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Michael F. Chiang, MD; Lei Jiang, BA; Rony Gelman, MD; Yunling E. Du, PhD; John T. Flynn, MD

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In reply

We appreciate the opportunity to respond to the thoughtful comments by Drs Good, Palmer, and Hardy. With regard to study design issues: (1) We agree that a contact retinal camera can alter the appearance of retinal vessels but note that many of these same changes may occur during indirect ophthalmoscopy with scleral depression. (2) It is true that our study images were presented to graders without peripheral views or demographic data. However, the standard photographic definition of plus disease also displays only the posterior retina.¹ Future research to determine whether this additional information would influence diagnostic reliability may be warranted. (3) We agree that our study did not directly measure whether multiple experts performing serial ophthalmoscopy on the same infants would diagnose plus disease consistently. The strengths and limitations of . . . [Full Text of this Article]

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