Can different types of retinal emboli be reliably differentiated from one another?

Purpose. To determine if ophthalmologists can agree on the qualitative assessment of visible retinal emboli. Methods. An inter and intraobserver agreement study of visible retinal emboli was undertaken to determine if different observers could agree on the qualitative assessment of visible retinal emboli. Seventeen fundus photographs, from eleven patients with embolie acute retinal artery occlusion were reviewed by 42 observers, of whom 30 were retinal specialists. Observers qualitatively assessed all visible retinal emboli and classified them categorically into one of three groups: cholesterol, calcifié or other. Results The overall kappa statistic was 0.063, representing slight agreement The kappa statistic for all cases ranged from slight (-0.082) to fair (0.268) agreement. The mean kappa for interobserver agreement was 0.073. The mean kappa for intraobserver agreement on photographs that were presented in different orientation was 0.032. The mean kappa statistic for intraobserver agreement on photographs taken with different magnification was 0.102. Conclusions. Overall both intraobserver and interobserver agreement on the qualitative assessment of retinal emboli was poor. With only slight agreement on the classification of embolie type, systemic evaluation of acute retinal arterial occlusion should not be based on qualitative assessment of retinal emboli.