Evaluation of the age-related eye disease study clinical lens grading system AREDS report No. 31.
OBJECTIVE
To examine the grading (interrater) reliability of the Age-Related Eye Disease Study (AREDS) Clinical Lens Grading System (ARLNS).


METHODS
Evaluation of diagnostic test or technology.


METHODS
One hundred fifty volunteers (284 eyes).


METHODS
Participants with lens opacities of varying severity were independently graded at the slit lamp for cataract severity by 2 examiners (retinal or anterior segment specialists) using the ARLNS, which employs 3 standard photographs of increasing severity for classifying each of the 3 major types of opacity. Lens photographs were taken and graded at a reading center using the more detailed AREDS System for Classifying Cataracts from photographs.


METHODS
The Pearson correlation, weighted-kappa, and limits-of-agreement statistics were used to assess the interrater agreement of the gradings.


RESULTS
Examinations were performed on 284 lenses (150 participants). Tests of interrater reliability between pairs of clinicians showed substantial agreement between clinicians for cortical and posterior subcapsular opacities and moderate agreement for nuclear opacities. A similar pattern and strength of agreement was present when comparing scores of retinal versus anterior segment specialists. Interrater agreement between clinical and reading center gradings was not as great as inter-clinician agreement.


CONCLUSIONS
Interrater agreements were in the moderate to substantial range for the clinical assessment of lens opacities. Inherent differences in cataract classification systems that rely on slit lamp vs photographic assessments of lens opacities may explain some of the disagreement noted between slit lamp and photographic gradings. Given the interrater reliability statistics for clinicians and the simplicity of the grading procedure, ARLNS is presented for use in studies requiring a simple, inexpensive method for detecting the presence and severity of the major types of lens opacities.


BACKGROUND
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Chew
Emily Y
EY
National Eye Institute, National Institutes of Health, Bethesda, Maryland 20850-1707, USA.
Kim
Jonghyeon
J
Sperduto
Robert D
RD
Datiles
Manuel B
MB
Coleman
Hanna R
HR
Thompson
Darby J S
DJ
Milton
Roy C
RC
Clayton
Janine A
JA
Hubbard
Larry D
LD
Danis
Ronald P
RP
Ferris
Frederick L
FL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002386:Cataract / Q000145:classification* / Q000175:diagnosis; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007908:Lens, Crystalline / Q000473:pathology*; D008268:Macular Degeneration / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography / Q000145:classification* / Q000295:instrumentation; D015203:Reproducibility of Results; D014792:Visual Acuity