Abstract
Purpose :
The Frisén scale is widely used in clinical and research settings to grade papilledema based on the degree of blurred optic disc margins and obscuration of vessels on the disc.1 Previous studies found that agreement among experts when performing Frisén grading of papilledema photographs from adult patients ranged from 36-39%.2,3 In this multicenter retrospective study, we assessed the inter-rater reliability of Frisén grading of pediatric papilledema fundus photographs.
Methods :
Four pediatric neuro-ophthalmologists from four different institutions submitted fundus photographs from children with papilledema. Photographs from both eyes and multiple clinic visits were permitted. Each neuro-ophthalmologist independently assigned a Frisén grade (1-5) to each photograph. Initial consensus was reached when at least three of four neuro-ophthalmologists graded the photograph identically. A consensus meeting was held to assign final consensus grades to photographs that did not reach initial consensus. Clinical and demographic characteristics of the consensus and non-consensus groups were compared. Additionally, inter-rater reliability was assessed using the intra-class correlation coefficient (ICC). A linear random effects model was used to estimate ICC among raters while accounting for patients who may have contributed multiple photographs over multiple visits to the dataset.
Results :
A total of 426 fundus photographs from 115 children were included. Five different fundus cameras were used, including Optos ultra-widefield imaging in 42 (10%) photographs. Initial consensus was reached in 281 (66%) photographs. There was no significant difference in clinical or demographic factors between patients whose photographs reached initial consensus and those that did not, except that Frisén grade was lower in the consensus photographs (2.3±1.2 vs. 2.7±1.1, p=0.0001). The overall ICC was 0.76. When Optos photographs were considered separately, the ICC was lower compared to non-Optos photographs (0.72 vs. 0.78, respectively).
Conclusions :
Inter-rater reliability of Frisén grading of pediatric papilledema fundus photographs is moderate to good. Factors that may decrease inter-rater reliability include more severe papilledema and the use of widefield imaging.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.