Table 4.

Level 2 and level 3 reader disagreements according to the consensus gold standard and impact on patient management (N=559).

Effect of disagreement		Reader A (n=323), n (%)		Level 3 reader for reader A (n=323), n (%)		Reader B (n=236), n (%)		Level 3 reader for reader B (n=236), n (%)
No impact on patient management		18 (5.6)		6 (1.9)		19 (8.1)		5 (2.1)
Impact on patient management		48 (14.9)		12 (3.7)		23 (9.8)		9 (3.8)
Total number of disagreements		66 (20.4)		18 (5.6)		42 (17.8)		14 (5.9)
No referral although indicated		9 (2.8)		4 (1.2)		6 (2.5)		6 (2.5)
Unnecessary referral		21 (6.5)		0 (0)		5 (2.1)		0 (0)
Imaging recommended sooner than necessary		14 (4.3)		0 (0)		11 (4.7)		1 (0.4)
Imaging recommended later than indicated		4 (1.2)		8 (2.5)		1 (0.4)		2 (0.9)
Significant misreads (no referral although indicated)
	Missed isolated microaneurysm within 1 DDa of the fovea.		6 (1.9)		3 (0.9)		5 (2.1)		6 (2.5)
	Confusion of neovascularization with an epiretinal membrane		0 (0)		1 (0.3)		0 (0)		0 (0)
	Under appreciation of ungradable imaging		3 (0.9)		0 (0)		1 (0.4)		0 (0)
Nonsignificant misreads
	Misreads with minimal impact on management		34 (10.5)		8 (2.5)		15 (6.4)		3 (1.3)
	Referrals as a precaution		4 (1.2)		0 (0)		1 (0.4)		0 (0)
	Under appreciation of ungradable imaging		1 (0.3)		0 (0)		1 (0.4)		0 (0)

^aDD: disc diameter.