Reproducibility in Grading Neovascular AMD Fluorescein Angiograms Using Digital vs. Film Imaging Modalities

Abstract

Abstract: : Purpose: To determine grader agreement in identifying and classifying features of choroidal neovascular lesions in film versus digital fluorescein angiograms in neovascular age-related macular degeneration (AMD). Methods: Nineteen patients from the University of Wisconsin ophthalmology clinic had both digital and film stereoscopic fluorescein angiograms taken of the same eye within a 10 day period. Two senior AMD graders at the Fundus Photograph Reading Center graded the digital angiograms and, two months later, graded the film angiograms. A mean grade was obtained from the two graders for the following variables: classic CNV, occult CNV, area of CNV, fluorescein leakage and blood. Results: Intermethod agreement for presence vs. absence of new vessels was 95% (K = .88) for classic CNV and 90% (K = .77) for occult CNV. The correlation coefficient for agreement on extent of new vessels was 0.89 for classic CNV, 0.74 for occult CNV and 0.71 for total CNV. The correlation coefficient for agreement on extent of leakage was 0.71 and for area of blood was 0.97. Conclusions: The variability observed between the digital and film fluorescein angiograms did not appear greater than the variability observed between graders evaluating film angiograms. With increasing use of digital angiography, evidence of its comparability to film angiography is reassuring.

Keywords: age-related macular degeneration • choroid: neovascularization • imaging/image analysis: clinical