June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Inter grader agreement in the Danish screening program for diabetic retinopathy
Author Affiliations & Notes
  • Anne Suhr Thykjær
    Ophthalmology, Odense Universitetshospital, Odense, Southern Denmark, Denmark
    Clinical institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Southern Denmark, Denmark
  • Lonny Stokholm
    OPEN, Open Patient Data Explorative Network, Odense, Southern Denmark, Denmark
  • Ryo Kawasaki
    Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka, Japan
  • Kurt Højlund
    Endocrinology, Odense Universitetshospital, Odense, Southern Denmark, Denmark
    Clinical institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Southern Denmark, Denmark
  • Katrine Hass Rubin
    OPEN, Open Patient Data Explorative Network, Odense, Southern Denmark, Denmark
  • Katja Schielke
    Ophthalmology, Aalborg Universitetshospital, Aalborg, North Denmark Region, Denmark
  • Caroline Laugesen
    Ophthalmology, Sjaellands Universitetshospital Roskilde, Roskilde, Sjaelland, Denmark
  • Nis Andersen
    The Danish registry of diabetic retinopathy and maculopathy, Denmark
  • Jens Andresen
    Association of Danish ophthalmologists, Denmark
  • Steffen Heegaard
    Ophthalmology, Rigshospitalet, Kobenhavn, Denmark
  • Jakob Grauslund
    Ophthalmology, Odense Universitetshospital, Odense, Southern Denmark, Denmark
    Clinical institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Southern Denmark, Denmark
  • Footnotes
    Commercial Relationships   Anne Thykjær None; Lonny Stokholm None; Ryo Kawasaki None; Kurt Højlund None; Katrine Rubin None; Katja Schielke None; Caroline Laugesen None; Nis Andersen None; Jens Andresen None; Steffen Heegaard None; Jakob Grauslund None
  • Footnotes
    Support  VELUX Foundation, Steno Diabetes Center Odense and M.L. Jørgensen & Gunnar Hansen foundation
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 567 – A0132. doi:
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      Anne Suhr Thykjær, Lonny Stokholm, Ryo Kawasaki, Kurt Højlund, Katrine Hass Rubin, Katja Schielke, Caroline Laugesen, Nis Andersen, Jens Andresen, Steffen Heegaard, Jakob Grauslund; Inter grader agreement in the Danish screening program for diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):567 – A0132.

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

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Abstract

Purpose : The Danish Registry of Diabetic Retinopathy (DiaBase) includes screening information from approximately 200,000 patients attending diabetic retinopathy (DR) screening in Denmark between 2013-2018. We performed a national, clinical validation study of the DR-gradings in the database to explore the inter grader agreement between the primary, screening ophthalmologist and a secondary certified grader.

Methods : Invitations to participate in the study were sent to all screening hospital departments as well as every practicing ophthalmologist nationwide. Fundus images and information on DR level, region of screening, image style and screening facility was uploaded by the primary grader to a secure database. These data were all blinded to the secondary grader during the grading process.
All grading of DR in a clinical setting in Denmark is standardized and performed using the International Clinical Diabetic Retinopathy (ICDR) scale, which was also the system applied in this study.
Fundus photographs from 230 patients (457 eyes) were included in the analysis.

Results : Images were received from all five Danish regions, from both practices (52.6%) and hospital based (47.4%) screening facilities.
Overall the reported levels of DR was 67.4%, 12.4%, 13.5%, 1.3% and 6.2% for no, mild, moderate, severe and proliferative DR. A significant difference (P<0.001) in the reported levels of DR between the screening facilities was observed; images from practicing ophthalmologists showed a distribution of 92%, 5%, 2%, 0% and 1% whereas images from hospital based ophthalmologists showed a distribution of 41%, 21%, 26%, 3%, and 11% for no, mild, moderate, severe and proliferative DR.
A weighted prevalence-adjusted, bias-adjusted kappa (PABAK) analysis was performed. The overall agreement between the primary and secondary graders was 93% (κ = 0.83). When sub-analyzed for screening facility the results were 96% (κ = 0.89) for practices and 90% (κ = 0.76) for hospitals.
Exact agreement between graders was observed in 78% of images.

Conclusions : In this nationwide study, we observed a high inter grader agreement of the gradings of DR performed by primary screening ophthalmologist and secondary certified grader in this nationwide study. From these results, it is reasonable to assume that the DR grades available in DiaBase, used for several large register-based studies, are primarily correct and eligible for continued use.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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