Variability among retina specialists in evaluating fluorescein angiograms of patients with neovascular age-related macular degeneration

Purpose: To determine the rate of agreement among five retina specialists in classifying various angiographic features of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), as evaluated on printed digital fluorescein angiogram (FA) frames, as well as determination of eligibility for photodynamic treatment (PDT) according to established guidelines. Methods: Ninety-two digital FAs demonstrating subfoveal CNV secondary to AMD were evaluated independently by five retina specialists. The pattern of classic component could be classified as no classic component, minimally classic, predominantly classic, or classic only. Each grader was asked to determine eligibility of each case to PDT according to established treatment guidelines, national health insurance guidelines, and one's own personal judgment. Results: The kappa coefficient of concordance calculated for all five observers regarding CNV localization was 0.285, indicating fair overall agreement, and was 0.295, indicating fair agreement, regarding classification of leakage pattern. The kappa coefficient of agreement calculated for all five graders regarding eligibility for treatment according to established international guidelines, national health insurance, and each grader's own personal judgment was 0.163, 0.33, and 0.164, respectively, indicating slight to fair overall agreement. Conclusion: Considerable variability may exist among retina specialists interpreting FAs and should be considered in the assessment of treatment guidelines.