title: Plus Disease in Retinopathy of Prematurity: Diagnostic Trends in 2016 Versus 2007.
abstract: OBJECTIVE
  To identify any temporal trends in the diagnosis of plus disease in retinopathy of prematurity (ROP) by experts.
  
  
  METHODS
  Reliability analysis.
  
  
  METHODS
  ROP experts were recruited in 2007 and 2016 to classify 34 wide-field fundus images of ROP as plus, pre-plus, or normal, coded as "3," "2," and "1," respectively, in the database. The main outcome was the average calculated score for each image in each cohort. Secondary outcomes included correlation on the relative ordering of the images in 2016 vs 2007, interexpert agreement, and intraexpert agreement.
  
  
  RESULTS
  The average score for each image was higher for 30 of 34 (88%) images in 2016 compared with 2007, influenced by fewer images classified as normal (P < .01), a similar number of pre-plus (P = .52), and more classified as plus (P < .01). The mean weighted kappa values in 2006 were 0.36 (range 0.21-0.60), compared with 0.22 (range 0-0.40) in 2016. There was good correlation between rankings of disease severity between the 2 cohorts (Spearman rank correlation ρ = 0.94), indicating near-perfect agreement on relative disease severity.
  
  
  CONCLUSIONS
  Despite good agreement between cohorts on relative disease severity ranking, the higher average score and classifications for each image demonstrate that experts are diagnosing pre-plus and plus disease at earlier stages of disease severity in 2016, compared with 2007. This has implications for patient care, research, and teaching, and additional studies are needed to better understand this temporal trend in image-based plus disease diagnosis.
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: Chace
authors.initials: C
authors.lastname: Moleta
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Campbell
authors.affiliation: Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Kalpathy-Cramer
authors.affiliation: Department of Ophthalmology, University of Illinois-Chicago, Chicago, Illinois.
authors.forename: R V Paul
authors.initials: RVP
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: Susan
authors.initials: S
authors.lastname: Ostmo
authors.affiliation: Department of Ophthalmology, University of Illinois-Chicago, Chicago, Illinois.
authors.forename: Karyn
authors.initials: K
authors.lastname: Jonas
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon. Electronic address: chiangm@ohsu.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological / Q000639:trends*; D004108:Dilatation, Pathologic; D005260:Female; D005544:Forecasting; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007231:Infant, Newborn; D008297:Male; D010781:Photography; D011446:Prospective Studies; D015203:Reproducibility of Results; D012169:Retinal Vein / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D014741:Video Recording