Original article
Optical Coherence Tomography Reader Agreement in Neovascular Age-related Macular Degeneration

https://doi.org/10.1016/j.ajo.2007.03.056Get rights and content

Purpose

To determine the interreader and intrareader agreement at the Optical Coherence Tomography (OCT) Reading Center at Duke for images produced for an interventional neovascular age-related macular degeneration (AMD) clinical trial.

Design

Retrospective, observational case series.

Methods

OCT was performed using the Stratus OCT Fast Macular Thickness Map (Carl Zeiss Meditec, Dublin, California, USA) scan mode and a 7-mm line scan centered on the fovea. Experienced OCT readers, certified to grade scans according to a standardized protocol, independently determined whether a scan was gradable. If gradable, each of the scans was graded for multiple morphologic characteristics. In addition, retinal thickness, subretinal fluid thickness, and choroidal neovascularization (CNV) thickness at the fovea were measured for each gradable scan. Interreader agreement was determined among three reader pairs. Readers regraded a subset of scans and intrareader agreement was determined.

Results

The interreader agreement was high for scan gradability and scan grades among three reader pairs, ranging from 84% to 100% and from 84% to 96%, respectively. Similarly, the intrareader agreement for scan gradability and scan grade, including comparison of adjudicated scan grades with readjudicated scan grades, was high and ranged from 91% to 100% and from 79% to 98%, respectively, except for scan grades of retinal pigment epithelium atrophy, when CNV was present. Highly reproducible results also were found for quantitative thickness measurements.

Conclusions

Well-trained OCT readers can grade independently, with a high level of interreader and intrareader agreement, multiple morphologic parameters of OCT scans obtained from eyes with neovascular AMD. Reproducible Stratus OCT scan data will be valuable to monitor treatment efficacy in interventional clinical trials of neovascular AMD.

Section snippets

Methods

Data were collected from an electronic database that contained the scan grades obtained from a multicenter interventional neovascular AMD treatment trial. At each study site, the Stratus OCT with Stratus 4.0 software (Carl Zeiss Meditec) was used to obtain OCT scans according to a standardized protocol. At each patient study visit, six radial scans and a 7-mm line scan offset 5 degrees from the horizontal obtained from the study eye was transmitted to the OCT Reading Center at Duke for further

Descriptive Variables

The study comprised 132 eyes of 110 patients; 61% were left eyes. The scans showed a wide range of pathologic features, varying from a relatively normal appearing retina, RPE, and choroid to those with multiple sites of pathologic characteristics. Among all the scans used in this study, 84.8% had ME, 55.4% had cysts, 43.2% had SRF, 13.1% had VMI changes, 8.1% had ERM, 42.0% had RPEE, 6.1% had ATR, and 74.1% had CNV.

Interreader Agreement

Overall, the interreader agreement of both scan gradability and scan grades was

Discussion

In this study, a wide range of pathologic features was observed and evaluated by the readers. We found that there was excellent interreader agreement for each of the eight parameters evaluated with respect to scan gradability and scan grades for all six radial scans and the 7-mm scan offset 5 degrees from horizontal. The intrareader agreement and the agreement between initial and repeat adjudication grades was high for all categories except for ATR. The thickness measurements were performed by

Nanfei Zhang will receive an MD from Duke University School of Medicine, Durham, North Carolina in May 2007. She will begin residency training in Ophthalmology at the University of California, Davis in July 2007. Ms Zhang research endeavors were mentored by Dr Glenn Jaffe at the Duke University Eye Center, and were supported by a Howard Hughes Fellowship. After her residency, she plans to pursue fellowship training in an academic setting that combines clinical training and research.

References (18)

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Nanfei Zhang will receive an MD from Duke University School of Medicine, Durham, North Carolina in May 2007. She will begin residency training in Ophthalmology at the University of California, Davis in July 2007. Ms Zhang research endeavors were mentored by Dr Glenn Jaffe at the Duke University Eye Center, and were supported by a Howard Hughes Fellowship. After her residency, she plans to pursue fellowship training in an academic setting that combines clinical training and research.

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