Validity of caruncular edema in the CAS Score for thyroid eye disease: a multi-observer image annotation study
Author: Marie Callet
Base Hospital / Institution: Rothschild Foundation Hospital
Rapid fire oral presentation
Abstract ID: 25-233
Purpose
To assess the inter-observer agreement on the presence of caruncular edema in thyroid eye disease (TED) and evaluate the validity of this item in the Clinical Activity Score (CAS), compared to two other ocular surface signs: conjunctival erythema and hyperemia.
Methods
A total of 535 clinical images from 274 patients with TED were independently annotated by three ophthalmologists for the presence of caruncular edema, conjunctival erythema, and hyperemia. Image sets were either randomized or grouped by patient. Inter-observer agreement was assessed using Fleiss’ kappa coefficient. Statistical analyses were performed with R (v4.4.1).
Results
Patients had a mean age of 55 years, and 70% were female. The inter-observer agreement for caruncular edema was low (κ = 0.10, 95% CI [0.06, 0.15]), suggesting poor reproducibility. Agreement for conjunctival erythema was fair (κ = 0.24, 95% CI [0.19, 0.28]), and for caruncular hyperemia was moderate (κ = 0.30, 95% CI [0.26, 0.35]).
Conclusion
The reproducibility of caruncular edema assessment among trained ophthalmologists is poor, casting doubt on the reliability of this item within the CAS scoring system for TED. In contrast, conjunctival hyperemia showed better agreement. Caruncular erythema showed limited agreement. These findings suggest the need to re-evaluate the relevance of caruncular edema as a major clinical criterion in the management algorithm of active TED.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Marie | Callet | Rothschild Fondation Hospital |
| Oceanne | Haelewynn | Rothschild Fondation Hospital |
| Laura | Licini | Rothschild Fondation Hospital |
| Pierre Vincent | Jacomet | Rothschild Fondation Hospital |
| Olivier | Galatoire | Rothschild Fondation Hospital |
