Analysis of intra-observer´s repeatability in retinopathy´s classification of patients with, both, clear and yellow IOL´S implantation.

Abstract

PURPOSE: to discriminate between different moderate retinopathies according to the clinical Age-Related Maculopathy Staging System (CARMS) using for it retinographies. Also to analyze de intra-observer`s reliability. METHODS: 808 retinographies were made to 101 subjects (both gender). Every patient had suffered cataract surgery with clear and yellow IOL´s implantation, 55 retinographies were classified by using CARMS system, which categorizes the images depending on the Drusen´s presence or absense, retinal pigment epithelium irregularities, geographic atrophy, pigment epithelium detachment and choroidal neovascularisation. The 55 retinographies categorizing was made by 2 experts in a blind, independent way. The method followed consisted in 2 different sequences with every of the 3 evaluated systems. The goal of the doubled-classification-method, with changing order no randomised, was to reject the influence of the evaluation of the previous image in the following one (Velo´s effect). Inter-observer´s repetability was checked, because of Kappa index was calculated, as an agreement parameter between both Experts. RESULTS: Intra-observer´s reliability analysis was the following: CARMS concondance obtained was 87.27% for observer A and 95.45% for the observer B. The expected concordance was 57.36% and 57044% for A and B respectively. Kappa index was 0.7016 and 008932 for A and B respectively. Drusen`s concordance obtained for observer A eas 87.27% and 98.18% for observer B. The expeted values were 59050% and 61.16% for A and B respectively. Kappa index was 0.6857 and 0.9532 for A and B respectively. Pigmentation´s concordance obteined was 87027% and 92.73%, for A and B observers. The expected concordance was 55021% and 53.72% for A and B and Kappa indexes were 0.7159 and 0.8429 for both. The reliability measured by Kappa index followed the rule: 0.80-1.00 (Excellent), 0.60-0.80 (Good), 0.40-0.60 (Moderate), 0.20-0.40 (Low), <0.20 (Bad). CONCLUSIONS: Kappa´s indexes obteined for the intra-observer analysis show a good reliability, between Godd and Excellent. A higher discrepancy in the firs retinas, which were classified, was observed. This means that a previous trainins is necessary.