COMPARABILITY OF OPHTHALMIC DIAGNOSES BY CLINICAL AND READING CENTER EXAMINERS IN THE VISUAL ACUITY IMPAIRMENT SURVEY PILOT STUDY

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Abstract
Technologic advances in ophthalmic equipment offer the possibiltty of replacing direct clinical examinations with Reading Center evaluations of data recorded in epidemiologic studies. Clinical and Reading Center examiners made independent ophthalmic diagnoses of 133 right and 132 left eyes of 138 adults in the Visual Acuity Impairment Survey Pilot Study, canied out in three US cities, Boston, Detroit, and Minneapolis, in August 1981–December 1982. The Reading Center diagnosed eye conditions using only photographic and visual field data collected at the time of the clinical examindon. In the comparisons of clinical and Reading Center evaluations reported here, only eyes judged by the examiners to have pathology severe enough to reduce visual acuity to 6/9 or worse were classified as having pathology. (No visual acuity criterion was required for the diagnosis of glaucoma or diabetic retinopathy.) There was agreement in diagnostic assessments between clinical and Readlng Center examiners in about 80% of eyes. The kappa statistic, which adjusts for chance agreement, was in the fair to good range: 0.60 for 133 right eyes and 0.62 for 132 left eyes. When the Reading Center examiners were provided with additional information on medical history, refractive error and best corrected visual acuity, the agreement between clinical and Reading Center assessments among the subset of eyes wtth 6/9 or worse vision again was in the fair to good range, with kappas of 0.61 for 45 right eyes and 0.68 for 48 lelt eyes. Interobserver agreement between Readlng Center examiners in diagnosing pathology was in the good to excellent range. Use of Reading Centers in future epidemiologic studies should be considered, but elimination of the clinical examinations is not recommended until modifications in the protocol describd here have been made and shown to improve levels of agreement between clinical and Reading Center examiners.