The objectives of the Barbados Incidence Study of Eye Diseases (BISED) are: (1) to determine the incidence and progression of open-angle glaucoma, age- related cataract, diabetic retinopathy and age-related macular degeneration, (2) to evaluate risk factors for the incidence of the above eye diseases, using baseline data collected during the previous Barbados Eye Study (BES) examination, and (3) to determine the incidence and progression of visual acuity impairment and their associated factors This proposal outlines the rationale for and function of the BISED Fundus Photography Reading Center (FPRC). The FPRC will provide data to classify fundus photographs in a standardized manner. The FPRC will evaluate the fundus photographs of all participants in the incidence study according to the same grading scheme used in the prevalence study, which evaluates the optic disc for glaucomatous changes and the macula for diabetic and age- related changes. The gradings from the two studies will be compared to identify participants with newly identified pathology or changes in previous pathology. In addition to repeating the prevalence grading protocol, an additional side-by-side comparison grading will be performed to identify progression of disease pathology not presently included in the prevalence study grading scheme. The FPRC personnel who attained excellent reproducibility (measured by Kappa statistics) with the original BES grading scheme, remain on staff. Findings from clinical examinations are notoriously variable. Incorporation of data from the FPRC improves the quality of the study by supplying reproducible independent gradings on all photographed participants. Since the BES protocol does not refer everyone for ophthalmic examination, the photographic findings will be the only ophthalmic finding on approximately 1/4 of the participants.
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