title: COMPARISON OF MANUAL AND SEMIAUTOMATED FUNDUS AUTOFLUORESCENCE ANALYSIS OF MACULAR ATROPHY IN STARGARDT DISEASE PHENOTYPE.
abstract: OBJECTIVE
  To evaluate manual and semiautomated grading techniques for assessing decreased fundus autofluorescence (DAF) in patients with Stargardt disease phenotype.
  
  
  METHODS
  Certified reading center graders performed manual and semiautomated (region finder-based) grading of confocal scanning laser ophthalmoscopy (cSLO) fundus autofluorescence (FAF) images for 41 eyes of 22 patients. Lesion types were defined based on the black level and sharpness of the border: definite decreased autofluorescence (DDAF), well, and poorly demarcated questionably decreased autofluorescence (WDQDAF, PDQDAF). Agreement in grading between the two methods and inter- and intra-grader agreement was assessed by kappa coefficients (κ) and intraclass correlation coefficients (ICC).
  
  
  RESULTS
  The mean ± standard deviation (SD) area was 3.07 ± 3.02 mm for DDAF (n = 31), 1.53 ± 1.52 mm for WDQDAF (n = 9), and 6.94 ± 10.06 mm for PDQDAF (n = 17). The mean ± SD absolute difference in area between manual and semiautomated grading was 0.26 ± 0.28 mm for DDAF, 0.20 ± 0.26 mm for WDQDAF, and 4.05 ± 8.32 mm for PDQDAF. The ICC (95% confidence interval) for method comparison was 0.992 (0.984-0.996) for DDAF, 0.976 (0.922-0.993) for WDQDAF, and 0.648 (0.306-0.842) for PDQDAF. Inter- and intra-grader agreement in manual and semiautomated quantitative grading was better for DDAF (0.981-0.996) and WDQDAF (0.995-0.999) than for PDQDAF (0.715-0.993).
  
  
  CONCLUSIONS
  Manual and semiautomated grading methods showed similar levels of reproducibility for assessing areas of decreased autofluorescence in patients with Stargardt disease phenotype. Excellent agreement and reproducibility were observed for well demarcated lesions.
authors.affiliation: *Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; †Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California; ‡Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; §Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; and ¶Department of Ophthalmology, Medical University Graz, Graz, Austria.
authors.forename: Laura
authors.initials: L
authors.lastname: Kuehlewein
authors.forename: Amir H
authors.initials: AH
authors.lastname: Hariri
authors.forename: Alexander
authors.initials: A
authors.lastname: Ho
authors.forename: Laurie
authors.initials: L
authors.lastname: Dustin
authors.forename: Yulia
authors.initials: Y
authors.lastname: Wolfson
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Strauss
authors.forename: Hendrik P N
authors.initials: HP
authors.lastname: Scholl
authors.forename: SriniVas R
authors.initials: SR
authors.lastname: Sadda
mesh_terms: D000328:Adult; D001284:Atrophy; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008268:Macular Degeneration / Q000151:congenital* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods; D061848:Optical Imaging; D010641:Phenotype; D011446:Prospective Studies; D015203:Reproducibility of Results; D000080362:Stargardt Disease