Evaluation and inter-observer analysis of retinography existing clinical classification system to categorize moderate retinopathies.
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2009
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Wasfi, M.
Vinas Pena, M.
Forlán, A.
Molina Gómez, C.
Chamorro Gutiérrez, E.
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Abstract
PURPOSE: To evaluate existing validated systems to classify retinopathies, to determine the interobserver agreement level.
METHODS: 55 retinographies (both gender >60 years old) were categorized following 3 stablished criteria: the International Classification and Grading System for ARM and AMD (BIRD), the Wisconsin Age-related Maculophathy Grading System (WISCONSIN) and the Clinical Age-related Maculophathy Staging System (CARMS). The categorizing was made by 2 experts in a blind, independent way. The goal of the doubled-classification-method, with changing order no randomised, was to reject the influence of the Velo effect. Inter-observer´s repeatability was checked as an agreement parameter between both Experts.
RESULTS: CARMS system was chosen, since allows a global pathology classification. CARMS concordance obtained was 81.89% (expected= 57.39% kappa index = 0.57). Drusen concordance obtained was 87.27% (Expected= 60.31% kappa index = 0.68). Pigmentation concordance obtained was 76.36% (expected = 54.46% kappa index= 0.48). The reliability measured by Kappa index followed the rule: 0.80-1.00 (Excellent). 0.60-0.80 (Good) and 0.40-0.60 (Moderate). 0.20-0.40 (Low) < 0.20 (Bad)
CONCLUSION: Existin Retinopathies classification systems can be improved, to solve the huge subjective level that they present. Kappa index obtained, shown medium concordance for the inter-observer analysis, except in Drusen case, dichotomy`s variable, which presented a good reliability. The worse behaviour of the Pigmentation´s variable respect to Drusen variable has to be noted. This has an important influence in the global CARMS reliability, so it makes this influence to fall down.