National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
University College London, Institute of Ophthalmology, London, UK.
Eye (Lond). 2022 Feb;36(2):392-397. doi: 10.1038/s41433-021-01490-5. Epub 2021 Mar 8.
To evaluate the inter-rater reliability for identification of complete retinal pigment epithelium and outer retinal atrophy (cRORA) on SD-OCT images as defined by the Classification of Atrophy Meetings (CAM) group.
Fifty images of anonymized SD-OCT line scans of eyes with cRORA due to AMD were selected. Each .tiff image was saved in both black-on-white (BW) and white-on-black (WB) format. Five retina-trained clinicians graded both sets of images twice for the diagnosis of cRORA based on the CAM group definition. Fleiss kappa statistic was calculated for inter-rater reliability and Cohen's kappa statistic for intra-grader and inter-grader reliability between any two graders.
The inter-grader reliability varied from as low as 0.28 to 0.92 for WB images and 0.34 to 0.86 for BW images. However, the inter-grader and intra-grader agreement was ĸ WB 0.92; ĸ BW 0.86 and ĸ 0.92 respectively, for graders accustomed to the CAM criteria. Fleiss kappa was ĸ 0.49 (p value < 0.0001) for WB images and ĸ 0.34 (p value < 0.0001 for BW images. Overall, the agreement was better using WB images for all parameters except RPE attenuation/loss.
There is significant variability in diagnosis of cRORA on SD-OCT by retina-trained ophthalmologists in the real world. The study highlights the need for training to recognise the different features of cRORA prior to its implementation in clinical practice.
评估根据分类会议（CAM）组定义，对 SD-OCT 图像中完全性视网膜色素上皮和外层视网膜萎缩（cRORA）的识别的观察者间可靠性。
选择 50 例因 AMD 导致的 cRORA 的匿名 SD-OCT 线扫描图像。将每个.tiff 图像分别以黑底白字（BW）和白底黑字（WB）格式保存。5 名接受过视网膜培训的临床医生根据 CAM 组的定义，对两组图像进行两次诊断 cRORA 的判读。计算 Fleiss kappa 统计量以评估观察者间可靠性，计算 Cohen's kappa 统计量以评估任何两位判读者之间的组内和组间可靠性。
WB 图像的观察者间可靠性从低至 0.28 到 0.92，BW 图像的观察者间可靠性从低至 0.34 到 0.86。然而，对于习惯于 CAM 标准的判读者，WB 图像的组内和组间一致性为 ĸ WB 0.92；BW 图像的组内和组间一致性为 ĸ BW 0.86 和 ĸ 0.92。Fleiss kappa 对于 WB 图像为 ĸ 0.49（p 值<0.0001），对于 BW 图像为 ĸ 0.34（p 值<0.0001）。总体而言，除 RPE 衰减/损失外，所有参数均使用 WB 图像的一致性更好。
在真实世界中，经过视网膜培训的眼科医生对 SD-OCT 中 cRORA 的诊断存在显著差异。该研究强调了在临床实践中实施之前，需要进行培训以识别 cRORA 的不同特征。
