September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Characterization of Errors in Retinopathy of Prematurity (ROP) Diagnosis by International Ophthalmology Residents
Author Affiliations & Notes
  • Kai B Kang
    Ophthalmology, Illinois Eye and Ear Infirmary, UIC, Chicago, Illinois, United States
  • Lakshmi Swamy
    Ophthalmology , Oregon Health & Science University, Portland, Oregon, United States
  • Samir N Patel
    Weill Cornell Medical College, New York, New York, United States
  • Karyn Jonas
    Ophthalmology, Illinois Eye and Ear Infirmary, UIC, Chicago, Illinois, United States
  • Susan Ostmo
    Ophthalmology , Oregon Health & Science University, Portland, Oregon, United States
  • Camila V. Ventura
    Altino Ventura Foundation, Recife, Brazil
  • Maria Ana Martinez-Castellanos
    Hospital Luis Sánchez Bulnes, Mexico City, Mexico
  • Rachelle Go Ang Sam Anzures
    Ospital ng Makati, Makati City, Philippines
  • Michael F Chiang
    Ophthalmology , Oregon Health & Science University, Portland, Oregon, United States
  • Robison Vernon Paul Chan
    Ophthalmology, Illinois Eye and Ear Infirmary, UIC, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Kai Kang, None; Lakshmi Swamy, None; Samir Patel, None; Karyn Jonas, None; Susan Ostmo, None; Camila Ventura, None; Maria Martinez-Castellanos, None; Rachelle Anzures, None; Michael Chiang, MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems, (Pleasanton, CA) (C); Robison Chan, None
  • Footnotes
    Support  Supported by a Departmental Grant from Research to Prevent Blindness, the St. Giles Foundation, NIH EY19474, Bernadotte Foundation for Children's Eyecare, the Novartis Excellence in Ophthalmic Vision Award (XOVA), the iNsight Foundation. MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, CA).
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Kai B Kang, Lakshmi Swamy, Samir N Patel, Karyn Jonas, Susan Ostmo, Camila V. Ventura, Maria Ana Martinez-Castellanos, Rachelle Go Ang Sam Anzures, Michael F Chiang, Robison Vernon Paul Chan; Characterization of Errors in Retinopathy of Prematurity (ROP) Diagnosis by International Ophthalmology Residents. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : In middle-income countries, advancement in neonatal survival for preterm infants has led to a rise in the number of children at risk for ROP. Therefore, there is an increased need for skilled ophthalmologists to care for these children and education for ROP care is becoming a more significant issue. The purpose of this study is to describe common errors in ROP diagnosis made by ophthalmology trainees in middle-income countries.

Methods : Ophthalmology residents from three different countries were each presented 16 web-based cases consisting of wide-field retinal images of ROP. Residents were asked to diagnose plus disease, zone, stage, and category (none, mild, type-2 ROP or pre-plus, treatment-requiring) for each eye. Responses were compared to expert-consensus reference standards. The frequency and types of errors were analyzed with descriptive statistics and t-tests.

Results : A total of 200 residents (22 from country A, 44 from country B, 134 from country C) completed the program. The error rate by all residents was 60% (60%, 66%, and 59% for residents from countries A, B, C) in detecting any categories of ROP and 36% (45%, 57%, 32% for countries A, B, C) for treatment-requiring ROP. Misdiagnoses of treatment-requiring ROP as type 2 ROP were most commonly associated with incorrectly identifying plus disease (overall plus disease error rate of 17% with correct category diagnosis and 67% when misdiagnosed, p<0.01). The error rate was the highest for type 2 disease (78% overall, 74%, 77%, 79% for country A, B, C), with a significant number of residents under-diagnosing type-2 disease (35% vs. 65% overall, p<0.01). PGY1 residents performed significantly worse than more senior residents in identification of category, APROP, plus disease, and stage in all three groups. There were no significant differences in error rates for zone among the residents.

Conclusions : International residents misdiagnosed ROP more than half of the time, with identification of plus disease and zone being the salient factors leading to incorrect diagnosis. Rates and reasons for misdiagnoses for each country were similar. This raises concerns for mismanagement by inexperienced examiners according to established guidelines. General ophthalmologists may provide ROP care; therefore, it is important to provide better access to ROP education and improve competency in ROP diagnosis by ophthalmology residents.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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