Consistency analysis of two fundus photograph reading methods based on stereoscopic color fundus photograph of diabetic retinopathy with macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

WangJingye ,  WangFenghua , ZhouYanping , 余奇 , 王卫峻 , 刘堃 , 孙晓东 , 许迅

Department of Ophthalmology, The Key Laboratory of Ocular Fundus Diseases of Shanghai, The First People's Hospital affiliated to Shanghai Jiaotong University, Shanghai 200080, China;

Corresponding author：

WangFenghua, Email: sighiris@gmail.com

Keywords：

Diabetic retinopathy/diagnosis; Diagnostic techniques, ophthalmological; Evaluation studies; Root cause analysis

DOI：

10.3760/cma.j.issn.1005-1015.2015.02.003

Video：

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Objective To analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods 450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. Results The κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). Conclusion The comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.

Citation： WangJingye, WangFenghua, ZhouYanping. Consistency analysis of two fundus photograph reading methods based on stereoscopic color fundus photograph of diabetic retinopathy with macular edema. Chinese Journal of Ocular Fundus Diseases, 2015, 31(2): 121-125. doi: 10.3760/cma.j.issn.1005-1015.2015.02.003 Copy

1.	Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs——an extension of the modified Airlie House classification. ETDRS report number 10.[J]. Ophthalmology, 1991, 98(Suppl 5):786-806.
2.	Danis RP, Scott IU, Qin H, et al. Association of fluorescein angiographic features with visual acuity and with optical coherence tomographic and stereoscopic color fundus photographic features of diabetic macular edema in a randomized clinical trial[J]. Retina, 2010, 30(10):1627-1637.
3.	许迅.规范眼底影像检查数据采集、评估行为, 提升眼底影像检查诊断技术应用水平[J].中华眼底病杂志, 2013, 29(5):499-452.
4.	Fleiss JL, Lecin B, Paik MC. Statistical Methods for Rates and Proportions[M]. 3rd ed.Hoboken:John Wiley & Sons Inc., 2003:608-610.
5.	陈喆, 新川达也, 许平, 等.非立体眼底彩色照片读片评价糖尿病视网膜病变的可行性[J].国际眼科杂志, 2007, 7(1):112-116.
6.	Wang H, Chhablani J, Freeman WR, et al. Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2012, 153(5):861-867.
7.	Lammer J, Bolz M, Baumann B, et al. Detection and analysis of hard exudates by polarization-sensitive optical coherence tomography in patients with diabetic maculopathy[J]. Invest Ophthalmol Vis Sci, 2014, 55(3):1564-1571.
8.	Kozak I, Bartsch DU, Cheng L, et al. Hyperreflective sign in resolved cotton wool spots using high-resolution optical coherence tomography and optical coherence tomography ophthalmoscopy[J]. Ophthalmology, 2007, 114(3):537-543.
9.	Munk MR, Dunavoelgyi R, Baratsits M, et al. Detection and Differentiation of Intraretinal Hemorrhage in Spectral Domain Optical Coherence Tomography. Curr Eye Res, 2014, 1-9.http://www.researchgate.net/publication/267102222..
10.	Diabetic retinopathy study. Report Number 6. Design, methods, and baseline results. Report Number 7. A modification of the Airlie House classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy[J]. Invest Ophthalmol Vis Sci, 1981, 21(1 Pt 2):1-226.
11.	Lee CS, Lee AY, Sim DA, et al. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography[J]. Am J Ophthalmol, 2015, 159(1):101-110.

1. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs——an extension of the modified Airlie House classification. ETDRS report number 10.[J]. Ophthalmology, 1991, 98(Suppl 5):786-806.
2. Danis RP, Scott IU, Qin H, et al. Association of fluorescein angiographic features with visual acuity and with optical coherence tomographic and stereoscopic color fundus photographic features of diabetic macular edema in a randomized clinical trial[J]. Retina, 2010, 30(10):1627-1637.
3. 许迅.规范眼底影像检查数据采集、评估行为, 提升眼底影像检查诊断技术应用水平[J].中华眼底病杂志, 2013, 29(5):499-452.
4. Fleiss JL, Lecin B, Paik MC. Statistical Methods for Rates and Proportions[M]. 3rd ed.Hoboken:John Wiley & Sons Inc., 2003:608-610.
5. 陈喆, 新川达也, 许平, 等.非立体眼底彩色照片读片评价糖尿病视网膜病变的可行性[J].国际眼科杂志, 2007, 7(1):112-116.
6. Wang H, Chhablani J, Freeman WR, et al. Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2012, 153(5):861-867.
7. Lammer J, Bolz M, Baumann B, et al. Detection and analysis of hard exudates by polarization-sensitive optical coherence tomography in patients with diabetic maculopathy[J]. Invest Ophthalmol Vis Sci, 2014, 55(3):1564-1571.
8. Kozak I, Bartsch DU, Cheng L, et al. Hyperreflective sign in resolved cotton wool spots using high-resolution optical coherence tomography and optical coherence tomography ophthalmoscopy[J]. Ophthalmology, 2007, 114(3):537-543.
9. Munk MR, Dunavoelgyi R, Baratsits M, et al. Detection and Differentiation of Intraretinal Hemorrhage in Spectral Domain Optical Coherence Tomography. Curr Eye Res, 2014, 1-9.http://www.researchgate.net/publication/267102222..
10. Diabetic retinopathy study. Report Number 6. Design, methods, and baseline results. Report Number 7. A modification of the Airlie House classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy[J]. Invest Ophthalmol Vis Sci, 1981, 21(1 Pt 2):1-226.
11. Lee CS, Lee AY, Sim DA, et al. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography[J]. Am J Ophthalmol, 2015, 159(1):101-110.

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Consistency analysis of two fundus photograph reading methods based on stereoscopic color fundus photograph of diabetic retinopathy with macular edema

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