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Intra- and interobserver concordance of a new classification system for myopic maculopathy

BACKGROUND: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the AT...

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Autores principales: Zhang, Rong-rong, Yu, Yan, Hou, Yin-fen, Wu, Chang-fan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063469/
https://www.ncbi.nlm.nih.gov/pubmed/33892678
http://dx.doi.org/10.1186/s12886-021-01940-4
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author Zhang, Rong-rong
Yu, Yan
Hou, Yin-fen
Wu, Chang-fan
author_facet Zhang, Rong-rong
Yu, Yan
Hou, Yin-fen
Wu, Chang-fan
author_sort Zhang, Rong-rong
collection PubMed
description BACKGROUND: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. METHODS: This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. CONCLUSIONS: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12886-021-01940-4.
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spelling pubmed-80634692021-04-23 Intra- and interobserver concordance of a new classification system for myopic maculopathy Zhang, Rong-rong Yu, Yan Hou, Yin-fen Wu, Chang-fan BMC Ophthalmol Research BACKGROUND: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. METHODS: This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. CONCLUSIONS: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12886-021-01940-4. BioMed Central 2021-04-23 /pmc/articles/PMC8063469/ /pubmed/33892678 http://dx.doi.org/10.1186/s12886-021-01940-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Zhang, Rong-rong
Yu, Yan
Hou, Yin-fen
Wu, Chang-fan
Intra- and interobserver concordance of a new classification system for myopic maculopathy
title Intra- and interobserver concordance of a new classification system for myopic maculopathy
title_full Intra- and interobserver concordance of a new classification system for myopic maculopathy
title_fullStr Intra- and interobserver concordance of a new classification system for myopic maculopathy
title_full_unstemmed Intra- and interobserver concordance of a new classification system for myopic maculopathy
title_short Intra- and interobserver concordance of a new classification system for myopic maculopathy
title_sort intra- and interobserver concordance of a new classification system for myopic maculopathy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063469/
https://www.ncbi.nlm.nih.gov/pubmed/33892678
http://dx.doi.org/10.1186/s12886-021-01940-4
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