Thapa Raba, Bajimaya Sanyam, Pradhan Eli, Sharma Sanjita, Kshetri BalBahadur, Paudyal Govinda
Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal.
Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal.
Clin Ophthalmol. 2020 Sep 21;14:2731-2737. doi: 10.2147/OPTH.S269002. eCollection 2020.
Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist.
Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k).
The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months.
Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.
糖尿病视网膜病变（DR）是发展中国家失明的一个新出现的原因。本研究旨在评估与眼科医生相比，联合医务人员（AMP）使用眼底照片对糖尿病患者视网膜检查结果进行分级的准确性。
六名AMP在接受为期两周、间隔两周的两次培训后，参与对糖尿病患者眼底照片进行分级，为期三个月和六个月。分级的眼底照片总数为1344张。视网膜专科医生的分级被用作金标准。使用kappa系数（k）评估评分者内和评分者间的一致性。
在三个月和六个月时，一半AMP的评分者内一致性对于任何视网膜异常的分级几乎是完美的，对于视网膜出血是实质性的。在三个月时，第二次评分时，对于任何视网膜异常（k = 0.60）和视网膜出血（k = 0.48），总体评分者间一致性为中等，对于黄斑渗出（k = 0.35）为一般。在六个月时，第二次评分时，AMP对于任何视网膜异常（k = 0.61）的总体评分者间一致性为实质性，对于视网膜出血（k = 0.30）为一般，对于黄斑渗出（k = 0.49）为中等。在三个月和六个月时，第一次评分时的总体评分者间一致性与第二次评分时几乎相似。
AMP的评分者内一致性对于任何视网膜异常几乎是完美的，对于视网膜出血是实质性的。AMP的评分者间一致性对于任何视网膜异常是实质性的，对于视网膜出血和黄斑渗出是中等的。在三个月和六个月时，一致性结果几乎相似。AMP可用于DR和其他视网膜病变的筛查，以便及时转诊，从而在资源匮乏地区减少失明。
