title: Telemedical diagnosis of retinopathy of prematurity: accuracy of expert versus non-expert graders.
abstract: OBJECTIVE
  To assess accuracy of telemedical retinopathy of prematurity (ROP) diagnosis by trained non-expert graders compared with expert graders.
  
  
  METHODS
  Eye examinations (n=248) from 67 consecutive infants were captured using wide-angle retinal photography (RetCam-II, Clarity Medical Systems, Pleasanton, California, USA). Non-expert graders attended two 1-h training sessions on image-based ROP diagnosis. Using a web-based telemedicine system, 14 non-expert and three expert graders provided a diagnosis for each eye: no ROP, mild ROP, type 2 pre-threshold ROP or treatment-requiring ROP. All diagnoses were compared with a reference standard of dilated indirect ophthalmoscopy by an experienced paediatric ophthalmologist.
  
  
  RESULTS
  For detection of type 2 or worse ROP, the mean (range) sensitivities and specificities were 0.95 (0.94-0.97) and 0.93 (0.91-0.96) for experts, 0.87 (0.71-0.97) and 0.73 (0.39-0.95) for resident non-experts, and 0.73 (0.41-0.88) and 0.91 (0.84-0.96) for student non-experts, respectively. For detection of treatment-requiring ROP, the mean (range) sensitivities and specificities were 1.00 (1.00-1.00) and 0.93 (0.88-0.96) for experts, 0.88 (0.50-1.00) and 0.84 (0.71-0.98) for resident non-experts, and 0.82 (0.42-1.00) and 0.92 (0.83-0.97) for student non-experts, respectively.
  
  
  CONCLUSIONS
  Mean sensitivity and specificity of trained non-experts were lower than that of experts, although several non-experts had high accuracy. Development of methods for training non-expert graders may help support telemedical ROP evaluation.
authors: Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors: Steven L
authors: SL
authors: Williams
authors: Lu
authors: L
authors: Wang
authors: Steven A
authors: SA
authors: Kane
authors: Thomas C
authors: TC
authors: Lee
authors: David J
authors: DJ
authors: Weissgold
authors: Audina M
authors: AM
authors: Berrocal
authors: Daniel
authors: D
authors: Rabinowitz
authors: Justin
authors: J
authors: Starren
authors: John T
authors: JT
authors: Flynn
authors: Michael F
authors: MF
authors: Chiang
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009518:New York; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education; D009887:Ophthalmoscopy / Q000379:methods; D010865:Pilot Projects; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods / Q000592:standards*