Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study system for evaluation of stereoscopic color fundus photographs and fluorescein angiograms: SCORE Study Report 9

Abstract

Objective: To describe the procedures and reproducibility for grading stereoscopic color fundus photographs and fluorescein angiograms of participants in the SCORE Study.

Methods: Standardized stereoscopic fundus photographs and fluorescein angiograms taken at 84 clinical centers were evaluated by graders at a central reading center. Type of retinal vein occlusion (RVO), area of retinal thickening, and area of retinal hemorrhage are evaluated from fundus photographs; area of fluorescein leakage and area of capillary nonperfusion are measured on fluorescein angiography. Temporal reproducibility consisted of annual regrading of a randomly selected dedicated subset of fundus photographs (60 subjects) and fluorescein angiograms (40 subjects) for 3 successive years. Contemporaneous reproducibility involved monthly regrading of a 5% random selection of recently evaluated fundus photographs (n = 73).

Results: The intergrader agreement for RVO type and presence of retinal thickening was greater than 90% in the 3 annual regrades. The intraclass correlation (ICC) for area of retinal thickening in the 3 years ranged from 0.39 to 0.64 and for area of retinal hemorrhage, 0.87 to 0.96. The ICC for area of fluorescein leakage ranged from 0.66 to 0.75 and for capillary nonperfusion, 0.94 to 0.97. The contemporaneous reproducibility results were similar to those of temporal reproducibility for all variables except area of retinal thickening (ICC, 0.84).

Conclusions: The fundus photography and fluorescein angiography grading procedures for the SCORE Study are reproducible and can be used for multicenter longitudinal studies of RVO. A systematic temporal drift occurred in evaluating area of retinal thickening.

Figures

Figure 1

Color grading of retinal vein occlusion. A, Evaluation of type of retinal vein occlusion using the quadrant grid. B, Evaluation of retinal thickening and retinal hemorrhages within the Early Treatment for Diabetic Retinopathy Study grid.

Figure 2

Evaluation of area of capillary nonperfusion. Early phase images (A) and area of fluorescein leakage from late phase images (B). The Early Treatment for Diabetic Retinopathy Study grid is overlaid on the field 2 image for area estimation in each subfield. Arrows indicate capillary nonperfusion.

Figure 3

Scatterplots comparing the 3 annual regrades with the original grade of record. A, Reproducibility for area of retinal thickening in disc areas. B, Reproducibility for area of retinal hemorrhage in disc areas. C, Reproducibility for area of fluorescein leakage in disc areas. D, Reproducibility for area of capillary loss in disc areas.