Abstract
Purpose :
The reliability of in-vivo lens opacity grading in epidemiologic studies has received little attention. Los Angeles Latino Eye Study (LALES) estimated lens opacity prevalence using the slit-lamp-based Lens Opacities Classification System II (LOCS II), albeit 2 decades ago. While LOCS III and other image-based systems have been developed, Study of Latinos “SOL” Ojos selected LOCS II in-vivo grading to 1) support direct comparison to LALES estimates; and, 2) optimize resources. SOL Ojos is an ancillary study to the Hispanic Community Health Study/Study of Latinos, a population-based, longitudinal, multicenter cohort of Hispanic/Latino adults of diverse backgrounds. Here, we assess inter- and intra-grader reliability of an image-based training and REDCap self-assessment tool using the LOCS II grading standard.
Methods :
The UIC IRB approved this study. A panel of 60 images with lens opacites was captured via a digital Nikon slit-lamp camera in fully dilated clinic patients and images uploaded to REDCap for self-assessment. SOL Ojos examiners received 3 training sessions using the LOCS II grading system and completed self-assessment using a digitized LOCS II standard photo viewed on study laptops at maximum brightness. Assessment coincided with launch of data collection (consensus determination), and every 6 months. Opacity-type grading results were dichotomized per LALES for analyses. Gwet’s AC1 was used to assess inter-grader cross-sectional agreement serially and intra-grader agreement longitudinally; Gwet's AC1 was selected over Fleiss' Kappa due to its decreased susceptibility to paradox.
Results :
Overall inter-grader cross-sectional agreement was moderate at 6, 12, and 18 months (Figure 1, 0.55-0.57), and similar by lens opacity type (posterior subcapsular, PSC, 0.63-0.68; cortical, 0.66-0.69; nuclear, 0.39-0.41). Longitudinally, overall intra-grader agreement varied from moderate to near perfect (Figure 2, 0.59-0.96), and similar by lens opacity type (PSC, 0.69-1.00; cortical, 0.61-0.96; nuclear, 0.33-0.95).
Conclusions :
Inter- and intra-grader reliability using an image-based training and REDCap self-assessment tool with LOCS II grading demonstrates moderate agreement by SOL Ojos examiners. Results support use of the LOCS II for lens opacity definitions and cataract assessment in SOL Ojos.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.