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VARIABILITY AMONG RETINA SPECIALISTS IN EVALUATING FLUORESCEIN ANGIOGRAMS OF PATIENTS WITH NEOVASCULAR AGERELATED MACULAR DEGENERATION

ZAYIT-SOUDRY, SHIRI MD*; ALFASI, MEIRAV MD; GOLDSTEIN, MICHAELLA MD*; MOISSEIEV, JOSEPH MD‡††; AXER-SIEGEL, RUTH MD§††; POLLACK, AYALA MD¶**; YASSUR, YUVAL MD#††; LOEWENSTEIN, ANAT MD*††

doi: 10.1097/IAE.0b013e31802c50a3
Original Articles
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Purpose: To determine the rate of agreement among five retina specialists in classifying various angiographic features of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), as evaluated on printed digital fluorescein angiogram (FA) frames, as well as determination of eligibility for photodynamic treatment (PDT) according to established guidelines.

Methods: Ninety-two digital FAs demonstrating subfoveal CNV secondary to AMD were evaluated independently by five retina specialists. The pattern of classic component could be classified as no classic component, minimally classic, predominantly classic, or classic only. Each grader was asked to determine eligibility of each case to PDT according to established treatment guidelines, national health insurance guidelines, and one’s own personal judgment.

Results: The κ coefficient of concordance calculated for all five observers regarding CNV localization was 0.285, indicating fair overall agreement, and was 0.295, indicating fair agreement, regarding classification of leakage pattern. The κ coefficient of agreement calculated for all five graders regarding eligibility for treatment according to established international guidelines, national health insurance, and each grader’s own personal judgment was 0.163, 0.33, and 0.164, respectively, indicating slight to fair overall agreement.

Conclusion: Considerable variability may exist among retina specialists interpreting FAs and should be considered in the assessment of treatment guidelines.

Significant variability may exit among retina specialists evaluating fluorescein angiograms of patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration in regard to morphologic features and may result in heterogeneous therapeutic decisions.

From *Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, †Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, ‡The Goldschleger Eye Institute, Sheba Medical Center, Tel–Hashomer, Israel, §Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel, ¶Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel, #Mor Eye Institute, Ramat Gan, **The Hebrew University, Jerusalem, and ††Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

None of the authors have proprietary interest in this study.

Reprint requests: Shiri Zayit-Soudry, Department of Ophthalmology, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel; e-mail: shirizayit@gmail.com

© The Ophthalmic Communications Society, Inc.