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Michael F. Chiang, MD, MA; Jeremy D. Keenan, MD, MPH; Justin Starren, MD, PhD; Yunling E. Du, PhD; William M. Schiff, MD; Gaetano R. Barile, MD; Joan Li, MD; Rose Anne Johnson, RN; Ditte J. Hess, CRA; John T. Flynn, MD

Arch Ophthalmol. 2006;124:322-327.

Objective  To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using remote review of digital images by 3 masked ophthalmologist readers.

Methods  An atlas was compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were independently reviewed by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist.

Results  Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader, 0.816/0.955 for the second reader, and 0.864/0.493 for the third reader. Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader, 0.850/0.973 for the second reader, and 0.900/0.953 for the third reader. When ROP was classified into ordinal categories, the overall weighted for interreader reliability was 0.743. Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers.

Conclusion  The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.

Author Affiliations: Departments of Ophthalmology (Drs Chiang, Keenan, Schiff, Barile, Li, and Flynn), Biomedical Informatics (Drs Chiang and Starren), and Radiology (Dr Starren), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York (Dr Du); Department of Pediatric Nursing, Jackson Memorial Hospital, Miami, Fla (Ms Johnson); and Bascom Palmer Eye Institute, Miami (Ms Hess).

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