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Assessing intergrader variability in incomplete outer retinal atrophy (iRORA) grading.

Lorenzo Ferro Desideri1, Davide Scandella2, Rodrigo Anguita3

  • 1Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland lorenzo.ferrodesideri@insel.ch.

The British Journal of Ophthalmology
|May 14, 2026
PubMed
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This summary is machine-generated.

Intergrader agreement for detecting incomplete outer retinal atrophy (iRORA) in age-related macular degeneration (AMD) using optical coherence tomography (OCT) was limited. Improving iRORA detection reliability is crucial for clinical trials and practice.

Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Biomarker Research

Background:

  • Incomplete outer retinal atrophy (iRORA) is a key biomarker for early age-related macular degeneration (AMD).
  • Accurate detection of iRORA is vital for monitoring disease progression and evaluating treatments.
  • Current grading criteria present challenges for consistent intergrader assessment.

Purpose of the Study:

  • To evaluate the intergrader variability in detecting iRORA using optical coherence tomography (OCT) scans.
  • To assess the reliability of iRORA as a biomarker and potential clinical trial endpoint.

Main Methods:

  • A cross-sectional study involving five international retinal experts grading 60 OCT B-scans for iRORA.
  • Utilized the Classification of Atrophy Meeting (CAM) criteria and a standardized online annotation platform.
Keywords:
Age-Related Macular Degeneration

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  • Assessed intergrader agreement using Cohen's Kappa and analyzed classification accuracy, sensitivity, and specificity.

    • Main Results:

    • Mean pairwise Cohen's Kappa was 0.425, indicating mild agreement among graders.
    • Agreement with the majority vote ranged from κ=0.48 to 0.67, with classification accuracy between 0.73 and 0.83.
    • High specificity (0.85-0.96) was observed, but sensitivity varied (0.59-0.83).

    Conclusions:

    • Intergrader reproducibility for iRORA detection remains limited despite standardized CAM definitions.
    • Challenges exist in consistently identifying early atrophic changes in AMD.
    • Refining grading guidelines and incorporating automated detection systems are recommended to enhance reliability.