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A. C. Tan, S. C. Loon, H. Choi; Locs III Cataract Grading Variability Between Junior and Senior Staff in a Singapore Hospital. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1923.
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To test the LOCS III cataract grading scale’s reliability amongst observers of different levels of ophthalmology experience. There is a wide variation in ophthalmology experience in most training hospitals. For LOCS III to be a good grading system there should be low inter-observer variability when used by doctors of all levels of experience.
This was a comparative study where a non-ophthalmology trainee (observer C), a basic ophthalmology trainee (observer B) and an ophthalmology consultant (observer A) graded 28 patient’s cataracts pre-operatively. The doctors had a meeting to discuss their interpretations of the LOCS III manual to standardise the grading system and graded a further 27 patients.
The inter-observer agreement values for the 3 different LOCS III categories (Graph 1) show there is a statistically significant increase in inter-observer agreement in the nuclear and cortical categories after the standardisation of the LOCS III system.The kappa values after standardization fall in the moderate range (0.41-0.60). There is no relation between the experience of the observer and the kappa values (Graph 2) with statistical significance.
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