Agreement among ophthalmologists in evaluating fluorescein angiograms in patients with neovascular age-related macular degeneration for photodynamic therapy eligibility (FLAP-study).
OBJECTIVE
To determine intraobserver and interobserver variation for classifying types of choroidal neovascularizations (CNV) in exudative age-related macular degeneration (ARMD).


METHODS
Intraexaminer and interexaminer reliability study.


METHODS
Digital high-quality fluorescein angiograms of 40 patients with neovascular ARMD were evaluated independently by 16 retinal specialists.


METHODS
Fluorescein angiographies were presented in two randomized sequences (series A and B) to each masked reader for classification of type of CNV into classic, occult, or mixed with classic component of less or greater 50%. Agreement was evaluated by calculating kappa statistics (kappa) and intraclass correlation coefficients.


RESULTS
The mean kappa coefficient was 0.64 +/- 0.11 for intraobserver variation, with a range from 0.44 to 0.89. For interobserver variation the intraclass correlation coefficients was calculated as 0.66 (95% confidence interval [CI] 0.56, 0.77) for series A and as 0.55 (95% CI 0.43, 0.67) for series B.


CONCLUSIONS
Angiographic classification of CNV secondary to ARMD can vary considerably not only between observers but also for repeated evaluation by the same observer. Because various current and emerging treatments including photodynamic therapy are based on specific angiographic characteristics, accurate interpretation will become more important.
Holz
Frank G
FG
Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Jorzik
Jork
J
Schutt
Florian
F
Flach
Ulrike
U
Unnebrink
Kristina
K
D020256:Choroidal Neovascularization / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy; D004608:Eligibility Determination; D005451:Fluorescein Angiography / Q000592:standards*; D006801:Humans; D008268:Macular Degeneration / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy; D008511:Medicine; D015588:Observer Variation; D009885:Ophthalmology / Q000592:standards*; D010778:Photochemotherapy; D015203:Reproducibility of Results; D013038:Specialization