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Early Treatment Diabetic Retinopathy Study Classification

A Proposed New Classification For Diabetic Retinopathy: The Concept Of Primary And Secondary Vitreopathy Dubey Ak, Nagpal P, Chawla S, Dubey B - Indian J Ophthalmol

A Proposed New Classification For Diabetic Retinopathy: The Concept Of Primary And Secondary Vitreopathy Dubey Ak, Nagpal P, Chawla S, Dubey B - Indian J Ophthalmol

Laser photocoagulation has changed the long-term outcome of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). [1] , [2] About 60 to 75% of PDR cases show complete regression of new vessels with pan retinal laser photocoagulation (PRP). [1] , [2] , [3] Successfully regressed PDR cases may require to undergo vitreoretinal surgery for different indications during follow up period. This is because of progressive vitreous contraction. [4] , [5] , [6] The pan metabolic disease of diabetes mellitus (DM) induces changes in vitreous tissue by non-enzymatic glycation of proteins, resembling age-related vitreous degeneration occurring at a much younger age. [7] , [8] , [9] , [10] Proliferative diabetic retinopathy further alters the vitreous by inclusion of vasogenic cells and fibrous tissue. [11] , [12] , [13] , [14] It is possible that the changes in vitreous due to DM which are independent of retinopathy and the changes in vitreous induced by PDR build indications for vitreoretinal surgery even in laser-treated PDR cases by vitreous contraction such as tractional retinal detachment (TRD), tractional macular edema, secondary rhegmatogenous retinal detachment and recurrent vitreous hemorrhages. [4] , [15] , [16] , [17] , [18] The existing classifications of diabetic retinopathy including the modified Airlie house classification [19] , [20] , [21] , [22] do not represent "diabetic vitreopathy" as a clinically identifiable division of the whole pathological complex. This study reviewed a large number of cases and proposed an expanded classification to identify diabetic vitreopathy as a separate class, relatively independent of laser treatment and status of retinopathy. Recently anti vascular endothelial growth factor (anti VEGF) drugs have b Continue reading >>

Early Treatment Diabetic Retinopathy Study Design And Baseline Patient Characteristics Etdrs Report Number 7

Early Treatment Diabetic Retinopathy Study Design And Baseline Patient Characteristics Etdrs Report Number 7

Early Treatment Diabetic Retinopathy Study Design and Baseline Patient Characteristics ETDRS Report Number 7 Early Treatment Diabetic Retinopathy Study Research Group The Early Treatment Diabetic Retinopathy Study (ETDRS), a multicenter collaborative clinical trial supported by the National Eye Institute, was designed to assess whether argon laser photocoagulation or aspirin treatment can reduce the risk of visual loss or slow the progression of diabetic retinopathy in patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy. The 3711 patients enrolled in the ETDRS were assigned randomly to either aspirin (650 mg per day) or placebo. One eye of each patient was assigned randomly to early argon laser photocoagulation and the other to deferral of photocoagulation. Both eyes were to be examined at least every 4 months and photocoagulation was to be initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected. Examination of a large number of baseline ocular and patient characteristics indicated that there were no important differences between randomized treatment groups at baseline. 2018 Digital Science & Research Solutions, Inc. All Rights Reserved | About us Privacy policy Legal terms VPAT Citation Count is the number of times that this paper has been cited by other published papers in the database. The Altmetric Attention Score is a weighted count of all of the online attention Altmetric have found for an individual research output. This includes mentions in public policy documents and references in Wikipedia, the mainstream news, social networks, blogs and more. More detail on the weightings of each source and how they contribute to the attention score is available here . The Relative Citation Rati Continue reading >>

Early Treatment Diabetic Retinopathy Study (etdrs)

Early Treatment Diabetic Retinopathy Study (etdrs)

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Early Treatment Diabetic Retinopathy Study (ETDRS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00000151 Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information To evaluate the effectiveness of both argon laser photocoagulation and aspirin therapy in delaying or preventing progression of early diabetic retinopathy to more severe stages of visual loss and blindness. To help determine the best time to initiate photocoagulation treatment in diabetic retinopathy. To monitor closely the effects of diabetes mellitus and of photocoagulation on visual function. To produce natural history data that can be used to identify risk factors and test etiologic hypotheses in diabetic retinopathy. Drug: Aspirin Procedure: Argon Laser Photocoagulation ETDRS was a multicenter, randomized clinical trial designed to evaluate argon laser photocoagulation and aspirin treatment in the management of patients with nonproliferative or early proliferative diabetic retinopathy. A total of 3,711 patients were recruited to be followed for a minimum of 4 years to provide long-term information on the risks and benefits of the treatments under study. The eligibility criteria for the ETDRS were designed to include a broad range of macular edema severity, from a few small hard exudates within a disc diameter of the fovea with normal visual acuity to extensive cystoid spaces with a visual acuity of 20/200. Continue reading >>

