anemia had better outcomes and less severe retinopathy than those with CM. In 116 patients with CM, fundi were followed up longitudinally during admission and in 27 patients after hospital discharge. A large increase in retinal hemorrhages was associated with death (P=.02). Retinal signs resolved over 1 to 4 weeks without retinal sequelae. Conclusions: In childhood CM, severity of retinopathy is related to prolonged coma and death. Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology.

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Inter-observer concordance in grading retinopathy in cerebral malaria

Cited by 24 publications

References 5 publications

Visual outcomes in children in Malawi following retinopathy of severe malaria

Visual outcomes in children in Malawi following retinopathy of severe malaria

Evidence from a natural experiment that malaria parasitemia is pathogenic in retinopathy-negative cerebral malaria

Prognostic Significance and Course of Retinopathy in Children WithSevere Malaria

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