Fundus image diagnostic agreement in uveitis utilizing free and open source software.
OBJECTIVE
To assess the adequacy of image agreement regarding uveitis based on color fundus and fluorescein angiography images alone, and to use free and open source applications to conduct an image agreement study.


METHODS
Cross-sectional agreement study.


METHODS
Baseline fundus and fluorescein images of patients with panuveitis, posterior, or intermediate uveitis enrolled in the Multi-center Uveitis Steroid Treatment (MUST) trial.


METHODS
Three fellowship-trained specialists in uveitis independently reviewed patient images using ClearCanvas™ and responded using Epi Info™. The diagnoses of the 3 reviewers were compared with the MUST clinician as a gold standard. A rank transformation adjusted for the possible variation in number of responses per patient. Chance-corrected interobserver agreement among the 3 reviewers was estimated with the ι coefficient. Confidence interval (CI) and SE were bootstrapped.


RESULTS
Agreement between the diagnoses of the respondents and the baseline MUST clinician's diagnosis was poor across all diagnostic categories, ι = 0.09 (95% CI, 0.07-0.11). The agreement among respondents alone also was poor, ι = 0.11 ± 0.02 (95% CI, 0.08-0.13). The specialists requested more patient historical and clinical information to make a diagnosis on all patients.


CONCLUSIONS
The role in distinguishing the multiple conditions in uveitis appears to be limited when based on fundus imaging alone. Future studies should investigate different categories of clinical data to supplement image data. Freely available applications have excellent utility in ophthalmic imaging agreement studies.
New York Eye and Ear Infirmary, New York, NY, USA.
Jane
J
Hsieh
Andrea F
AF
Honda
Mayte
M
Suárez-Fariñas
C Michael
CM
Samson
Sanjay
S
Kedhar
John
J
Mauro
Jasmine
J
Francis
Jason
J
Badamo
Vicente A
VA
Diaz
John H
JH
Kempen
Paul A
PA
Latkany
D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000592:standards*; D004359:Drug Therapy, Combination; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015588:Observer Variation; D010781:Photography; D015203:Reproducibility of Results; D031300:Retinal Vasculitis / Q000175:diagnosis; D012984:Software; D011795:Surveys and Questionnaires; D041623:Tomography, Optical Coherence; D014605:Uveitis / Q000175:diagnosis* / Q000188:drug therapy
D005938:Glucocorticoids; D007166:Immunosuppressive Agents