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

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.