Author: Catarina Castro (Portugal)
Co-authors: Catarina Castro, João Heitor Marques, Nisa Silva, Ana Carolina Abreu, Maria João Furtado, Miguel Lume
Purpose
To evaluate the degree of agreement for detection of lesions in eyes with diabetic retinopathy (DR) and retinal vein occlusion (RVO) between conventional fundus photography (CFP) and multicolor fundus imaging (MFI).
Setting/Venue
Department of Ophthalmology, Centro Hospitalar Universitário do Porto
Methods
Cross-sectional analysis of consecutive eyes with DR and RVO who underwent CFP (Topcon TRC-50DX® fundus camera) and MFI (Spectralis HRA+OCT Heidelberg Engineering® platform) between January and March 2021. Images were obtained in the same day, after proper pupil dilation. Images in which the details of the optic disc and vascular arcades were not defined were excluded. The following lesions were considered in DR: microaneurysms (MA), microhemorrhages (MH), soft exudates (SE), hard exudates (HE), neovascularization (NV) and laser treatment (LT). In RVO we considered hemorrhages (HR), venous engorgement (VE), venous sheathing (VS) and optociliary shunts (OS). Firstly, an independent and blind analysis of all images was carried out by two experienced medical retina doctors (Observer 1 [O1] and Observer 2 [O2]), and lesions were classified as “present” or “absent”. Then, each observer performed a paired comparison in cases where lesions presented in both imagens of the same eye, to assess if lesions were similarly detected in CFP and MFI. The degree of agreement between observers and between exams was assessed with a Cohen’s Kappa. Cohen’s Kappa values between 0.41 and 0.60 indicate moderate agreement, between 0.61 and 0.80 indicate substantial agreement and from 0.81 to 1.00 indicate almost perfect agreement.
Results
A total of 115 eyes with DR and 33 with RVO were analyzed. Regarding DR, the agreement between CFP and MFI for O1 was almost perfect for MA, MH and NV and substantial for SE, HE and LT. For O2 was almost perfect for MA, MH, NV and HE and substantial for SE and LT. SE were detected more frequently in MFI by both observers (O1: 17.4% vs 11.3%; O2: 17.4% vs 10.4%), as well as LT (O1: 54.8% vs 38.3%; O2: 52.2% vs 35.7%) and HE (O1: 44.3% vs 38.8%; O2: 45.2% vs 40.0%). Regarding RVO, for O1 the agreement was almost perfect for HR, NV, VE and OS and substantial for VS. For O2 was almost perfect for HR, NV, VE and VS and moderate for OS. VS was detected more frequently in MFI by O1 (12.1% vs 6.1%) and OS in CFP by O2 (24.2% vs 12.1%). On paired analysis O2 considered that in 75% of cases VS was easier to identify in MFI and O1 that in 71.4% of cases OS were better identified in CFP. Agreement between observers was substantial to almost perfect for all lesions in both exams except for OS in MFI (moderate).
Conlusions
The agreement of MFI and CFP to detect lesions in DR and RVO was substantial to almost perfect for most lesions. Despite this, MFI seems more appropriate to detect SE and LT in eyes with DR and VS in eyes with RVO and OS seem easier to detect in CFP. The use of both types of fundus imaging may increase the rate of detection of lesions that otherwise might not be noticed.
Financial Disclosure
No financial disclosures regarding any of the authors.
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