Concordance between retina specialists and a preferred practice pattern in treatment and follow-up criteria for diabetic retinopathy. The Mexico City Diabetes Study Retinopathy Group.

Proper detection, adequate laser therapy and follow-up of diabetic retinopathy (DR), using guidelines established by landmark studies, are important to prevent blindness. In this report we analyze the agreement between 11 retina specialists and the Preferred Practice Pattern of the American Academy of Ophthalmology in the therapeutic and follow-up criteria for DR. Color fundus stereophotographs of seven standard fields of each eye of 15 diabetics were sent to 11 retina specialists. Their treatment and follow-up criteria were surveyed. For treatment of DR mean percent agreement was 65%. Kappa statistic, which corrects for chance agreement, was between -0.23 and 0.63 with a mean of 0.26. The therapeutic recommendations for macular edema were analyzed separately and the mean kappa was between -0.10 and 0.71 with a mean of 0.32. With respect to recommendations for interval until follow up, following initial visit, mean percent agreement was 73% with a kappa statistic between -0.22 and 0.33 and a mean of 0.07. Based on conventional interpretation of kappa statistic these mean values are in the range of poor agreement. Since there is a significant discrepancy in the concordance level in both therapeutic and follow-up recommendations for the management of DR, there is a need to improve agreement in these criteria, since these are key elements in the decision making process of the specialist caring for diabetic patients.