title: Interobserver and intraobserver reliability of detecting age-related macular degeneration using a nonmydriatic digital camera.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Centre Hospitalier Intercommunal, Université Paris 12-Henri-Mondor, Créteil, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Le Tien
authors.forename: Maté
authors.initials: M
authors.lastname: Strého
authors.forename: Philippe
authors.initials: P
authors.lastname: d'Athis
authors.forename: Elodie
authors.initials: E
authors.lastname: Taillandier-Heriche
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.forename: Hassina
authors.initials: H
authors.lastname: Mahiddine
authors.forename: Gabriel
authors.initials: G
authors.lastname: Coscas
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Lejonc
authors.forename: Gisèle
authors.initials: G
authors.lastname: Soubrane
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
mesh_terms: 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