title: Telemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality.
abstract: OBJECTIVE
  To prospectively measure accuracy, reliability, and image quality of telemedical retinopathy of prematurity (ROP) diagnosis.
  
  
  METHODS
  Two-hundred forty-eight eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks' and/or 35 to 37 weeks' postmenstrual age (PMA) using a standard protocol. Data were uploaded to a Web-based telemedicine system and interpreted by 3 expert retinal specialist graders who provided a diagnosis (no ROP, mild ROP, type 2 prethreshold ROP, treatment-requiring ROP) and an evaluation of image quality for each eye. Findings were compared with a reference standard of indirect ophthalmoscopy by an experienced pediatric ophthalmologist.
  
  
  RESULTS
  At 35 to 37 weeks' PMA, sensitivity and specificity for diagnosis of mild or worse ROP were 0.908 and 1.000 for grader A, 0.971 and 1.000 for grader B, and 0.908 and 0.977 for grader C. Sensitivity and specificity for diagnosis of type 2 prethreshold or worse ROP were 1.000 and 0.943 for grader A, 1.000 and 0.930 for grader B, and 1.000 and 0.851 for grader C. At 35 to 37 weeks' PMA, weighted kappa for intergrader reliability was 0.791 to 0.889, and kappa for intragrader reliability for detection of type 2 prethreshold or worse ROP was 0.769 to 1.000. Image technical quality was rated as "adequate" or "possibly adequate" for diagnosis in 93.3% to 100% of eyes.
  
  
  CONCLUSIONS
  A telemedicine system using nurse-captured retinal images has the potential to improve existing shortcomings of ROP management, particularly at later PMAs.
authors.affiliation: Department of Ophthalmology, Columbia University College of Physicians and Surgeons, 635 W 165th St, Box 92, New York, NY 10032, USA. chiang@dbmi.columbia.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Mihai
authors.initials: M
authors.lastname: Busuioc
authors.forename: Yunling E
authors.initials: YE
authors.lastname: Du
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kane
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lee
authors.forename: David J
authors.initials: DJ
authors.lastname: Weissgold
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.forename: Osode
authors.initials: O
authors.lastname: Coki
authors.forename: John T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Justin
authors.initials: J
authors.lastname: Starren
mesh_terms: D001724:Birth Weight; D005865:Gestational Age; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards*; D007091:Image Processing, Computer-Assisted / Q000592:standards; D007231:Infant, Newborn; D017283:Neonatal Nursing / Q000592:standards*; D009887:Ophthalmoscopy / Q000592:standards*; D010781:Photography / Q000295:instrumentation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D019113:Telepathology / Q000592:standards*