title: Accuracy of ROPtool vs individual examiners in assessing retinal vascular tortuosity.
abstract: OBJECTIVE
  To prospectively determine if tortuosity assessment by a computer program (ROPtool) that traces retinal blood vessels and measures their tortuosity was more accurate than that of individual pediatric ophthalmologists.
  
  
  METHODS
  One hundred eighty-five high-quality RetCam images from premature infants were circulated to 3 retinopathy of prematurity (ROP) experts and 3 other pediatric ophthalmologists ("examiners") who graded the tortuosity in each quadrant as normal, pre-plus, or plus. These same images were analyzed using ROPtool.
  
  
  RESULTS
  Using expert consensus as the standard, ROPtool's overall accuracy of 95% (175 of 185) for identifying tortuosity sufficient for plus disease was similar to that of examiner 1 (93%; 172 of 185; P = .50), examiner 2 (93%; 172 of 185; P = .50), and examiner 3 (91%; 168 of 185; P = .10). ROPtool's sensitivity of 97% (36 of 37) compared favorably with that of examiner 1 (65%; 24 of 37; P < .001), examiner 2 (70%; 26 of 37; P < .001), and examiner 3 (81%; 30 of 37; P = .06).
  
  
  CONCLUSIONS
  Computer-assisted analysis of retinal images can potentially reduce subjectivity in the diagnosis of plus disease and optimize timing of follow-up and treatment for ROP.
authors.affiliation: Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina USA. david.wallace@duke.edu
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
authors.forename: Zheen
authors.initials: Z
authors.lastname: Zhao
authors.forename: Sin-Ho
authors.initials: SH
authors.lastname: Jung
mesh_terms: D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007231:Infant, Newborn; D010781:Photography / Q000295:instrumentation; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity