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Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy

Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy
Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy

Purpose: to examine the level of agreement and reasons for disagreement between grading of diabetic retinopathy and maculopathy using mydriatic digital photographs in a diabetic retinopathy screening service (DRSS) and hospital eye service (HES). 

Methods: English NHS Diabetic Eye Screening Programme grades for diabetic retinopathy prospectively recorded on a hospital electronic medical record were compared to the grades from the DRSS event that prompted referral. In cases of disagreement, images were reviewed. 

Results: data for 1,501 patients (3,002 eyes) referred between 2008 and 2011 were analyzed. The HES retinopathy grades were R0 (no retinopathy) in 341 eyes, R1 (background retinopathy) in 1,712 eyes, R2 (pre-proliferative retinopathy) in 821 eyes, and R3 (proliferative retinopathy) in 128 eyes. The DRSS grades were in agreement in 2,309 eyes (76.9%), recorded a lower grade in 227 eyes, and recorded a higher grade in 466 eyes. Agreement was substantial (κ = 0.65). The commonest cause for disagreement was overgrading of R1 as R2 by hospital clinicians. The HES maculopathy grades were M0 (no maculopathy) in 2,267 eyes and M1 (maculopathy) in 735 eyes. The DRSS were in agreement in 2,111 eyes (70.2%), recorded a lower grade in 106 eyes, and recorded a higher grade in 785 eyes. Agreement was fair (κ = 0.39). The commonest cause for disagreement was hospital clinicians missing fine exudates. 

Conclusions: this study establishes a benchmark standard for agreement between HES and DRSS grading. Review of DRSS and grading reports images for newly referred patients is likely to improve levels of agreement, particularly for diabetic retinopathy, and should be strongly encouraged.

Diabetes mellitus, Diabetic retinopathy, Maculopathy, Screening
1120-6721
550-558
Healy, Rachel
21bd5a60-1acc-48e7-9a1d-ba73a9a529ad
Sallam, Ahmed
150f19eb-a53c-4df1-b426-afe4e73a6d46
Jones, Vanessa
0221c4ef-04ad-40ce-b52f-fa5ce74da050
Donachie, Paul H.J.
ff9da07a-e148-4e14-97bf-5333b834b3f0
Scanlon, Peter H.
4e3d2310-c79e-42db-ae29-7a7d6b278aa3
Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Johnston, Robert L.
fa9df252-a6c7-4ce5-8d8e-644b5a100d21
Healy, Rachel
21bd5a60-1acc-48e7-9a1d-ba73a9a529ad
Sallam, Ahmed
150f19eb-a53c-4df1-b426-afe4e73a6d46
Jones, Vanessa
0221c4ef-04ad-40ce-b52f-fa5ce74da050
Donachie, Paul H.J.
ff9da07a-e148-4e14-97bf-5333b834b3f0
Scanlon, Peter H.
4e3d2310-c79e-42db-ae29-7a7d6b278aa3
Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Johnston, Robert L.
fa9df252-a6c7-4ce5-8d8e-644b5a100d21

Healy, Rachel, Sallam, Ahmed, Jones, Vanessa, Donachie, Paul H.J., Scanlon, Peter H., Stratton, Irene M. and Johnston, Robert L. (2013) Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy. European Journal of Ophthalmology, 24 (4), 550-558. (doi:10.5301/ejo.5000404).

Record type: Article

Abstract

Purpose: to examine the level of agreement and reasons for disagreement between grading of diabetic retinopathy and maculopathy using mydriatic digital photographs in a diabetic retinopathy screening service (DRSS) and hospital eye service (HES). 

Methods: English NHS Diabetic Eye Screening Programme grades for diabetic retinopathy prospectively recorded on a hospital electronic medical record were compared to the grades from the DRSS event that prompted referral. In cases of disagreement, images were reviewed. 

Results: data for 1,501 patients (3,002 eyes) referred between 2008 and 2011 were analyzed. The HES retinopathy grades were R0 (no retinopathy) in 341 eyes, R1 (background retinopathy) in 1,712 eyes, R2 (pre-proliferative retinopathy) in 821 eyes, and R3 (proliferative retinopathy) in 128 eyes. The DRSS grades were in agreement in 2,309 eyes (76.9%), recorded a lower grade in 227 eyes, and recorded a higher grade in 466 eyes. Agreement was substantial (κ = 0.65). The commonest cause for disagreement was overgrading of R1 as R2 by hospital clinicians. The HES maculopathy grades were M0 (no maculopathy) in 2,267 eyes and M1 (maculopathy) in 735 eyes. The DRSS were in agreement in 2,111 eyes (70.2%), recorded a lower grade in 106 eyes, and recorded a higher grade in 785 eyes. Agreement was fair (κ = 0.39). The commonest cause for disagreement was hospital clinicians missing fine exudates. 

Conclusions: this study establishes a benchmark standard for agreement between HES and DRSS grading. Review of DRSS and grading reports images for newly referred patients is likely to improve levels of agreement, particularly for diabetic retinopathy, and should be strongly encouraged.

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More information

e-pub ahead of print date: 12 September 2013
Keywords: Diabetes mellitus, Diabetic retinopathy, Maculopathy, Screening

Identifiers

Local EPrints ID: 486880
URI: http://eprints.soton.ac.uk/id/eprint/486880
ISSN: 1120-6721
PURE UUID: 2020ee6a-9285-4c12-9a81-785de1e3d417
ORCID for Irene M. Stratton: ORCID iD orcid.org/0000-0003-1172-7865

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Date deposited: 08 Feb 2024 17:31
Last modified: 11 May 2024 02:04

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Contributors

Author: Rachel Healy
Author: Ahmed Sallam
Author: Vanessa Jones
Author: Paul H.J. Donachie
Author: Peter H. Scanlon
Author: Irene M. Stratton ORCID iD
Author: Robert L. Johnston

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