Accuracy of retinopathy of prematurity image-based diagnosis by pediatric ophthalmology fellows: Implications for training

• Published in: Journal of AAPOS Vol. 15; no. 6; pp. 573 - 578
• Main Authors: Myung, Jane S., MD, Paul Chan, Robison Vernon, MD, Espiritu, Michael J., MD, Williams, Steven L., MD, Granet, David B., MD, Lee, Thomas C., MD, Weissgold, David J., MD, Chiang, Michael F., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.12.2011
• Subjects: Area Under Curve; Fellowships and Scholarships; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Observer Variation; Ophthalmology; Ophthalmology - education; Ophthalmoscopy - methods; Reference Standards; Reproducibility of Results; Retinopathy of Prematurity - diagnosis; Sensitivity and Specificity
• ISSN: 1091-8531; 1528-3933
• DOI: 10.1016/j.jaapos.2011.06.011

Purpose 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.