Validity and Agreement of Uveitis Experts in Interpretation of Ocular Photographs for Diagnosis of Behçet Uveitis

Abstract

Purpose: To evaluate agreement and estimate sensitivity and specificity of uveitis specialists' interpretation of ocular photographs in diagnosing Behçet uveitis.

Methods: Fourteen Turkish uveitis specialists, masked to demographic and clinical features of patients, independently labeled ocular photographs (29 Behçet/30 other diagnoses) as “Behçet uveitis” or “non-Behçet.” Level of agreement was evaluated using kappa statistics. Photographs were categorized based on ocular signs captured and performance of observers.

Results: Exact agreement with the correct diagnosis was 56–81%. Seven reviewers correctly labeled more than 70% of photographs. Interobserver agreement among those 7 reviewers revealed moderate (κ = 0.41–0.60) or substantial (κ = 0.61–0.80) agreement in 76% of pairs. Smooth layered hypopyon, superficial retinal infiltrate with retinal hemorrhages, and branch retinal vein occlusion with vitreous haze were correctly recognized as Behçet uveitis by majority of reviewers.

Conclusions: There are ocular signs of Behçet disease that can be considered diagnostic even in the absence of any other clinical information.

• Behçet uveitis
• diagnosis
• expert agreement
• ocular photographs
• uveitis

Acknowledgments

The authors thank Y. Akova, C. Apaydin, N. Berker, S. Emre, S. Kadayifcilar, A. Kurt, B. Mudun, O. Saatci, G. Sobaci, A. Topalkara, P. Ozdal, F. Uzunoglu, and, N. Yalcindag (in alphabetical order) for their contribution in reviewing the ocular photographs. The authors also thank members of the Turkish Working Group for Ocular Diagnostic Criteria of Behçet Disease (TWOBD), A. Gül, H. Kazokoglu, and E. Mirza (in alphabetical order) for their contribution in the conception of this study.

Notes

*The study was presented as a poster at the 15th International Conference on Behçet's Disease, Yokohama, Japan, 13–15 July 2012.