Reproducibility of SIMPLE classification for diabetic retinopathy screening and its comparison to current Italian guidelines.

IF 1.4 4区 医学 Q3 OPHTHALMOLOGY
European Journal of Ophthalmology Pub Date : 2025-03-01 Epub Date: 2024-08-07 DOI:10.1177/11206721241272230
Maria Carla Donati, Lorenzo Cifarelli, Alberto Morelli, Ludovica Alonzo, Ruggero Tartaro, Paola Sasso, Martina Maceroni, Angelo Maria Minnella, Stanislao Rizzo, Edoardo Mannucci, Valentina Vitale, Katie Curran, Tunde Peto, Fabrizio Giansanti, Gianni Virgili
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引用次数: 0

Abstract

Purpose: To evaluate the reproducibility of SIMPLE (Single field Image Multi Parameters defined Lesions Extent), a new Diabetic Retinopathy (DR) classification for screening of 45° single field fundus pictures of patients with diabetes (PwDM), assessing DR, Diabetic Maculopathy (DMac) and referral rate agreement and comparing it to current Italian Guidelines (IG).

Materials and methods: We conducted a retrospective, observational, multicentre study, collecting 1000 retinal 45° single field images of PwDM obtained during routine visits in two diabetes clinics. Three ophthalmologists evaluated each image, determining the presence and number of specific DR lesions and then assigning a stage according to the current IG for screening. SIMPLE staging was performed automatically via Excel software, based on the pre-specified DR characteristics observed by the graders. We analysed intra-centre, inter-centre and total inter-grader agreement for DR and DMac stage and referral rate of the two classifications.

Results: Agreement amongst the three graders was consistently higher when using SIMPLE classification than when using current IG classification. For DR, kappa (k) was 0.86 with IG and 0.95 with SIMPLE classification; for DMac, k-IG was 0.78, while k-SIMPLE was 0.96; concordance on the referral rate was 0.91 with IG and 0.99 with SIMPLE. Similar results were obtained in sub-analyses for the evaluation of intra-centre and inter-centre concordance.

Conclusions: Our results suggest that the new SIMPLE classification has an excellent reproducibility amongst graders, comparable or superior to the current IG for DR screening proposed in 2015, improving the standardisation of the decision on referability.

用于糖尿病视网膜病变筛查的 SIMPLE 分类的可重复性及其与意大利现行指南的比较。
目的:评估 SIMPLE(单视野图像多参数定义病变范围)的可重复性,这是一种新的糖尿病视网膜病变(DR)分类方法,用于筛查糖尿病患者(PwDM)的 45°单视野眼底图像,评估 DR、糖尿病黄斑病变(DMac)和转诊率的一致性,并将其与现行的意大利指南(IG)进行比较:我们进行了一项回顾性、观察性、多中心研究,收集了 1000 张在两家糖尿病诊所例行就诊时获得的 PwDM 视网膜 45° 单视野图像。三位眼科医生对每张图像进行评估,确定是否存在特定的 DR 病变以及病变的数量,然后根据现行的筛查 IG 进行分期。SIMPLE 分期是根据分级人员观察到的预先指定的 DR 特征,通过 Excel 软件自动进行的。我们分析了中心内、中心间和分级员之间在 DR 和 DMac 分期上的一致性以及两种分级的转诊率:结果:使用 SIMPLE 分级法时,三位分级员之间的一致性始终高于使用当前 IG 分级法时。对于 DR,采用 IG 分级法的卡帕(k)为 0.86,而采用 SIMPLE 分级法的卡帕(k)为 0.95;对于 DMac,采用 IG 分级法的卡帕(k)为 0.78,而采用 SIMPLE 分级法的卡帕(k)为 0.96;采用 IG 分级法的转诊率为 0.91,而采用 SIMPLE 分级法的转诊率为 0.99。在评估中心内和中心间一致性的子分析中也得到了类似的结果:我们的研究结果表明,新的 SIMPLE 分级在分级者之间具有极佳的可重复性,与 2015 年提出的 DR 筛查现行 IG 相当或更优,提高了转诊决定的标准化程度。
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来源期刊
CiteScore
3.60
自引率
0.00%
发文量
372
审稿时长
3-8 weeks
期刊介绍: The European Journal of Ophthalmology was founded in 1991 and is issued in print bi-monthly. It publishes only peer-reviewed original research reporting clinical observations and laboratory investigations with clinical relevance focusing on new diagnostic and surgical techniques, instrument and therapy updates, results of clinical trials and research findings.
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