Classification Of Diabetic Retinopathy And Diabetic Macular Edema

Classification Of Diabetic Retinopathy And Diabetic Macular Edema

Go to: MODIFIED AIRLIE HOUSE CLASSIFICATION In 1968 a group of experts met in Airlie House, Virginia to discuss what was known at the time about DR. An important outcome of that symposium was the development of a standarized classification of DR[10]. This classification was modified and used in the Diabetic Retinopathy Study (DRS). Briefly, it consisted of comparing stereophotographs in 7 standard photographic fields with the patient’s findings in those same 7 photographic fields[11]. This same classification was modified for use in the Early Treatment of Diabetic Retinopathy Study (ETDRS). It became the gold standard for many years. The modified Airlie House Classification of DR is based on grading of stereophotographs of 7 fields and classifies DR into 13 complex levels ranging from level 10 (absence of retinopathy) to level 85 (severe vitreous hemorrhage or retinal detachment involving the macula)[12]. It is an excellent tool in the research setting but its clinical applicability is limited due to its complexity. Most ophthalmologists do not use this classification in their daily clinical work. The ETDRS introduced the term clinically significant macular edema (CSME). CSME was defined upon slit lamp biomicroscopy as “(1) thickening of the retina at or within 500 μm of the center of the macula; or (2) hard exudate at or within 500 μm of the center of the macula associated with thickening of adjacent retina; or (3) a zone of retinal thickening 1 disc area or larger, any part of which is within 1 disc diameter of the center of the macula”[12]. The ETDRS found that macular photocoagulation was effective in reducing visual loss from CSME. Others have divided diabetic macular edema (DME) into focal and diffuse subtypes[13]. Focal DME was initially defined as edema Continue reading >>

Standardized Etdrs Testing Vectorvision

Standardized Etdrs Testing Vectorvision

ETDRS acuity testing has become the worldwide standard for visual acuity testing, replacing the Snellen and Sloan acuity tests. ETDRS stands for Early Treatment Diabetic Retinopathy Study. The ETDRS test is designed to eliminate inaccuracies in the Snellen and Sloan tests. Standardized ETDRS CSV-1000 and ESV-3000 Both the CSV-1000 and the ESV-3000 ETDRS testing device have patented (Patent # 5,078,486) self-calibrated test lighting. The CSV-1000 device incorporates highly advanced miniature standardized fluorescent light source technology. The ESV-3000 device incorporates highly advanced LED light source technology. The auto-calibration circuitry constantly monitors the fluorescent/LED light source and calibrates each test luminance to 85 cd/m2 or 3 cd/m2. Other ETDRS testers are not standardized and have no circuitry to control the test lighting. They use "off-the-shelf" non-standardized fluorescent bulbs that require a bulb "burn-in" period. The bulbs must be constantly replaced and each time a bulb is replaced, there is an additional "burn-in" period. No testing can be accomplished during the "burn-in" period. The CSV-1000 allows testing up to 20/200 at a test distance of 8 feet. The device is operated by infrared remote control. The ESV-3000 is the only large-format standardized ETDRS testing device. The ESV-3000 allows testing up to 20/200 ETDRS Acuity at a test distance of 4 meters The device is operated by infrared remote control. The ESV-3000 is designed specifically for clinical trials where large-format ETDRS testing (up to 20/200) is performed at 4 meters. Unlike other large-format back-lit devices for ETDRS evaluation, the light level is calibrated and held constant, allowing the automatic replication of testing light levels from different clinical trials l Continue reading >>

Classification Of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale For Diabetic Retinopathy And Diabetic Macular Edema

Classification Of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale For Diabetic Retinopathy And Diabetic Macular Edema

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [emailprotected] Instructions for Participation and Credit There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. Follow these steps to earn CME/CE credit: Read the target audience, learning objectives, and author disclosures. Study the educational content online or printed out. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage. The credit that you receive is based on your user profile. Classification of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale for Diabetic Retinopathy and Diabetic Macular Edema Authors: Author Continue reading >>

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographs--an Extension Of The Modified Airlie House Classification. Etdrs Report Number 10. Early Treatment Diabetic Retinopathy Study Research Group.

