Interobserver agreement in the evaluation of acute retinal artery occlusion

Objective: To determine the agreement between two ophthalmologists in the evaluation of two important funduscopic features related to acute retinal artery occlusion: retinal cloudy swelling and visible retinal emboli. Design: An interobserver variability study in which two ophthalmologists (one trained in glaucoma, the other in neuro-ophthalmology) independently viewed fundus photographs and categorized them with respect to the presence or absence of cloudy swelling and retinal emboli. Inter- and intraobserver agreement was calculated with the κ statistic. Setting: Retina service at a university- affiliated hospital in Kingston, Ont. Patients: The fundus photographs of 102 patients were included: 60 with acute retinal artery occlusion, 30 with conditions mimicking acute retinal artery occlusion and 12 healthy patients. Results: Both interobserver and intraobserver agreement as to the presence of retinal cloudy swelling were very high (κ = 0.835 and 0.866 respectively). More variability was seen for the presence of retinal emboli, but, overall, interobserver and intraobserver agreement were still high (κ = 0.726 and 0.629 respectively). Conclusions: Our results suggest that clinicians use similar visual clues to categorize fundi with respect to retinal cloudy swelling and visible retinal emboli.