CONCORDANCE BETWEEN RETINA SPECIALISTS AND A PREFERRED PRACTICE PATTERN IN TREATMENT AND FOLLOW-UP CRITERIA FOR DIABETIC-RETINOPATHY

Proper detection, adequate laser therapy and follow-up of diabetic ret inopathy (DR), using guidelines established by landmark studies, are i mportant to prevent blindness, In this report we analyze the agreement between 11 retina specialists and the Preferred Practice Pattern of t he American Academy of Ophthalmology in the therapeutic and follow-up criteria for DR, Color fundus stereophotographs of seven standard fiel ds of each eye of 15 diabetics were sent to 11 retina specialists, The ir treatment and follow-up criteria were surveyed, For treatment of DR mean percent agreement was 65%, Kappa statistic, which corrects for c hance agreement, was between -0.23 and 0.63 with a mean of 0.26, The t herapeutic recommendations for macular edema were analyzed separately and the mean kappa was between -0.10 and 0.71 with a mean of 0.32, Wit h respect to recommendations for interval until follow up, following i nitial visit, mean percent agreement was 73% with a kappa statistic be tween -0.22 and 0.33 and a mean of 0.07, Based on conventional interpr etation of kappa statistic these mean values are in the range of poor agreement, Since there is a significant discrepancy in the concordance level in both therapeutic and follow-up recommendations for the manag ement of DR, there is a need to improve agreement in these criteria, s ince these are key elements in the decision making process of the spec ialist caring for diabetic patients.