Agreement between clinician and reading center gradings of diabetic retinopathy severity level at baseline in a phase 2 study of intravitreal bevacizumab for diabetic macular edema.

Journal Article (Journal Article;Multicenter Study)

PURPOSE: To evaluate agreement in diabetic retinopathy severity classification by retina specialists performing ophthalmoscopy versus reading center (RC) grading of seven-field stereoscopic fundus photographs in a phase 2 clinical trial of intravitreal bevacizumab for center-involved diabetic macular edema. METHODS: Clinicians' grading scale used four levels: microaneurysms only, mild/moderate nonproliferative diabetic retinopathy (NPDR), severe NPDR, and proliferative diabetic retinopathy (PDR) or prior panretinal photocoagulation (PRP) or both. The RC scale used eight levels: microaneurysms only, mild NPDR, moderate NPDR, moderately severe NPDR, severe NPDR, mild PDR, moderate PDR, and high-risk PDR. Percent agreement and kappa statistic were defined by collapsing RC categories to match those used by clinicians. RESULTS: There was agreement in 89/118 eyes (75%) with kappa = 0.55 (95% confidence interval [0.41, 0.68]). In six eyes, disagreements were of potential substantial clinical importance: five eyes with subtle retinal neovascularization and one with a small preretinal hemorrhage identified only in photographs. CONCLUSIONS: Clinician grading of retinopathy severity had moderate agreement with RC grading and might be useful for placing eyes into broad baseline categories.

Full Text

Duke Authors

Cited Authors

  • Scott, IU; Bressler, NM; Bressler, SB; Browning, DJ; Chan, CK; Danis, RP; Davis, MD; Kollman, C; Qin, H; Diabetic Retinopathy Clinical Research Network Study Group,

Published Date

  • January 2008

Published In

Volume / Issue

  • 28 / 1

Start / End Page

  • 36 - 40

PubMed ID

  • 18185135

Pubmed Central ID

  • PMC2377181

International Standard Serial Number (ISSN)

  • 0275-004X

Digital Object Identifier (DOI)

  • 10.1097/IAE.0b013e31815e9385


  • eng

Conference Location

  • United States