Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study

摘要

Background Early detection can reduce irreversible blindness from retinal diseases. This study aims to assess the intra- and inter-rater agreement of retinal pathologies observed on fundus photographs between an ophthalmologist and two-mid level ophthalmic personnel (MLOPs). Method A population-based, cross-sectional study was conducted among subjects 60?years and above in the Bhaktapur district of Nepal. Fundus photographs of 500 eyes of 500 subjects were assessed. The macula-centered 45-degree photographs were graded twice by one ophthalmologist and two MLOPs. Intra-rater and inter-rater agreements were assessed for the ophthalmologist and the MLOPs. Result Mean age was 70.22?years?±?6.94 (SD). Retinal pathologies were observed in 55.6?% of photographs (age-related macular degeneration: 34.2?%; diabetic retinopathy: 4.2?%; retinal vein occlusion: 3.8?%). Twelve (2.4?%) fundus pictures were non-gradable. The intra-rater agreement for overall retinal pathologies, retinal hemorrhage, and maculopathy were substantial both for the ophthalmologist as well as for the MLOPs. There was moderate inter-rater agreement between the ophthalmologist and the first MLOP on second rating for overall retinal pathologies, [kappa (k) ; 95?% CI =?0.59 (0.51–0.66)], retinal hemorrhage [ k; 95 % CI =?0.60 (0.41–0.78)], and maculopathy [ k; 95 % CI =?0.52 (0.43–0.60)]. Inter-rater agreement between the ophthalmologist and the second MLOP for second rating was moderate for overall retinal pathologies [ k; 95?% CI =?0.52 (0.44–0.60)], substantial agreement for retinal hemorrhage [ k; 95?% CI =?0. 68 (0.52–0.84)], moderate agreement for maculopathy [ k; 95?% CI =?0.59 (0.50–0.67)]. Conclusion There is moderate agreement between the MLOPs and the ophthalmologist in grading fundus photographs for retinal hemorrhages and maculopathy.