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Accuracy, Reliability, and Image Quality

Michael F. Chiang, MD; Lu Wang, MD, MS; Mihai Busuioc, OD, MD; Yunling E. Du, PhD; Patrick Chan, BA; Steven A. Kane, MD, PhD; Thomas C. Lee, MD; David J. Weissgold, MD; Audina M. Berrocal, MD; Osode Coki, BSN; John T. Flynn, MD; Justin Starren, MD, PhD

Arch Ophthalmol. 2007;125(11):1531-1538.

Objective  To prospectively measure accuracy, reliability, and image quality of telemedical retinopathy of prematurity (ROP) diagnosis.

Methods  Two-hundred forty-eight eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks’ and/or 35 to 37 weeks' postmenstrual age (PMA) using a standard protocol. Data were uploaded to a Web-based telemedicine system and interpreted by 3 expert retinal specialist graders who provided a diagnosis (no ROP, mild ROP, type 2 prethreshold ROP, treatment-requiring ROP) and an evaluation of image quality for each eye. Findings were compared with a reference standard of indirect ophthalmoscopy by an experienced pediatric ophthalmologist.

Results  At 35 to 37 weeks' PMA, sensitivity and specificity for diagnosis of mild or worse ROP were 0.908 and 1.000 for grader A, 0.971 and 1.000 for grader B, and 0.908 and 0.977 for grader C. Sensitivity and specificity for diagnosis of type 2 prethreshold or worse ROP were 1.000 and 0.943 for grader A, 1.000 and 0.930 for grader B, and 1.000 and 0.851 for grader C. At 35 to 37 weeks' PMA, weighted for intergrader reliability was 0.791 to 0.889, and for intragrader reliability for detection of type 2 prethreshold or worse ROP was 0.769 to 1.000. Image technical quality was rated as "adequate" or "possibly adequate" for diagnosis in 93.3% to 100% of eyes.

Conclusion  A telemedicine system using nurse-captured retinal images has the potential to improve existing shortcomings of ROP management, particularly at later PMAs.

Author Affiliations: Departments of Ophthalmology (Drs Chiang, Wang, Busuioc, Kane, and Flynn and Mr Chan) and Biomedical Informatics (Drs Chiang and Starren) and Division of Neonatology (Ms Coki), Columbia University College of Physicians and Surgeons and Department of Epidemiology and Public Health, Albert Einstein College of Medicine (Dr Du), New York, New York; Division of Ophthalmology, Childrens Hospital Los Angeles, Los Angeles, California (Dr Lee); Retina Center of Vermont, Burlington (Dr Weissgold); and Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Dr Berrocal).

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