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographs--an Extension Of The Modified Airlie House Classification. Etdrs Report Number 10. Early Treatment Diabetic Retinopathy Study Research Group.

Generate a file for use with external citation management software. Ophthalmology. 1991 May;98(5 Suppl):786-806. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. The modified Airlie House classification of diabetic retinopathy has been extended for use in the Early Treatment Diabetic Retinopathy Study (ETDRS). The revised classification provides additional steps in the grading scale for some characteristics, separates other characteristics previously combined, expands the section on macular edema, and adds several characteristics not previously graded. The classification is described and illustrated and its reproducibility between graders is assessed by calculating percentages of agreement and kappa statistics for duplicate gradings of baseline color nonsimultaneous stereoscopic fundus photographs. For retinal hemorrhages and/or microaneurysms, hard exudates, new vessels, fibrous proliferations, and macular edema, agreement was substantial (weighted kappa, 0.61 to 0.80). For soft exudates, intraretinal microvascular abnormalities, and venous beading, agreement was moderate (weighted kappa, 0.41 to 0.60). A double grading system, with adjudication of disagreements of two or more steps between duplicate gradings, led to some improvement in reproducibility for most characteristics. Continue reading >>

Classification Of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale For Diabetic Retinopathy And Diabetic Macular Edema

Classification Of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale For Diabetic Retinopathy And Diabetic Macular Edema

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [emailprotected] Instructions for Participation and Credit There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. Follow these steps to earn CME/CE credit: Read the target audience, learning objectives, and author disclosures. Study the educational content online or printed out. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage. The credit that you receive is based on your user profile. Classification of Diabetic Retinopathy: A Proposed International Clinical Disease Severity Grading Scale for Diabetic Retinopathy and Diabetic Macular Edema King H, Aubert Continue reading >>

Diabetic Retinopathy Grading And Classification

Diabetic Retinopathy Grading And Classification

Accurately grading diabetic retinopathy can be a significant challenge for beginning ophthalmology residents. After nervously searching Google in the physicians workroom for the diabetic retinopathy grading scale more often than I care to admit, I have decided to summarize the classification criteria for diabetic retinopathy, at least in a way that makes sense to me. I hope you find this summary helpful. No retinopathy and mild NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings No apparent diabetic retinopathy (No DR) No abnormalities (no microaneurysms) Mild nonproliferative diabetic retinopathy (Mild NPDR) Microaneurysms ONLY In reality, there is not much difference in risk between diabetic eyes with no retinopathy and those with mild retinopathy. Both have a very low risk of progressing to PDR; in fact, the Early Treatment Diabetic Retinopathy Study (ETDRS) did not examine those with no retinopathy nor mild NPDR. However, the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) did include these individuals in its study, and found that the rate of progression to PDR after four years was less than 1% for both young and older patients with no diabetic retinopathy, compared to 4.1% in younger patients with a rare microaneurysm and hemorrhage and even less in older patients with these findings. In other words, a diabetic patient with no retinopathy has a <1% chance of developing PDR and a diabetic patient with a rare MA/DBH has a <5% chance of progressing to PDR in the next four years. All things considered, this is pretty low risk. These patients can be followed every 12 months. Moderate NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings Moderate nonproliferative diabetic retinopathy (Moderate NPDR) More than just micro aneurysms (wi Continue reading >>

Association Of Elevated Serum Lipid Levels With Retinal Hard Exudate In Diabetic Retinopathyearly Treatment Diabetic Retinopathy Study (etdrs) Report 22

Association Of Elevated Serum Lipid Levels With Retinal Hard Exudate In Diabetic Retinopathyearly Treatment Diabetic Retinopathy Study (etdrs) Report 22

