Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance audit

Patra, Sudeshna; Gomm, E. M. W.; Macipe, M.; Bailey, Clare

doi:10.1111/j.1464-5491.2009.02767.x

Cited by 17 publications

(12 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A single study showed that retinal photographs assessed by optometrists could achieve >91% sensitivity in detecting R3 or sight-threatening retinopathy 20. Data on the effectiveness of individual screening modalities are widely available 13,17,19,23.…”

Section: Discussionmentioning

confidence: 99%

“…However, in selected screening programs, primary and secondary gradings are performed by trained opticians. Whilst data are available on the effectiveness of individual screening modalities,10–13,17–19 there is currently only one study that has looked at the interobserver agreement between primary graders and an expert grader 20. Information on the safety, effectiveness, and agreement between primary and secondary graders for images of patients undergoing routine diabetic eye screening in a community optometry-based retinopathy screening program has not yet been reported.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Grader agreement, and sensitivity and specificity of digital photography in a community optometry-based diabetic eye screening program

Sellahewa¹,

Simpson²,

Maharajan³

et al. 2014

OPTH

View full text Add to dashboard Cite

BackgroundDigital retinal photography with mydriasis is the preferred modality for diabetes eye screening. The purpose of this study was to evaluate agreement in grading levels between primary and secondary graders and to calculate their sensitivity and specificity for identifying sight-threatening disease in an optometry-based retinopathy screening program.MethodsThis was a retrospective study using data from 8,977 patients registered in the North Nottinghamshire retinal screening program. In all cases, the ophthalmology diagnosis was used as the arbitrator and considered to be the gold standard. Kappa statistics were used to evaluate the level of agreement between graders.ResultsAgreement between primary and secondary graders was 51.4% and 79.7% for detecting no retinopathy (R0) and background retinopathy (R1), respectively. For preproliferative (R2) and proliferative retinopathy (R3) at primary grading, agreement between the primary and secondary grader was 100%. Where there was disagreement between the primary and secondary grader for R1, only 2.6% (n=41) were upgraded by an ophthalmologist. The sensitivity and specificity for detecting R3 was 78.2% and 98.1%, respectively. None of the patients upgraded from any level of retinopathy to R3 required photocoagulation therapy. The observed kappa between the primary and secondary grader was 0.3223 (95% confidence interval 0.2937–0.3509), ie, fair agreement, and between the primary grader and ophthalmology for R3 was 0.5667 (95% confidence interval 0.4557–0.6123), ie, moderate agreement.ConclusionThese data provide information on the safety of a community optometry-based retinal screening program for screening as a primary and as a secondary grader. The level of agreement between the primary and secondary grader at a higher level of retinopathy (R2 and R3) was 100%. Sensitivity and specificity for R3 were 78.2% and 98.1%, respectively. None of the false-negative results required photocoagulation therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Grader agreement, and sensitivity and specificity of digital photography in a community optometry-based diabetic eye screening program

Sellahewa¹,

Simpson²,

Maharajan³

et al. 2014

OPTH

View full text Add to dashboard Cite

show abstract

“…The audit result demonstrated a good interobserver agreement (better than the audit standard 80 % in all the categories). It meant the acceptable level of DR grading quality and accuracy from the primary graders [ 50 ]. The UK NSC grading standard recommends primary-secondary-arbitrator grading (universal and independent regrading) rule.…”

Section: Validity Of Dr Screening Programmesmentioning

confidence: 99%

Screening of the Retina in Diabetes Patients by Morphological Means

Xiao

Kanagasingam

2014

Teleophthalmology in Preventive Medicine

View full text Add to dashboard Cite

“…41,42 Multiple studies have validated this grading scale to be very consistent between eye care professionals. [43][44][45] ETDRS also established follow-up guidelines depending on the level of DR: 1) DM without DR or mild non-proliferative DR (NPDR) (microaneurysm and hemorrhages in one quadrant of the eye) follow-up in 12 months; 2) moderate NPDR (hemorrhages and microaneurysm or exudates in more than one quadrant) follow-up in 6 months; 3) severe NPDR (4-2-1 rule, microaneurysm or hemorrhages in all four quadrants, venous beading in two quadrants, or intraretinal microvascular abnormalities vasculopathy in one quadrant) follow-up in 3 months; and 4) PDR requires an urgent referral for treatment. The presence of CSME at any stage of DR, independent of acuity also requires an urgent referral to a retinologist.…”

Section: Fundus Examination and Photographymentioning

confidence: 99%

Early interventions to prevent retinal vasculopathy in diabetes: a review

Harrison¹,

Yevseyenkov²

2015

OPTO

View full text Add to dashboard Cite

Diabetic eye disease is a public health concern in all areas of the world as a leading cause of blindness in the working aged to elderly populations. Diabetes damages the lining of the microvasculature throughout the body through prolonged exposure to hyperglycemic conditions. The ocular changes are progressive with very little recourse for improvement once damage begins. Current treatments for the eye focus mainly on the late stages of the disease when neovascularization or edema threatens sight. Early interventions for diabetic vasculopathy involve metabolic therapy to improve blood glucose and blood pressure control. Technology improvements have a large part to play in advancing diagnosis of diabetic eye disease. These new technologies offer both structural and functional means for assessment of retinal health. This review focuses on current treatments for diabetic eye disease at all stages with an emphasis on new and early interventions. It also details established and emerging technologies used for earlier detection of diabetic eye disease, which is vital to the development and approval of much needed treatments targeted at earlier stages of diabetic retinopathy. Possible future treatments should be aimed to prevent retinal vasculopathy from progressing. This review will explore current research on this topic and what is needed moving forward.

show abstract

Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance audit

Cited by 17 publications

References 5 publications

Grader agreement, and sensitivity and specificity of digital photography in a community optometry-based diabetic eye screening program

Grader agreement, and sensitivity and specificity of digital photography in a community optometry-based diabetic eye screening program

Screening of the Retina in Diabetes Patients by Morphological Means

Early interventions to prevent retinal vasculopathy in diabetes: a review

Contact Info

Product

Resources

About