Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal

Raba Thapa,1 Sanyam Bajimaya,1 Eli Pradhan,1 Sanjita Sharma,1 BalBahadur Kshetri,2 Govinda Paudyal1 1Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal; 2Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, NepalCorrespon...

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Autores principales:	Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri BB, Paudyal G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	intra-rater agreement inter-rater agreement retinal pathologies allied medical personnel ophthalmologist diabetic retinopathy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/b3967f219e5b4ecab85e3698c490e2a7
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spelling	oai:doaj.org-article:b3967f219e5b4ecab85e3698c490e2a72021-12-02T10:26:52ZAgreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal1177-5483https://doaj.org/article/b3967f219e5b4ecab85e3698c490e2a72020-09-01T00:00:00Zhttps://www.dovepress.com/agreement-on-grading-retinal-findings-of-patients-with-diabetes-using--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Raba Thapa,1 Sanyam Bajimaya,1 Eli Pradhan,1 Sanjita Sharma,1 BalBahadur Kshetri,2 Govinda Paudyal1 1Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal; 2Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, NepalCorrespondence: Raba ThapaVitreo-Retina Specialist, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, NepalTel +977-1-4493775Fax + 977-1-4474937Email rabathapa@live.comIntroduction: Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist.Materials and Methods: Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k).Results: The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months.Conclusion: Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.Keywords: inter-rater agreement, retinal pathologies, allied medical personnel; AMP, ophthalmologist, diabetic retinopathy; DRThapa RBajimaya SPradhan ESharma SKshetri BBPaudyal GDove Medical Pressarticleintra-rater agreementinter-rater agreementretinal pathologiesallied medical personnelophthalmologistdiabetic retinopathyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 2731-2737 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	intra-rater agreement inter-rater agreement retinal pathologies allied medical personnel ophthalmologist diabetic retinopathy Ophthalmology RE1-994
spellingShingle	intra-rater agreement inter-rater agreement retinal pathologies allied medical personnel ophthalmologist diabetic retinopathy Ophthalmology RE1-994 Thapa R Bajimaya S Pradhan E Sharma S Kshetri BB Paudyal G Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
description	Raba Thapa,1 Sanyam Bajimaya,1 Eli Pradhan,1 Sanjita Sharma,1 BalBahadur Kshetri,2 Govinda Paudyal1 1Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal; 2Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, NepalCorrespondence: Raba ThapaVitreo-Retina Specialist, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, NepalTel +977-1-4493775Fax + 977-1-4474937Email rabathapa@live.comIntroduction: Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist.Materials and Methods: Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k).Results: The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months.Conclusion: Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.Keywords: inter-rater agreement, retinal pathologies, allied medical personnel; AMP, ophthalmologist, diabetic retinopathy; DR
format	article
author	Thapa R Bajimaya S Pradhan E Sharma S Kshetri BB Paudyal G
author_facet	Thapa R Bajimaya S Pradhan E Sharma S Kshetri BB Paudyal G
author_sort	Thapa R
title	Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
title_short	Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
title_full	Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
title_fullStr	Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
title_full_unstemmed	Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal
title_sort	agreement on grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel when compared to an ophthalmologist at a diabetic retinopathy screening program in nepal
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/b3967f219e5b4ecab85e3698c490e2a7
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Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal

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