June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Diagnostic Accuracy of Ophthalmoscopy vs. Telemedicine in Retinopathy of Prematurity Examination
Author Affiliations & Notes
  • Travis Redd
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • hilal biten
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • Chace Moleta
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • J. Peter Campbell
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • Susan Ostmo
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • Karyn Elizabeth Jonas
    Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, United States
  • Robison Vernon Paul Chan
    Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, United States
  • Michael F Chiang
    Ophthalmology, Oregon Healthy & Science University, Milwaukie, Oregon, United States
  • Footnotes
    Commercial Relationships   Travis Redd, None; hilal biten, None; Chace Moleta, None; J. Peter Campbell, None; Susan Ostmo, None; Karyn Jonas, None; Robison Chan, Visunex Medical Systems (Fremont, CA) (C); Michael Chiang, Clarity Medical Systems (Pleasanton, CA) (S), Novartis (Basel, Switzerland) (C)
  • Footnotes
    Support  Supported by grant P30EY10572 from the National Institutes of Health (Bethesda, MD), and by unrestricted departmental funding from Research to Prevent Blindness (New York, NY). Supported by grants R01EY19474 and R21EY22387 from the National Institutes of Health (Bethesda, MD), and by grant 1622679 from the National Science Foundation (Arlington, VA).
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4739. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Travis Redd, hilal biten, Chace Moleta, J. Peter Campbell, Susan Ostmo, Karyn Elizabeth Jonas, Robison Vernon Paul Chan, Michael F Chiang; Diagnostic Accuracy of Ophthalmoscopy vs. Telemedicine in Retinopathy of Prematurity Examination. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4739.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose : Retinopathy of prematurity (ROP) examinations have traditionally been performed using binocular indirect ophthalmoscopy (BIO). Telemedicine using digital fundus imaging (DFI) is an emerging strategy that may improve the delivery of ophthalmic care. Traditional telemedicine studies have assessed accuracy of telemedicine compared to BIO as a gold standard. However, there is little published literature that directly compares the accuracy of DFI vs. BIO using a consensus reference standard.

Methods : We developed a web-based platform to allow storage and interpretation of wide-angle fundus photos of infants undergoing ROP examinations. As part of a prospective cohort study, infants who met screening criteria at 7 participating centers were examined directly via BIO by experienced clinicians and indirectly via DFI grading by 3 trained graders independently. These examination findings were combined into a consensus reference standard diagnosis for each imaging session for zone, stage, plus and category. We calculated the agreement of both DFI and BIO with the gold standard using percent agreement and weighted kappa statistics.

Results : A total of 1553 eye examinations were classified using both DFI and BIO. On average, BIO was slightly more accurate than DFI in identifying zone (91 vs 89%, p<0.01), stage (88 vs 75%, p<0.01), and overall disease category (84 vs 77%, p<0.01), whereas DFI was slightly more accurate than BIO in diagnosing plus disease (92 vs 88%, p<0.01). There was significant inter-grader variability in both groups (Table 1). BIO was more sensitive in identifying stage 3 disease (85 vs 73%, p<0.01; n=136), but not zone I (78 vs 78%; n=165), plus disease (74 vs 79%, p=0.41; n=50), or any referral-warranted ROP (RWROP, defined as Stage 3, Zone I, or Plus disease; 84 vs 79%, p=0.10; n=251).

Conclusions : This study compared the accuracy and sensitivity of DFI to BIO in ROP examination. Key findings were: 1) Accuracy of ROP diagnosis varies between graders, both using DFI and BIO; 2) There was no significant difference in the sensitivity of BIO and DFI to detect RWROP; 3) BIO was slightly more accurate in identifying zone, stage, and category of ROP, while DFI was slightly more accurate in identifying plus disease. These results show that neither DFI nor BIO is completely accurate, and that inter-grader diagnostic variability is high using current criteria regardless of exam method.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×