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Volume 15
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10.3390/diagnostics15060763
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Article

Foveal Hypoplasia Grading with Optical Coherence Tomography: Agreement and Challenges Across Experience Levels

by
Riddhi Shenoy
1,
Gail D. E. Maconachie
1,2,
Swati Parida
3,
Zhanhan Tu
1,
Abdullah Aamir
1,
Chung S. Chean
3,
Ayesha Roked
1,
Michael Taylor
3,
George Garratt
1,
Sohaib Rufai
1,
Basu Dawar
3,
Steven Isherwood
3,
Ryan Ramoutar
3,
Alex Stubbing-Moore
3,4,
Esha Prakash
1,
Kishan Lakhani
1,
Ethan Maltyn
1,
Jennifer Kwan
3,
Ian DeSilva
3,
Helen J. Kuht
1,
Irene Gottlob
1,5 and
Mervyn G. Thomas
1,3,*add Show full author list remove Hide full author list
1
The University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, School of Psychology and Vision Sciences, Leicester LE2 7LX, UK
2
Division of Ophthalmology and Orthoptics, Health Science School, University of Sheffield, Sheffield S10 2TN, UK
3
Department of Ophthalmology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
4
Department of Ophthalmology, Nottingham University Hospitals, Nottingham NG7 2UH, UK
5
Cooper Neurological Institute and Cooper Medical School of Rowan University, Camden, NJ 08002, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(6), 763; https://doi.org/10.3390/diagnostics15060763
Submission received: 27 January 2025 / Revised: 8 March 2025 / Accepted: 17 March 2025 / Published: 18 March 2025
(This article belongs to the Special Issue New Perspectives in Ophthalmic Imaging)
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Abstract

Background/Objectives: The diagnosis and prognosis of arrested foveal development or foveal hypoplasia (FH) can be made using the Leicester grading system for FH and optical coherence tomography (OCT). In clinical practice, ophthalmologists and ophthalmic health professionals with varying experience consult patients with FH; however, to date, the FH grading system has only been validated amongst experts. We compare the inter-grader and intra-grade agreement of healthcare professionals against expert consensus across all grades of FH. Methods: Handheld and table-mounted OCT images (n = 341) were graded independently at a single centre by experts (n = 3) with over six years of experience and “novice” medical and allied health professionals (n = 5) with less than three years of experience. Sensitivity, specificity, and Cohen’s kappa scores were calculated for each grader, and expert vs. novice performance was compared. Results: All graders showed high sensitivity (median 97% (IQR: 94–99)) and specificity (median 94% (IQR: 90–95)) in identifying the presence or absence of FH. No significant difference was seen in specificity between expert and novice graders, but experts had significantly greater diagnostic sensitivity (median difference = 5.3%, H = 5.00, p = 0.025). Expert graders had the highest agreement with the ground truth and novice graders showed great variability in grading uncommon grades, such as atypical FH. The proposed causes of misclassification included macular decentring in handheld OCT scans in children. Conclusions: Ophthalmologists of varying experience and allied health professionals can accurately identify FH using handheld and table-mounted OCT images. FH identification and paediatric OCT interpretation can be improved in wider ophthalmic clinical settings through the education of ophthalmic staff.
Keywords: fovea; albinism; paediatric ophthalmology; optical coherence tomography fovea; albinism; paediatric ophthalmology; optical coherence tomography

Share and Cite

MDPI and ACS Style

Shenoy, R.; Maconachie, G.D.E.; Parida, S.; Tu, Z.; Aamir, A.; Chean, C.S.; Roked, A.; Taylor, M.; Garratt, G.; Rufai, S.; et al. Foveal Hypoplasia Grading with Optical Coherence Tomography: Agreement and Challenges Across Experience Levels. Diagnostics 2025, 15, 763. https://doi.org/10.3390/diagnostics15060763

AMA Style

Shenoy R, Maconachie GDE, Parida S, Tu Z, Aamir A, Chean CS, Roked A, Taylor M, Garratt G, Rufai S, et al. Foveal Hypoplasia Grading with Optical Coherence Tomography: Agreement and Challenges Across Experience Levels. Diagnostics. 2025; 15(6):763. https://doi.org/10.3390/diagnostics15060763

Chicago/Turabian Style

Shenoy, Riddhi, Gail D. E. Maconachie, Swati Parida, Zhanhan Tu, Abdullah Aamir, Chung S. Chean, Ayesha Roked, Michael Taylor, George Garratt, Sohaib Rufai, and et al. 2025. "Foveal Hypoplasia Grading with Optical Coherence Tomography: Agreement and Challenges Across Experience Levels" Diagnostics 15, no. 6: 763. https://doi.org/10.3390/diagnostics15060763

APA Style

Shenoy, R., Maconachie, G. D. E., Parida, S., Tu, Z., Aamir, A., Chean, C. S., Roked, A., Taylor, M., Garratt, G., Rufai, S., Dawar, B., Isherwood, S., Ramoutar, R., Stubbing-Moore, A., Prakash, E., Lakhani, K., Maltyn, E., Kwan, J., DeSilva, I., ... Thomas, M. G. (2025). Foveal Hypoplasia Grading with Optical Coherence Tomography: Agreement and Challenges Across Experience Levels. Diagnostics, 15(6), 763. https://doi.org/10.3390/diagnostics15060763

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