title: Evaluation of Screening for Retinopathy of Prematurity by ROPtool or a Lay Reader.
abstract: OBJECTIVE
  To determine if (1) tortuosity assessment by a computer program (ROPtool, developed at the University of North Carolina, Chapel Hill, and Duke University, and licensed by FocusROP) that traces retinal blood vessels and (2) assessment by a lay reader are comparable with assessment by a panel of 3 retinopathy of prematurity (ROP) experts for remote clinical grading of vascular abnormalities such as plus disease.
  
  
  METHODS
  Validity and reliability analysis of diagnostic tools.
  
  
  METHODS
  Three hundred thirty-five fundus images of prematurely born infants.
  
  
  METHODS
  Three hundred thirty-five fundus images of prematurely born infants were obtained by neonatal intensive care unit nurses. A panel of 3 ROP experts graded 84 images showing vascular dilatation, tortuosity, or both and 251 images showing no evidence of vascular abnormalities. These images were sent electronically to an experienced lay reader who independently graded them for vascular abnormalities. The images also were analyzed using the ROPtool, which assigns a numerical value to the level of vascular abnormality and tortuosity present in each of 4 quadrants or sectors. The ROPtool measurements of vascular abnormalities were graded and compared with expert panel grades with a receiver operating characteristic (ROC) curve. Grades between human readers were cross-tabulated. The area under the ROC curve was calculated for the ROPtool, and sensitivity and specificity were computed for the lay reader.
  
  
  METHODS
  Measurements of vascular abnormalities by ROPtool and grading of vascular abnormalities by 3 ROP experts and 1 experienced lay reader.
  
  
  RESULTS
  The ROC curve for ROPtool's tortuosity assessment had an area under the ROC curve of 0.917. Using a threshold value of 4.97 for the second most tortuous quadrant, ROPtool's sensitivity was 91% and its specificity was 82%. Lay reader sensitivity and specificity were 99% and 73%, respectively, and had high reliability (κ, 0.87) in repeated measurements.
  
  
  CONCLUSIONS
  ROPtool had very good accuracy for detection of vascular abnormalities suggestive of plus disease when compared with expert physician graders. The lay reader's results showed excellent sensitivity and good specificity when compared with those of the expert graders. These options for remote reading of images to detect vascular abnormalities deserve consideration in the quest to use telemedicine with remote reading for efficient delivery of high-quality care and to detect infants requiring bedside examination.
authors.affiliation: Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan.
authors.forename: Ashkan M
authors.initials: AM
authors.lastname: Abbey
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Cagri G
authors.initials: CG
authors.lastname: Besirli
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Andrews
authors.affiliation: Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan.
authors.forename: Antonio
authors.initials: A
authors.lastname: Capone
authors.affiliation: Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Drenser
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Susan
authors.initials: S
authors.lastname: Ostmo
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Michael
authors.initials: M
authors.lastname: Chiang
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan. Electronic address: mgjt46@aol.com.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Trese
mesh_terms: D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D009885:Ophthalmology; D010781:Photography; D012372:ROC Curve; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity