title: Fluorescein angiography-based diagnosis for retinopathy of prematurity: expert-non expert comparison.
abstract: OBJECTIVE
  To evaluate accuracy and inter-rater reliability of RetCam fundus images and digital camera fluorangioscopic images in acute retinopathy of prematurity (ROP) by comparing diagnoses given by trainee ophthalmologists with those provided by expert ophthalmologists.
  
  
  METHODS
  This is a multicenter retrospective observational study of diagnostic data from 48 eyes of 24 premature infants with classical ROP, stage II, as evaluated by RetCam 3 and fluorescein angiography (FA). Average gestational age was 25.4 weeks, average weight 804.7 g. A staging grid (with ocular fundus divided into 3 concentric zones) and 24 15° sectors centered around the optic papilla were superimposed on 360° retina photomontages (Photoshop) made from RetCam and FA images. Non expert vs expert diagnosis agreement was measured for each sector by means of Cohen kappa (Fleiss, 1981).
  
  
  RESULTS
  A high degree of concordance was found. Inter-rater agreement between expert and non expert interpretations of retinal photomontages was greater for fluorangiographic images than for RetCam images, with κ = 0.61-1 for 120/152 (78.9%) sectors examined on the RetCam images and  κ = 0.61-1 for 168/198 (84.8%) sectors examined on the FA images.
  
  
  CONCLUSIONS
  The FA images appear to be easier to interpret than RetCam images, both by expert and non expert ophthalmologists. The results confirm that FA is a good examination technique with a high degree of reliability, even where trainee practitioners are involved. This suggests that retinopathy management can be improved by entrusting diagnostic responsibilities to trainee ophthalmologists, in order to extend access to correct diagnosis, recognition of threshold lesions, and prompt treatment.
authors.affiliation: Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Clinica Oculistica, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia - Italy. r.guagliano@smatteo.pv.it
authors.forename: Rosanna
authors.initials: R
authors.lastname: Guagliano
authors.forename: Donatella
authors.initials: D
authors.lastname: Barillà
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertone
authors.forename: Anna
authors.initials: A
authors.lastname: Maffia
authors.forename: Francesca
authors.initials: F
authors.lastname: Periti
authors.forename: Laura
authors.initials: L
authors.lastname: Spallone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Anselmetti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Giacosa
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Bianchi
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D019793:Fluorescein; D005451:Fluorescein Angiography / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education / Q000592:standards*; D010781:Photography; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000145:classification / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D019793:Fluorescein