Utility of Fluorescein Angiography for the Diagnosis and Management of Retinopathy of Prematurity (ROP)

Abstract

Purpose: To determine the influence of fluorescein angiography (FA) on the diagnosis and management of ROP

Methods: 32 sets (16 color fundus photographs; 16 color fundus photographs paired with the corresponding FA) of wide-angle retinal images from infants with ROP were compiled on a secure web site. Each image set was interpreted independently by 9 ROP experts (3 pediatric ophthalmologists; 6 vitreoretinal surgeons), who provided a diagnosis and management plan each case, first based on color fundus photographs alone, and then by color fundus photographs and corresponding FA. Sensitivity and specificity of the ROP diagnosis was calculated using a consensus reference standard diagnosis, determined from the diagnosis of the color fundus images by three experienced readers in combination with the clinical diagnosis based on ophthalmoscopic examination. The kappa statistic was used to analyze the average inter-grader agreement among experts for the diagnosis of zone, stage, plus disease, and category. A computer generated diagnosis of zone was also derived based on measurement of the expert’s identification of the macular center combined with the location of the optic disc center and peripheral ROP.

Results: Computer generated diagnosis of zone agreed with the expert’s diagnosis of zone in 28 of 45 (62%) cases using color fundus photographs and in 31 of 45 (69%) cases using FA. With the supplementation of fluorescein angiograms to color fundus photographs, there were statistically significant improvements in the sensitivity for diagnosing stage 2 or worse (p = 0.016), stage 3 or worse (p = 0.008), pre-plus or worse (p = 0.031), and type-2 ROP or worse (p = 0.013) as compared to the consensus reference standard diagnosis. No significant changes in specificity were seen with the addition of fluorescein angiograms to color fundus photographs.For identification of treatment-requiring ROP, there was a statistically significant difference in inter-grader agreement when viewing the color fundus photographs alone versus the color fundus photographs + FA.

Conclusions: FA continues to have an evlolving role in the diagnosis and management of ROP. Among experts, there is variability in diagnosis and management of ROP based on FA. Using FA may influence diagnosis of type-2 ROP, but did not affect agreement among ROP experts in the diagnosis of stage, zone, or plus disease in this study.