Author: Catarina Monteiro (Portugal)
Co-authors: Susana Henriques, Inês Coutinho, Júlio Almeida, Joana Roque, Filomena Silva, Isabel Prieto
Purpose
Diabetic macular edema (DME) is one of the main causes of low visual acuity in patients with diabetic retinopathy (DR). Optical coherence tomography (OCT) allows the evaluation and quantification of DME, namely through central macular thickness (CMT), which is the most used parameter in clinical practice. However, there is no strong correlation between the best corrected visual acuity (BCVA) and DME, so other factors must be taken into account. The purpose of this work was to determine the intra and inter-observer variability of the DME classification proposed by the European School for Advanced Studies in Ophthalmology (ESASO), based on the identification of several qualitative parameters in the OCT.
Setting/Venue
The study was conducted in the Ophthalmology Department in Hospital Professor Doutor Fernando da Fonseca in Lisbon, Portugal
Methods
Double-blind prospective study with 51 patients (73 eyes) with DME. A foveolar location OCT was performed. ESASO classification was used, based on 1 quantitative parameter (T, foveal thickness) and 6 qualitative parameters (C, intraretinal cysts; E, disruption of the ellipsoid zone; D, DRIL, disorganization of the inner retinal layers; H, number of hyper-reflective foci; F, presence of subfoveal fluid; V, vitreoretinal relationship). The classification was carried out by 2 operators, 2 times a month apart. Statistical analysis was performed using the SPSS program, and the Cohen Kappa test was used to assess the agreement between the observations.
Results
51 patients with a mean age of 67 ± 9 years were evaluated. The inter-observer agreement is fair for parameters E (k = 0.28) and H (k = 0.36), moderate for parameters C (k = 0.46) and D (k = 0.45), substantial for parameter V (k = 0.75) and almost perfect for parameter F (k = 0.88). The intra-observer agreement is moderate for parameters C (k = 0.52), E (k = 0.59) and D (k = 0.41), substantial for parameter H (k = 0.76) and almost perfect for parameters F (k = 0.88) and V (k = 0.83).
Conlusions
The classification of DME based on qualitative parameters in the OCT is subjective and presents important differences between observers and the same observer on different days, especially in parameters C, E, D and H. Parameters F and V have less variability both intra and inter-observer.
Financial Disclosure
I have no financial relations to declare
Comments
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