title: Accuracy of retinopathy of prematurity diagnosis by retinal fellows.
abstract: OBJECTIVE
  The purpose of this study was to measure the accuracy of retinopathy of prematurity (ROP) diagnosis by retinal fellows.
  
  
  METHODS
  An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II, Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study Web site, from which an expert pediatric retinal specialist and 7 retinal fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. The sensitivity and specificity of each retinal fellow were calculated and subsequently compared with a reference standard of diagnosis by an expert pediatric retinal specialist.
  
  
  RESULTS
  For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.751 (0.512-0.953), and specificity was 0.841 (0.707-0.976). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.914 (0.667-1.000), and specificity was 0.871 (0.678-0.987).
  
  
  CONCLUSIONS
  In general, fellows showed high accuracy for detecting ROP. However, 3 of 7 fellows achieved <80% sensitivity for diagnosis of type 2 or worse ROP, and 2 of 7 achieved <90% sensitivity for diagnosis of treatment-requiring ROP. This could lead to undermanagement and undertreatment of clinically significant disease and raises potential concerns about the quality of ROP screening examinations performed by less-experienced examiners.
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Paul Chan
authors.forename: Steven L
authors.initials: SL
authors.lastname: Williams
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yonekawa
authors.forename: David J
authors.initials: DJ
authors.lastname: Weissgold
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lee
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing; D006801:Humans; D007231:Infant, Newborn; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education*; D010781:Photography / Q000379:methods; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000145:classification / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013038:Specialization