Objective: To evaluate the relationship between serum lipid levels, retinal hard exudate, and visual acuity in patients with diabetic retinopathy. Design: Observational data from the Early Treatment Diabetic Retinopathy Study. Participants: Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, the first 2709 enrolled had serum lipid levels measured. Main Outcome Measures: Baseline fasting serum lipid levels, best-corrected visual acuity, and assessment of retinal thickening and hard exudate from stereoscopic macular photographs. Results: Patients with elevated total serum cholesterol levels or serum low-density lipoprotein cholesterol levels at baseline were twice as likely to have retinal hard exudates as patients with normal levels. These patients were also at higher risk of developing hard exudate during the course of the study. The risk of losing visual acuity was associated with the extent of hard exudate even after adjusting for the extent of macular edema. Conclusions: These data demonstrate that elevated serum lipid levels are associated with an increased risk of retinal hard exudate in persons with diabetic retinopathy. Although retinal hard exudate usually accompanies diabetic macular edema, increasing amounts of exudate appear to be independently associated with an increased risk of visual impairment. Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity. The observational data from the Early Treatment Diabetic Retinopathy Study suggest that lipid lowering may also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diab Continue reading >>

A Severity Scale For Diabetic Macular Edema Developed From Etdrs Data | Iovs | Arvo Journals

A Severity Scale For Diabetic Macular Edema Developed From Etdrs Data | Iovs | Arvo Journals

A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data From the Departments of Population Health Sciences, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts; and the National Eye Institute, Bethesda, Maryland. National Eye Institute, Bethesda, Maryland. Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin; the Investigative Ophthalmology & Visual Science November 2008, Vol.49, 5041-5047. doi:10.1167/iovs.08-2231 A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account Ronald E. Gangnon, Matthew D. Davis, Larry D. Hubbard, Lloyd M. Aiello, Emily Y. Chew, Frederick L. Ferris, Marian R. Fisher, the Early Treatment Diabetic Retinopathy Study Research Group; A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data. Invest. Ophthalmol. Vis. Sci. 2008;49(11):5041-5047. doi: 10.1167/iovs.08-2231. ARVO (1962-2015); The Authors (2016-present) purpose. To develop a severity scale for diabetic macular edema (DME) and to assess relationships between severity and duration of DME and visual acuity (VA). methods. From the Early Treatment Diabetic Retinopathy Study (ETDRS), mean baseline VA scores were tabulated for 7422 eyes cross-classified by (1) location of retinal thickening (RT) and its area within 1 disc diameter of the macular center, and (2) degree of RT at the center. Adjacent (row, column, and off-diagonal) cells with the greatest similarity in baseline VA (mean and SD) based on a Gaussian (normal) likelihood were merged. An initial eight-step scale was chosen using the Schwarz criterion (Bayesian information criterion; BIC) and was r Continue reading >>

C-peptide And The Classification Of Diabetes Mellitus Patients In The Early Treatment Diabetic Retinopathy Study Report Number 6

C-peptide And The Classification Of Diabetes Mellitus Patients In The Early Treatment Diabetic Retinopathy Study Report Number 6

C-peptide and the classification of diabetes mellitus patients in the Early treatment diabetic retinopathy study report number 6 Mary Jane Prior - Maryland Medical Research Institute Thaddeus Prout - Greater Baltimore Medical Center Dayton Miller - Centers for Disease Control and Prevention Robin Ewart - University of Louisville Dinesh Kumar - University of Southern California The ETDRS Research Group - Greater Baltimore Medical Center, University of Louisville, Centers for Disease Control and Prevention, Maryland Medical Research Institute, University of Southern California The Early Treatment Diabetic Retinopathy Study (ETDRS), conducted at 22 clinical centers during the period 1980 to 1989, collected baseline data on C-peptide levels after ingestion of Sustacal in 582 patients with diabetes mellitus, prior to enrollment in the trial. Data on several clinical factors associated with diabetes were also collected from all 3711 enrolled patients. C-peptide data were used to develop sets of clinical criteria for the classification of ETDRS patients and to compare and contrast definitions of type of diabetes used in previous studies. The distribution of C-peptide levels was strikingly bimodal, suggesting a division of study participants into two groups--those with levels at 80 pmol/L or less and those with more than 80 pmol/L of C-peptide after Sustacal ingestion. Constellations of clinical characteristics that could serve as proxies for C-peptide level were ascertained. The result was two sets of clinically developed definitions for type of diabetes in the ETDRS. According to the more restrictive set of definitions, three groups were identified, compared to two groups using the "broad" set of definitions. Discriminant analysis was also used to classify ETDRS patients, yi Continue reading >>

