title: Accuracy of retinopathy of prematurity image-based diagnosis by pediatric ophthalmology fellows: implications for training.
abstract: OBJECTIVE
  To measure the accuracy of image-based retinopathy of prematurity (ROP) diagnosis by pediatric ophthalmology fellows.
  
  
  METHODS
  This was a comparative case series of expert versus nonexpert clinicians in image-based ROP diagnosis. 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 website from which an expert pediatric retinal specialist and five pediatric ophthalmology fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. Two different retinal specialists experienced in ROP examination served as additional controls. Primary outcome measures were sensitivity and specificity of image-based ROP diagnosis by fellows compared to a reference standard of image-based interpretation by the expert pediatric retinal specialist. Secondary outcome measure was intraphysician reliability.
  
  
  RESULTS
  For detection of mild or worse ROP, the mean (range) sensitivity among the five fellows was 0.850 (0.670-0.962) and specificity was 0.919 (0.832-0.964). For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.527 (0.356-0.709) and specificity was 0.938 (0.777-1.000). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.515 (0.267-0.765) and specificity was 0.949 (0.805-1.00).
  
  
  CONCLUSIONS
  Pediatric ophthalmology fellows in this study demonstrated high diagnostic specificity in image-based ROP diagnosis; however, sensitivity was lower, particularly for clinically significant disease.
authors.affiliation: Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Myung
authors.forename: Robison Vernon
authors.initials: RV
authors.lastname: Paul Chan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Espiritu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Williams
authors.forename: David B
authors.initials: DB
authors.lastname: Granet
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lee
authors.forename: David J
authors.initials: DJ
authors.lastname: Weissgold
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D019540:Area Under Curve; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education; D009887:Ophthalmoscopy / Q000379:methods*; D012015:Reference Standards; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity