Comparability of two fundus photograph reading centers in grading cytomegalovirus retinitis progression☆
Section snippets
Patient selection
From the Johns Hopkins AIDS Ophthalmology Clinic, patients were enrolled who had newly diagnosed, active CMV retinitis, had received no prior treatment for CMV retinitis, had a diagnosis of AIDS, were age 18 years or older, and had received no treatment for extraocular CMV disease within the previous 28 days. The CRVR study was approved by the Johns Hopkins Hospital Joint Committee for Clinical Investigation before enrollment, and patients gave written, informed consent. Patients underwent a
Presence and location of CMV retinitis
Patients entering the study were required to have CMV retinitis involving at least one eye, based on clinical examination. In the sample of 77 patients (154 eyes) selected for comparison of results, the two FPRCs (designated FPRC A and FPRC B) both detected retinitis in at least one eye of all patients. To determine bilaterality of disease, however, individual eyes were considered. Among 154 eyes, agreement on presence/absence was 94.8% (present in 98 eyes and absent in 48 eyes). Of the 8 eyes
Discussion
Centralized assessment of CMV retinitis progression from standardized fundus photographs, employing one of several FPRCs, has been a widely used method of determining outcomes in various studies. Recognized benefits of using a central FPRC include: (1) standardization of assessment across multiple clinics; (2) masking of graders to patient characteristics other than retinal morphology (i.e., treatment assignment); (3) ability to test reproducibility of evaluations; and (4) opportunity to reduce
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Fundus image diagnostic agreement in uveitis utilizing free and open source software
2013, Canadian Journal of OphthalmologyCitation Excerpt :The agreement observed was sufficiently poor that it is unlikely that the reviewer’s equipment was the primary constraint, especially given that the reviewers considered the conditions adequate. It should be noted that some infectious causes of uveitis such as cytomegalovirus retinitis would lend itself well to an image agreement study, but infectious causative agent was excluded from MUST.24 Separately, MUST OCT data were analyzed by Domalpally et al.,25 who reported excellent intergrader agreement of OCT macular edema.
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This research was supported by Grant R01-EY-10268 from the National Eye Institute, National Institutes of Health, Bethesda, MD. Additional support was obtained from NEI grants K23 EY00386 (J.H.K.) and K24 E4004505 (D.A.J.). Dr. Jabs is the recipient of a Research to Prevent Blindness Senior Scientific Investigator Award. Dr. Jabs is a Research to Prevent Blindness Senior Scientific Investigator.