Optical coherence tomography angiography image quality assessment at varying retinal expertise levels

Purpose: to compare optical coherence tomography angiography (oct-a) image quality gradings performed by readers of varying retinal expertise levels in different retinal diseases. methods: central 3
3 mm2 oct-a images (angiovue, optovue) of 57 healthy controls (50.9 ± 22.4 years) and 148 patients (66.5 ± 14.1 years) affected by various chorioretinal diseases were retrospectively analyzed including early age related macular degeneration (amd, n ¼ 26), neovascular amd (namd, n ¼ 22), and geographic atrophy due to amd (ga, n ¼ 6), glaucoma (n ¼ 28), central serous chorioretinopathy (csc, n ¼ 14), epiretinal membrane (em, n ¼ 26), retinitis pigmentosa (rp, n ¼ 16), and retinal venous occlusion (rvo, n ¼ 10). a senior expert in medical retina (se), an ophthalmology resident (or), and a non-ophthalmologic medical doctor (md) independently assessed oct-a image quality using the motion artifact score (mas) and the segmentation accuracy score (sas). results: regarding mas, inter-reader agreement between se and or was 93.7% (cohen's kappa ¼ 0.907) and 85.4% (cohen's kappa ¼ 0.786) between se and md. regarding sas, inter-reader agreement between se and or was 95.1% (cohen's kappa ¼ 0.92) and 92.2% (cohen's kappa ¼ 0.874) between se and md. in the sas analysis, signal strength index (ssi) and presence of retinal pathology had a significant influence on the overall agreement (p ¼ 0.046; p < 0.001). conclusions: oct-a image quality assessment can be performed most reliably by an ophthalmologist with knowledge in retinal image analysis. yet, well-instructed non-ophthalmologic assessors show only slightly inferior results and, thus, may be integrated in routine oct-a image quality assessment as well.