title: Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy.
abstract: BACKGROUND
  Disorganization of the retinal inner layers (DRIL) on optical coherence tomography (OCT) is thought to represent retinal capillary non-perfusion (CNP) in eyes with diabetic retinopathy. This study was designed to evaluate the ability of DRIL to accurately predict CNP.
  
  
  METHODS
  Retrospective masked reliability and diagnostic accuracy study performed in the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre, London, UK SAMPLES: Retinal images of patients with diabetic retinopathy
  
  
  METHODS
  The OCT images from 90 separate areas of angiographically confirmed perfused and non-perfused areas of the macula from 37 eyes of 31 patients were anonymized and coded. Two masked graders independently graded these OCT scans for the presence or absence of DRIL to determine the intergrader reliability. The diagnostic accuracy of DRIL in identifying CNP was evaluated from the results obtained.
  
  
  METHODS
  Sensitivity and specificity of DRIL in accurately detecting CNP RESULTS: The intergrader agreement was high with a Cohen's kappa of 0.909. DRIL was present in 84.4% (38/45) of non-perfused retina and none in perfused retina (0/45). The sensitivity and specificity of DRIL in detecting angiographic evidence of CNP was 84.4% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 86.5%.
  
  
  CONCLUSIONS
  The presence of DRIL is a reliable predictor of areas of macular CNP. However, DRIL is not a universal finding of non-perfusion, with some cases exhibiting absence of DRIL despite angiographic CNP.
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Luke
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Ramu
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Triantafyllopoulou
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Namritha V
authors.initials: NV
authors.lastname: Patrao
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Comyn
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Hykin
authors.affiliation: NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
mesh_terms: D000368:Aged; D002196:Capillaries / Q000473:pathology; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005189:False Positive Reactions; D005260:Female; D005451:Fluorescein Angiography / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D055351:Retinal Neurons / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000592:standards
keywords: diabetic retinopathy; diagnostic study; retinal-imaging