June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Uncertainty in the diagnosis of Pre-plus Disease in Retinopathy of Prematurity
Author Affiliations & Notes
  • Allison Rebecca Loh
    Ophthalmology, Oregon Health and Science University, Portland, OR
  • Michael Ryan
    Ophthalmology, Oregon Health and Science University, Portland, OR
  • Katherine Abrahams
    Ophthalmology, Oregon Health and Science University, Portland, OR
  • Esra Ataer-Cansizoglu
    Electrical and Computer Engineering, Northeastern University, Boston, MA
  • Robison Vernon Paul Chan
    Ophthalmology, Weill Cornell Medical College, New York, NY
  • Audina M Berrocal
    Ophthalmology, Bascom Palmer Eye Institute, Miami, FL
  • Jayashree Kalpathy-Cramer
    Radiology, Harvard Medical School, Charleston, MA
  • Veronica Bolon-Canedo
    Informatics, University of A Coruña, A Coruña, Spain
  • Deniz Erdogmus
    Electrical and Computer Engineering, Northeastern University, Boston, MA
  • Michael F Chiang
    Ophthalmology, Oregon Health and Science University, Portland, OR
  • Footnotes
    Commercial Relationships Allison Loh, None; Michael Ryan, None; Katherine Abrahams, None; Esra Ataer-Cansizoglu, None; Robison Chan, NIH Grant EY 19474 (F), Research to Prevent Blindness (F), The St. Giles Foundation (F); Audina Berrocal, Alcon Allergan (S); Jayashree Kalpathy-Cramer, None; Veronica Bolon-Canedo, None; Deniz Erdogmus, None; Michael Chiang, Clarity Medical Systems (S), NIH EY 19474 (F), NIH Grant EY 22387 (F), Research to Prevent Blindness (F), St. Giles Foundation (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 611. doi:
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      Allison Rebecca Loh, Michael Ryan, Katherine Abrahams, Esra Ataer-Cansizoglu, Robison Vernon Paul Chan, Audina M Berrocal, Jayashree Kalpathy-Cramer, Veronica Bolon-Canedo, Deniz Erdogmus, Michael F Chiang; Uncertainty in the diagnosis of Pre-plus Disease in Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):611.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To measure the impact of pre-plus categorization by examining the diagnostic accuracy of experts as well as calculating quantitative tortuosity values using novel computer analysis.

Methods: Wide-angle retinal images captured from 73 infants during ROP-screening were interpreted by 2 experts using a 3-level (plus/pre-plus/neither) scale. Image-based interpretations were integrated with the clinical ophthalmoscopic exam to define a reference standard diagnosis for each image. Each image was analyzed quantitatively using a computer-based algorithm to generate a vascular tortuosity index (TI). Diagnostic performance of each expert and the computer-generated tortuosity index were compared based on absolute agreement and receiver operating characteristic area under the curve (AUC), with 3-level vs. 2-level (plus/not plus) classification of plus disease.

Results: Absolute agreement between experts and the reference standard was 92% in the 3-level classification and improved to 96% in the 2-level classification. Diagnostic performance of experts measured by AUC was 0.94 in the 3-level classification, and 0.97 in the 2-level classification. Diagnostic performance of the computer-based tortuosity index measured by AUC was 0.91 in the 3-level classification, and 0.90 in the 2-level classification. Sensitivity and specificity of computer-generated plus-disease diagnosis were 89% sensitivity/81%-specificity in the 3-level classification, and 100%-sensitivity/66% specificity in the 2-level classification.

Conclusions: Classifications of ROP that included a pre-plus disease category decreased the diagnostic performance of both experts and computer based systems. This study suggests that uncertainty in the diagnosis of pre-plus disease hinders diagnostic performance. Further clarification is needed in the definition of pre-plus disease to improve the accuracy and consistency of diagnosing retinopathy of prematurity.

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