LAUSR

PURPOSE To determine if agreement between subjective interpretations of Scheimpflug tomography maps of corneas with Fuchs endothelial corneal dystrophy (FECD) is affected by daily and hourly changes in corneal edema. DESIGN Reliability analysis. METHODS Scheimpflug imaging pachymetry and posterior elevation maps of corneas with a range of severity of FECD were evaluated in a randomized manner for the presence of three tomographic features of edema. Agreement between interpretations of one masked observer was assessed (percentage, and κ-statistic with 95% CI) for images taken within minutes on the same day, for images taken at a similar time on a different day, and for images taken over the course of a morning. Intra- and inter-observer agreement was also assessed. RESULTS Interpretations for individual tomographic features agreed for ≥88% of images (κ≥0.75) taken within minutes on the same day; complete disagreement (i.e. disagreement for all 3 tomographic features in an image) occurred in ≤3% of images. Interpretations agreed for ≥77% of images (κ≥0.52) taken at a similar time on a different day; complete disagreement did not occur. Interpretations agreed for ≥81% of images (κ≥0.61) taken over the course of a morning; complete disagreement occurred ≤6% of images. Intra-observer agreement was ≥93% (κ≥0.83) and inter-observer agreement was ≥93% (κ≥0.66); complete disagreement did not occur. CONCLUSIONS Subjective interpretation of Scheimpflug images in FECD is highly repeatable for disease classification. Although small variations in interpretations resulted from pathophysiologic changes in corneal hydration and other factors, clinically significant disagreements in interpretation were uncommon and therefore unlikely to affect clinical decision-making.