Vol. 47 No. 1 Original Article PDF

Agreement Between Clinical and Angiographic Staging of Diabetic Retinopathy in a Tertiary Government Hospital in the Philippines

Ronald Gonin C. Paraan, M.D.
Romulo N. Aguilar, M.D., Ph.D.

Department of Ophthalmology and Visual Sciences
Philippine General Hospital, University of the Philippines – Manila

Correspondence: Ronald Gonin C. Paraan, M.D.
Department of Ophthalmology and Visual Sciences UP-PGH, Taft Avenue, Manila
Email: rcparaan.sbcm@gmail.com

Disclaimer: The investigators of this study have no financial relationship or any conflicts of interest to report.


Objective: The main objective of this study is to determine the agreement between the clinical staging of diabetic retinopathy (DR) with fluorescein angiography (FA) staging in an actual clinic.

Methods: This was a retrospective cross-sectional study conducted in a single retina clinic. One hundred and thirty-four (134) eyes with newly diagnosed diabetic retinopathy were included in the study. Patients with ocular findings that prevented the proper examination of the retina or who had undergone laser treatment were excluded. Outcome measures were the staging of DR between the two modalities. The distribution of stages of DR according to clinical evaluation and angiography were determined. The rate of under-diagnosing and over-diagnosing the stage of DR was calculated. Sensitivity and specificity of clinical ophthalmoscopy against FA in staging DR was also included. The kappa coefficient was used to measure agreement between the two modalities.

Results: Kappa coefficient was computed at 0.198 with a 95% confidence interval from 0.105 – 0.291. Agreement between the two modalities were observed in 37.3% of the eyes. More than half or 56.7% of the eyes were under-diagnosed on clinical examination while 6% were over-diagnosed. Clinically, most of the eyes were staged as non-proliferative diabetic retinopathy (NPDR) moderate (n=53). Based on FA, NPDR severe (n=70) was the most common stage. Clinical staging of DR showed a sensitivity of 58 – 75%, and specificity of 63% – 99%.

Conclusion: There was a poor agreement between the clinical and angiographic staging of DR in the included sample. NPDR severe had the most agreements while NPDR mild was the most under-diagnosed stage, and PDR early the most over-diagnosed stage. In this single training institution, there was a tendency to assign a less severe stage of DR based on clinical evaluation. Clinical evaluation with an indirect ophthalmoscope and a 20 D lens had a low sensitivity but high specificity in staging DR.

Keywords: Diabetic Retinopathy, Fluorescein Angiography, Ophthalmoscopy, Diabetes Mellitus, Philippines

Philipp J Ophthalmol 2022;47:9-14