Interobserver and intraobserver reliability of detecting age-related macular degeneration using a nonmydriatic digital camera.
OBJECTIVE
To evaluate the interobserver and intraobserver reliability of detecting early and late age-related macular degeneration (AMD) using a nonmydriatic digital camera in two distinct groups of older people.


METHODS
Prospective study.


METHODS
The two groups consisted of a series of patients older than 70 years hospitalized in a geriatric unit and a younger series of people older than 55 years. In both groups, nonmydriatic color fundus photographs were obtained and graded independently by two ophthalmologists (V.L. and M.S.). No ophthalmic examination was performed. Main outcome measures were frequencies of early and late AMD and interobserver and intraobserver agreement.


RESULTS
Among 233 patients in group 1 (mean age, 84.6 years), only 119 patients (51%) could undergo photography because of associated multiple morbidities. Mean age of group 2 was 63.8 years. In group 1, 35 (14.5%) of 238 pictures were ungradable. In series 2, 65 (9.1%) of 716 pictures were ungradable. Frequencies of early and late AMD were 30.3% and 5.9% vs 12.6% and 2.6% in series 1 and 2, respectively. Interobserver and intraobserver agreement was good or excellent (kappa > 0.6) in both groups.


CONCLUSIONS
In the entire geriatric cohort, 43% of the patients had gradable pictures allowing a diagnosis. These patients would otherwise have had no access to any form of funduscopy. In the younger population, nonmydriatic pictures permitted a diagnosis in 90% of the individuals. Detection of AMD with a nonmydriatic digital camera may lead to large-scale screening and specific management.
Le Tien
Valérie
V
Department of Ophthalmology, Centre Hospitalier Intercommunal, Université Paris 12-Henri-Mondor, Créteil, France.
Strého
Maté
M
d'Athis
Philippe
P
Taillandier-Heriche
Elodie
E
Paillaud
Elena
E
Mahiddine
Hassina
H
Coscas
Gabriel
G
Lejonc
Jean-Louis
JL
Soubrane
Gisèle
G
Souied
Eric H
EH
D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000295:instrumentation; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography / Q000145:classification / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results