June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Reproducibility of Grading Superficial vs Deep Retinal Hemorrhage in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2).
Author Affiliations & Notes
  • Samuel A Whittier
    Department of Ophthalmology and Visual Science, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Adrian Au
    Retinal Disorders and Ophthalmic Genetic Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
  • David Sarraf
    Retinal Disorders and Ophthalmic Genetic Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
  • Neal L Oden
    The Emmes Company LLC, Rockville, Maryland, United States
  • Paul C Van Veldhuisen
    The Emmes Company LLC, Rockville, Maryland, United States
  • Ingrid U Scott
    Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Michael S Ip
    Department of Ophthalmology - Doheny Eye Institute, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Sheila Watson
    Department of Ophthalmology and Visual Science, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Barbara Blodi
    Department of Ophthalmology and Visual Science, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Amitha Domalpally
    Department of Ophthalmology and Visual Science, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Footnotes
    Commercial Relationships   Samuel Whittier, None; Adrian Au, None; David Sarraf, Amgen (C), Amgen (F), Bayer (C), Genentech (F), Heidelberg (F), Novartis (C), Optovue (C), Optovue (F), Regeneron (F), Topcon (F); Neal Oden, None; Paul Van Veldhuisen, None; Ingrid Scott, PI - National Eye Institute Grant (F), Previous Consultant - Regeneron (C), Previously on Safety/Review Committee - Novartis Grants (S); Michael Ip, Aerie (C), Alimera (C), Allergan (C), Amgen (C), Apellis (C), Cell Lineage Therapeutics (C), Clearside (C), Genentech (C), Novartis (C), OCCURX (C), Regeneron (C), RegenexBio (C); Sheila Watson, None; Barbara Blodi, None; Amitha Domalpally, None
  • Footnotes
    Support  NEI Grants: U10EY023529, U10EY023533, U10EY023521; This project was supported in part by an unrestricted research grant from Research to Prevent Blindness, Inc. (New York, NY) to the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. The funding organization had no role in the design or conduct of this research.
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3183. doi:
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      Samuel A Whittier, Adrian Au, David Sarraf, Neal L Oden, Paul C Van Veldhuisen, Ingrid U Scott, Michael S Ip, Sheila Watson, Barbara Blodi, Amitha Domalpally; Reproducibility of Grading Superficial vs Deep Retinal Hemorrhage in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2).. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3183.

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

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Abstract

Purpose : The intraretinal location of hemorrhage in eyes with central retinal vein occlusion (CRVO) may provide important information regarding disease severity and visual acuity outcomes. The purpose of this post-hoc evaluation is to investigate the reproducibility of grading superficial (nerve fiber layer) vs deep retinal hemorrhage on color fundus photographs (CFP) in participants from the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2).

Methods : Baseline three-field CFP of 54 study eyes in the SCORE2 cohort were evaluated. A grid was developed to differentiate 9 distinct subfields (Figure 1). Expert graders evaluated for percent involvement of superficial hemorrhage in each of the 9 subfields, and evaluated for percent involvement of deep hemorrhage in 8 subfields, excluding the optic disc. Graders also evaluated eyes for optic disc swelling, disc pallor, cotton wool spots, and retinal folds. Reproducibility was measured using predetermined parameters: exact agreement, agreement within 5%, 10% and 20%. Intergrader reproducibility was calculated using kappa statistics.

Results : All 54 study eyes had gradable images. Average intergrader reproducibility among fields with superficial hemorrhage was 36.6% exact agreement, 56.4% within 5%, 67.5% within 10%, and 85% within 20%. Reproducibility among fields with deep hemorrhage was 66.4% exact agreement, 88% within 5%, 93.1% within 10%, and 98.8% within 20%. Across all fields, the weighted kappa score range for grading percent superficial and deep hemorrhage was 0.43 – 0.71 and 0.49 – 0.69, respectively. Kappa scores for the assessments of disc swelling, disc edema, cotton wool spots, and retinal folds were 0.34, 1.0, 0.8, and 0.64, respectively.

Conclusions : In SCORE2, a novel method for grading area of superficial and deep retinal hemorrhage demonstrated agreement within 20% in ≥85% of the eyes. Intergrader reproducibility for both superficial and deep hemorrhage was moderate to substantial, depending on the field graded. Employing this method in a large scale longitudinal analysis will help define the role of retinal hemorrhage location as a predictive biomarker of therapeutic and visual outcome in CRVO.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure 1. Grid placed on a right eye with CRVO: F1 optic disc; F2-F5 peripapillary region; F6, F8 peri-arcade regions; F7 macula; and F9 nasal retina.

Figure 1. Grid placed on a right eye with CRVO: F1 optic disc; F2-F5 peripapillary region; F6, F8 peri-arcade regions; F7 macula; and F9 nasal retina.

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