{
  "abstract": "Background/Aims To assess the intergrader variability in detecting incomplete outer retinal atrophy (iRORA), an optical coherence tomography (OCT) biomarker for early atrophic changes in age-related macular degeneration (AMD) and a potential clinical trial endpoint.Methods We performed a cross-sectional intergrader agreement study using 60 OCT B-scans enriched for iRORA features from non-exudative AMD eyes. Five international retinal experts independently graded images for iRORA presence according to the current Classification of Atrophy Meeting (CAM) criteria, using a standardised online annotation platform. Pairwise agreement was assessed with Cohen’s Kappa; agreement with the majority vote, sensitivity and specificity were calculated using a leave-one-out approach. Annotation lead times were recorded to explore links between decision speed and grading consistency.Results Mean pairwise Cohen’s Kappa was 0.425 (range 0.19–0.73), indicating mild agreement. Agreement with the majority vote ranged from κ=0.48 to 0.67, with classification accuracy between 0.73 and 0.83. Sensitivity varied from 0.59 to 0.83, while specificity remained high (0.85–0.96). Annotation lead times were generally shorter when grader decisions aligned with the majority consensus.Conclusion Despite standardised CAM definitions, intergrader reproducibility for iRORA detection remains limited, reflecting challenges in consistent early atrophy identification. Refinement of grading guidelines and integration of automated detection systems could improve reliability for AMD clinical trials and clinical practice.",
  "authors": [
    {
      "affiliations": [
        "Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"
      ],
      "name": "Lorenzo Ferro Desideri"
    },
    {
      "affiliations": [
        "ARTORG Research Center Biomedical Engineering Research, University of Bern, Bern, Switzerland"
      ],
      "name": "Davide Scandella"
    },
    {
      "affiliations": [
        "Moorfields Eye Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Rodrigo Anguita"
    },
    {
      "affiliations": [
        "University of Utah Health John A Moran Eye Center, Salt Lake City, Utah, USA"
      ],
      "name": "Steffen Schmitz-Valckenberg"
    },
    {
      "affiliations": [
        "Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, UK"
      ],
      "name": "Usha Chakravarthy"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany"
      ],
      "name": "Frank G Holz"
    },
    {
      "affiliations": [
        "Department of Surgical, Medical, Dental and Morphological Sciences, Faculty of Medicine, UNIMORE-University of Modena and Reggio Emilia, Modena, Italy",
        "Ophthalmology Unit-Policlinic of Modena, Modena, Italy"
      ],
      "name": "Giuseppe Querques"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"
      ],
      "name": "Sebastian Wolf"
    },
    {
      "affiliations": [
        "ARTORG Research Center Biomedical Engineering Research, University of Bern, Bern, Switzerland"
      ],
      "name": "Raphael Sznitman"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"
      ],
      "name": "Martin Zinkernagel"
    }
  ],
  "title": "Assessing intergrader variability in incomplete outer retinal atrophy (iRORA) grading",
  "uid": "57cb5611-1fac-5bf7-b896-e0b550314e2a"
}