METHODOLOGY FOR RETINAL PHOTOGRAPHY AND ASSESSMENT OF DIABETIC-RETINOPATHY - THE EURODIAB IDDM COMPLICATIONS STUDY
METHODOLOGY FOR RETINAL PHOTOGRAPHY AND ASSESSMENT OF DIABETIC-RETINOPATHY - THE EURODIAB IDDM COMPLICATIONS STUDY
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DOI：
10.1007/s001250050303
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发表时间：
1995-04-01
期刊：
影响因子：
8.2
通讯作者：
SJOLIE, AK
中科院分区：
文献类型：
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作者：
ALDINGTON, SJ;KOHNER, EM;SJOLIE, AK
我们提出了45度视网膜摄影的方法，并详细介绍了一种用于糖尿病视网膜病变评估的45度现场分级标准的新系统的开发、应用和验证。该系统是为EURO-DIAB IDDM并发症研究而开发的，该研究是欧共体资助的糖尿病流行病学和预防协同行动计划（EURODIAB）的一部分。糖尿病视网膜病变的评估由训练有素的彩色视网膜照片读者使用新开发的系统集中进行。该系统被证明是可接受的准确，可重复和相对简单的应用。它与公认的“黄金标准”7场30度立体摄影（使用改进的Airlie House分类方案进行评估）相比，新系统在48只眼睛中进行了验证。根据临床视网膜病变情况选择分层随机样本：5名，无视网膜病变；25、非增殖性视网膜病变；16、增殖或光凝固；加上2，眼睛有潜在的混淆性病变（静脉闭塞）。两个系统在48只眼睛中的43只眼睛中正确检测到简单的视网膜病变，检测结果100%一致。两个系统都正确地识别了两个已知的混淆静脉阻塞病例。在患有糖尿病视网膜病变（n = 41）的眼睛中，当严重程度分为三组：轻度背景，中度/重度背景和增生性/光凝性背景时，使用新系统的至少一个评分者（五分之一）在41只眼睛中有38只（93%）的验证结果匹配，三个或更多的评分者在31只（76%）的眼睛中匹配。个别而言，五个年级学生的2个领域分配与已核实的水平非常一致（协议中位数为37，范围为28-43）。通过对主要研究中随机选择的10% （n = 252只眼睛）和5% （n = 123只眼睛）的样本进行观察者内部和观察者之间的变异测量来评估可重复性，以结果kappa值表示，以获得机会校正的比例一致性。观察者之间的kappa值为0.85，观察者之间的kappa值为0.83，表明两种测量方法非常一致。这种方法对大型流行病学研究特别有用，因为参与研究的中心在视网膜摄影方面的经验有限。
We present the methodology for 45 degrees retinal photography and detail the development, application and validation of a new system of 45 degrees field grading standards for the assessment of diabetic retinopathy. The systems were developed for the EURO-DIAB IDDM Complications Study, part of a European Community funded Concerted Action Programme into the epidemiology and prevention of diabetes (EURODIAB). Assessment of diabetic retinopathy was carried out centrally by a trained reader of colour retinal photographs using the newly-developed system. The system proved to be acceptably accurate, repeatable and relatively simple to apply. It compared well with the recognised 'gold standard' 7-field 30 degrees stereo photography (assessed using a modified Airlie House classification scheme), against which the new system was validated in a series of 48 eyes. Selection was as a stratified random sample based on clinical retinopathy status: 5, no retinopathy; 25, non-proliferative retinopathy; 16, proliferative or photocoagulated; plus 2, eyes with potentially confounding lesions (vein occlusion). Simple presence of retinal lesions was correctly detected by both systems in 43 of the 48 eyes, giving 100 % agreement on detection. Both systems correctly identified the two known cases of confounding vein occlusion. In eyes with diabetic retinopathy (n = 41), when severity was expressed in three groups: mild background, moderate/severe background and proliferative/ photocoagulated, at least one grader (out of five) using the new system matched the verified results in 38 out of 41 (93 %) eyes and three or more graders matched in 31 (76 %) eyes. Individually the five graders' 2-field allocations agreed well with the verified levels (median number of agreements 37, range 28-43). Repeatability was assessed by measures of within and between observer variation using randomly selected samples of 10 % (n = 252 eyes) and 5 % (n = 123 eyes) of the main study, respectively, expressed as a resultant kappa value for chance-corrected proportional agreement. Within observer assessment yielded a kappa of 0.85 and between observers a value of 0.83 indicating very good agreement for both measures. The method is particularly useful for large epidemiological studies, in which participating centres have a limited experience in retinal photography.