Comparability of two fundus photograph reading centers in grading cytomegalovirus retinitis progression

Hubbard, Larry D.; Ricks, Michelle O.; Martin, Barbara K.; Bressler, Neil M.; Kempen, John H.; Dunn, James P.; Jabs, Douglas A.; Cytomegalovirus Retinitis and Viral Resistance Study Group,

doi:10.1016/j.ajo.2003.10.002

« Previous Next »American Journal of Ophthalmology
Volume 137, Issue 3 , Pages 426-434, March 2004

Comparability of two fundus photograph reading centers in grading cytomegalovirus retinitis progression☆

Larry D. Hubbard, MAT
- Department of Ophthalmology and Visual Sciences, the University of Wisconsin Medical School, Madison Wisconsin, USA (L.D.H.)
- Inquiries to Larry D. Hubbard, MAT, University of Wisconsin Fundus Photograph Reading Center, Park West One, 406 Science Drive, Suite 400, Madison, WI 53711-1068, USAfax: 608-263-0525
Michelle O. Ricks, MS
- Department of Ophthalmology (M.O.R., N.M.B., J.H.K., J.P.D., D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Barbara K. Martin, PhD
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (B.K.M., J.H.K., D.A.J.)
Neil M. Bressler, MD
- Department of Ophthalmology (M.O.R., N.M.B., J.H.K., J.P.D., D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
John H. Kempen, MD, PhD
- Department of Ophthalmology (M.O.R., N.M.B., J.H.K., J.P.D., D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (B.K.M., J.H.K., D.A.J.)
James P. Dunn, MD
- Department of Ophthalmology (M.O.R., N.M.B., J.H.K., J.P.D., D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Douglas A. Jabs, MD, MBA
- Department of Ophthalmology (M.O.R., N.M.B., J.H.K., J.P.D., D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine (D.A.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (B.K.M., J.H.K., D.A.J.)
Cytomegalovirus Retinitis and Viral Resistance Study Group

Accepted 3 October 2003.

Abstract

Purpose

To compare grading of cytomegalovirus retinitis progression by two different fundus photograph reading centers (FPRCs).

Design

Patients with AIDS followed in an ophthalmology service were enrolled in a prospective epidemiologic study of the prevalence and incidence of resistant cytomegalovirus in vitro.

Methods

We compared masked replicate gradings by two different FPRCs of monthly fundus photographs for retinitis progression (onset of a separate new lesion or expansion of an existing lesion by ≥one-half disk diameter).

Results

For 77 patients, Kaplan-Meier plots of progression over time were similar between FPRCs (median time to progression, 65 vs 69 days). Agreement between FPRCs was 51% (kappa [κ] = .37, “fair”) on exact visit of progression (28 patients) or on absence of progression through follow-up (11 patients) and 62% (κ = .38) on progression visit ± 1 month. Eight of 12 patients with progression graded as more than 1 month apart were only 2 months apart. Considering each monthly visit as a choice point, overall agreement on progression was 78% (κ = .55, “moderate”). Baseline evaluation of retinitis showed 95% agreement on presence/absence and a concordance correlation coefficient of .75 for extent in combined zones 1 and 2. Rates of retinal loss over follow-up were estimated as 2.8%/month vs 2.0%/month (P = .015).

Conclusions

By adopting similar protocols and procedures, different FPRCs can achieve good agreement on presence and extent of cytomegalovirus retinitis. Further efforts to harmonize evaluation through ongoing comparison of gradings would likely improve agreement on retinitis progression.

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☆ This research was supported by Grant R01-EY-10268 from the National Eye Institute, National Institutes of Health, Bethesda, MD. Additional support was obtained from NEI grants K23 EY00386 (J.H.K.) and K24 E4004505 (D.A.J.). Dr. Jabs is the recipient of a Research to Prevent Blindness Senior Scientific Investigator Award. Dr. Jabs is a Research to Prevent Blindness Senior Scientific Investigator.

PII: S0002-9394(03)01262-5

doi:10.1016/j.ajo.2003.10.002

« Previous Next »American Journal of Ophthalmology
Volume 137, Issue 3 , Pages 426-434, March 2004

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