Ruamviboonsuk Paisan, Teerasuwanajak Khemawan, Tiensuwan Montip, Yuttitham Kanokwan
Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand.
Ophthalmology. 2006 May;113(5):826-32. doi: 10.1016/j.ophtha.2005.11.021.
To assess agreement among a group of ophthalmic care providers, including ophthalmologists and trained nonphysician personnel, in the interpretation of single-field digital fundus images for diabetic retinopathy screening.
Interobserver reliability study.
Twelve ophthalmic care personnel, including 3 retina specialists, 3 general ophthalmologists, 3 ophthalmic nurses, and 3 ophthalmic photographers.
All participants were to read 400 good single-field digital fundus images of diabetic patients from a community hospital. The nonphysician personnel group read the images 1 month after attending a 2-day intensive instruction course regarding diabetic retinopathy screening. The ophthalmologists read the images without additional training. The 3 retina specialists read the images again together 2 months later to form a consensus regarding retinopathy severity and macular edema for each case. All readers used the Early Treatment Diabetic Retinopathy Study standard photographs as guidelines.
The kappa statistic was used for the reliability assessment of the diabetic retinopathy severity and macular edema, and for the identification of cases that needed referral to ophthalmologists.
There is only fair agreement among all readers. The multirater kappa coefficient for retinopathy severity is 0.34; for macular edema, 0.27; and for referral cases, 0.28. Retina specialists have the best agreement among all groups (kappa = 0.58 for retinopathy severity or macular edema, kappa = 0.63 for referrals). There is also fair agreement when all readers are compared with the consensus of retina specialists (kappas = 0.35, 0.28, and 0.29 for retinopathy severity, macular edema, and referrals, respectively), and the retina specialist group also has the best agreement (kappas = 0.63, 0.65, and 0.67 for retinopathy severity, macular edema, and referrals).
Without additional training, retina specialists may be the most reliable personnel to interpret single-field digital fundus images for diabetic retinopathy screening. For other ophthalmic care personnel to achieve comparable reliability, a comprehensive instruction course with specific continuing education is essential. Authorized nonphysician interpreters should be experts, and new standard photographs for single-field digital fundus image interpretation may also be required to improve interobserver reliability.
评估包括眼科医生和经过培训的非医师人员在内的一组眼科护理人员对用于糖尿病视网膜病变筛查的单视野数字眼底图像的解读一致性。
观察者间可靠性研究。
12名眼科护理人员，包括3名视网膜专科医生、3名普通眼科医生、3名眼科护士和3名眼科摄影师。
所有参与者需阅读一家社区医院400例糖尿病患者的高质量单视野数字眼底图像。非医师人员组在参加为期2天的关于糖尿病视网膜病变筛查的强化培训课程1个月后阅读这些图像。眼科医生在未接受额外培训的情况下阅读图像。2个月后，3名视网膜专科医生再次共同阅读图像，以就每例病例的视网膜病变严重程度和黄斑水肿形成共识。所有读者均以糖尿病视网膜病变早期治疗研究标准照片作为指导。
kappa统计量用于评估糖尿病视网膜病变严重程度和黄斑水肿的可靠性，以及确定需要转诊给眼科医生的病例。
所有读者之间的一致性仅为一般。视网膜病变严重程度的多评价者kappa系数为0.34；黄斑水肿为0.27；转诊病例为0.28。视网膜专科医生在所有组中一致性最佳（视网膜病变严重程度或黄斑水肿的kappa值为0.58，转诊病例的kappa值为0.63）。当将所有读者与视网膜专科医生的共识进行比较时，一致性也为一般（视网膜病变严重程度、黄斑水肿和转诊病例的kappa值分别为0.35、0.28和0.29），并且视网膜专科医生组的一致性也是最佳的（视网膜病变严重程度、黄斑水肿和转诊病例的kappa值分别为0.63、0.65和0.67）。
在没有额外培训的情况下，视网膜专科医生可能是解读用于糖尿病视网膜病变筛查的单视野数字眼底图像最可靠的人员。对于其他眼科护理人员而言，要达到可比的可靠性，开展具有特定继续教育内容的综合培训课程至关重要。经授权的非医师解读人员应是专家，可能还需要用于单视野数字眼底图像解读的新标准照片以提高观察者间的可靠性。
