Accuracy and reliability of remote retinopathy of prematurity diagnosis.
OBJECTIVE
To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using remote review of digital images by 3 masked ophthalmologist readers.


METHODS
An atlas was compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were independently reviewed by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist.


RESULTS
Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader, 0.816/0.955 for the second reader, and 0.864/0.493 for the third reader. Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader, 0.850/0.973 for the second reader, and 0.900/0.953 for the third reader. When ROP was classified into ordinal categories, the overall weighted kappa for interreader reliability was 0.743. Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers.


CONCLUSIONS
The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.
Chiang
Michael F
MF
Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY, USA. chiang@dbmi.columbia.edu
Keenan
Jeremy D
JD
Starren
Justin
J
Du
Yunling E
YE
Schiff
William M
WM
Barile
Gaetano R
GR
Li
Joan
J
Johnson
Rose Anne
RA
Hess
Ditte J
DJ
Flynn
John T
JT
D001724:Birth Weight; D003941:Diagnostic Techniques, Ophthalmological; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015588:Observer Variation; D009887:Ophthalmoscopy; D010781:Photography / Q000379:methods*; D012015:Reference Standards; D019114:Remote Consultation; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000145:classification / Q000175:diagnosis*; D012680:Sensitivity and Specificity