July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Diagnostic accuracy and interobserver variability of macular disease evaluation using optical coherence tomography
Author Affiliations & Notes
  • Siegfried Karl Wagner
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Reena Chopra
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
    DeepMind, United Kingdom
  • Joseph R Ledsam
    DeepMind, United Kingdom
  • Harry Askham
    DeepMind, United Kingdom
  • Sam Blackwell
    DeepMind, United Kingdom
  • Livia Faes
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
    Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
  • Konstantinos Balaskas
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Trevor Back
    DeepMind, United Kingdom
  • Pearse Andrew Keane
    NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Footnotes
    Commercial Relationships   Siegfried Wagner, None; Reena Chopra, DeepMind (E); Joseph Ledsam, DeepMind (E); Harry Askham, DeepMind (E); Sam Blackwell, DeepMind (E); Livia Faes, None; Konstantinos Balaskas, Alimera (R), Allergan (R), Bayer (F), Bayer (R), Novartis (F), Novartis (R); Trevor Back, DeepMind (E); Pearse Keane, Allergan (R), Bayer (R), Bayer (S), Carl Zeiss Meditec (R), DeepMind (C), Haag-Streit (R), Heidelberg Engineering (R), Novartis (R), Novartis (S), Optos (C), Topcon (R)
  • Footnotes
    Support  Supported by the National Institute for Health Research as an Academic Clinical Fellow
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1849. doi:
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      Siegfried Karl Wagner, Reena Chopra, Joseph R Ledsam, Harry Askham, Sam Blackwell, Livia Faes, Konstantinos Balaskas, Trevor Back, Pearse Andrew Keane; Diagnostic accuracy and interobserver variability of macular disease evaluation using optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1849.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To characterize the diagnostic accuracy and interobserver variability of macular spectral-domain optical coherence tomography (OCT) in patients presenting to an ophthalmic teaching hospital with suspected macular disease among eight retinal specialists.

Methods : Four ophthalmologists and four optometrists analyzed 997 macular OCTs acquired with the 3D OCT - 2000 (Topcon, Japan) from a randomly selected retrospective cohort of 1000 patients presenting with a suspected macular problem to Moorfields Eye Hospital between June 2012 and January 2017. Scans were analysed by each specialist on two occasions in a random order at least one week apart - the first review consisted of the OCT alone while the second incorporated additional clinical information, such as age, visual acuity, fundus photo and a brief clinical narrative. Clinicians were asked to give a diagnosis of choroidal neovascularization (CNV), non-CNV related macular retinal edema (MRE), other pathology or normal. The gold standard diagnosis was the final diagnosis at a specialist retinal clinic following ancillary investigations, such as fluorescein angiography. Interobserver variability was assessed with the Fleiss kappa statistic. Diagnostic accuracy outcome measures were sensitivity, specificity, positive predictive value and negative predictive value. Pearson correlation coefficient was used to examine the association between years of experience and diagnostic accuracy.

Results : Interobserver variability was excellent among both optometrists (κ 0.739) and ophthalmologists (κ 0.827) improving when OCT was combined with clinical information (optometrists: κ 0.812, ophthalmologists: κ 0.878). Diagnostic accuracy was generally high, particularly when combined with additional clinical information. For the sight-threatening pathology of CNV, sensitivity and specificity were respectively 89% and 99% for ophthalmologists and 86% and 97% for optometrists. A strong correlation was noted between years of experience and diagnostic accuracy (r = 0.86, p < 0.01).

Conclusions : OCT is highly sensitive and specific in the diagnosis of macular disease, especially when combined with additional demographic and clinical details. Diagnostic accuracy appears to improve proportionally with years of retinal experience. There is strong agreement among experts in qualitative OCT interpretation across a range of macular pathology.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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