Comparison of strategies for grading retinal images of premature infants for referral warranted retinopathy of prematurity.
OBJECTIVE
To determine the accuracy of identifying referral-warranted retinopathy of prematurity (RW-ROP, defined as any zone I ROP, stage 3 or worse, or plus disease) from retinal image sets using three grading protocols: a single optic disk-centered image, a set of 3 horizontal images, and a 5-image set.


METHODS
In this secondary analysis of images from the e-ROP study, a weighted sample of 250 image sets from 250 infants (125 with RW-ROP and 125 without RW-ROP) was randomly selected. The sensitivities and specificities for detecting RW-ROP and its components from a single disk center image, along with nasal and temporal retinal images, were calculated and compared with the e-ROP grading of RW-ROP of all 5 retinal images (disk center and nasal, temporal, superior, and inferior retinal images).


RESULTS
RW-ROP was identified with a sensitivity of 11.2% (95% CI, 6.79%-17.9%) using a single disk center image, with a sensitivity of 70.4% (95% CI, 61.9%-77.9%) using 3 horizontal images, and a statistically higher sensitivity of 82.4% (95% CI, 75.0%-89.0%) using all 5 images (P = 0.002). The specificities were 100%, 86.4%, and 90.4%, respectively. For grading using 3 horizontal images, sensitivity was 14.3% for plus disease, 25% for zone I ROP, and 71.2% for stage 3 or worse compared to 40.8%, 50%, and 79.8% for grading using 5-image sets, respectively.


CONCLUSIONS
Both a single, disk-centered, posterior pole image and 3 horizontal images were less effective than a 5-image set in determining the presence of RW-ROP on qualitative grading by trained readers.
Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: david.rogers@nationwidechildrens.org.
David L
DL
Rogers
Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio.
Don L
DL
Bremer
Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio.
Rae R
RR
Fellows
Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Agnieshka
A
Baumritter
Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Ebenezer
E
Daniel
Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Max
M
Pastilli
Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Gui-Shang
GS
Ying
Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Graham E
GE
Quinn
D001724:Birth Weight; D017408:Guidelines as Topic; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000592:standards*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D009887:Ophthalmoscopy / Q000379:methods*; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012160:Retina / Q000000981:diagnostic imaging*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012720:Severity of Illness Index