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographsan Extension Of The Modified Airlie House Classification

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographsan Extension Of The Modified Airlie House Classification

Grading Diabetic Retinopathy from Stereoscopic Color Fundus PhotographsAn Extension of the Modified Airlie House Classification Article in Ophthalmology 98(5S)May 1991 with 178 Reads Early Treatment Diabetic Retinopathy Study Research Group The modified Airlie House classification of diabetic retinopathy has been extended for use in the Early Treatment Diabetic Retinopathy Study (ETDRS). The revised classification provides additional steps in the grading scale for some characteristics, separates other characteristics previously combined, expands the section on macular edema, and adds several characteristics not previously graded. The classification is described and illustrated and its reproducibility between graders is assessed by calculating percentages of agreement and kappa statistics for duplicate gradings of baseline color nonsimultaneous stereoscopic fundus photographs. For retinal hemorrhages and/ or microaneurysms, hard exudates, new vessels, fibrous proliferations, and macular edema, agreement was substantial (weighted kappa, 0.61 to 0.80). For soft exudates, intraretinal microvascular abnormalities, and venous beading, agreement was moderate (weighted kappa, 0.41 to 0.60). A double grading system, with adjudication of disagreements of two or more steps between duplicate gradings, led to some improvement in reproducibility for most characteristics. Do you want to read the rest of this article? ... For each eye, DR severity score was assigned based on the modified Airlie House Classification 28 into none (ETDRS levels 10-15), minimal non-proliferative (NPDR, level 15-20), mild NPDR (level 35), moderate NPDR (level 43-47), severe NPDR (level 53), or proliferative DR (PDR, score >60) 28 . Based on the worse eye score, any DR was defined as a severity level of 15 Continue reading >>

Early Treatment Diabetic Retinopathy Study Design And Baseline Patient Characteristics: Etdrs Report Number 7

Early Treatment Diabetic Retinopathy Study Design And Baseline Patient Characteristics: Etdrs Report Number 7

Volume 98, Issue 5, Supplement , May 1991, Pages 741-756 Early Treatment Diabetic Retinopathy Study Design and Baseline Patient Characteristics: ETDRS Report Number 7 Get rights and content The Early Treatment Diabetic Retinopathy Study (ETDRS), a multicenter collaborative clinical trial supported by the National Eye Institute, was designed to assess whether argon laser photocoagulation or aspirin treatment can reduce the risk of visual loss or slow the progression of diabetic retinopathy in patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy. The 3711 patients enrolled in the ETDRS were assigned randomly to either aspirin (650 mg per day) or placebo. One eye of each patient was assigned randomly to early argon laser photocoagulation and the other to deferral of photocoagulation. Both eyes were to be examined at least every 4 months and photocoagulation was to be initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected. Examination of a large number of baseline ocular and patient characteristics indicated that there were no important differences between randomized treatment groups at baseline. Continue reading >>

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographsan Extension Of The Modified Airlie House Classification: Etdrs Report Number 10

Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographsan Extension Of The Modified Airlie House Classification: Etdrs Report Number 10

Volume 98, Issue 5, Supplement , May 1991, Pages 786-806 Grading Diabetic Retinopathy from Stereoscopic Color Fundus PhotographsAn Extension of the Modified Airlie House Classification: ETDRS Report Number 10 Get rights and content The modified Airlie House classification of diabetic retinopathy has been extended for use in the Early Treatment Diabetic Retinopathy Study (ETDRS). The revised classification provides additional steps in the grading scale for some characteristics, separates other characteristics previously combined, expands the section on macular edema, and adds several characteristics not previously graded. The classification is described and illustrated and its reproducibility between graders is assessed by calculating percentages of agreement and kappa statistics for duplicate gradings of baseline color nonsimultaneous stereoscopic fundus photographs. For retinal hemorrhages and/ or microaneurysms, hard exudates, new vessels, fibrous proliferations, and macular edema, agreement was substantial (weighted kappa, 0.61 to 0.80). For soft exudates, intraretinal microvascular abnormalities, and venous beading, agreement was moderate (weighted kappa, 0.41 to 0.60). A double grading system, with adjudication of disagreements of two or more steps between duplicate gradings, led to some improvement in reproducibility for most characteristics. Continue reading >>

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