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Nasrin N. Tehrani, Amila De Alwis, Derek Stephens; Determining Extent Of Retinal Vascularization In Retinopathy Of Prematurity (ROP): Comparison Of Color Images And Fluorescein Angiograms. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3155.
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We wished to assess the ability of 3 clinicians with expertise in ROP, to determine the extent of retinal vascularization comparing color images (CI) and flourescein angiograms (FFA).
CI and FFA were obtained (1 image per quadrant, 4 images per eye) in 9 eyes of 9 premature infants with type 1 ROP. All CI were randomly mixed, and the process repeated for FFAs. In each set of CI and FFAs, 5 randomly chosen images were presented twice through the data set. Images were displayed on a standard monitor. Three observers were asked to rate their ability to draw the demarcation line between vascularized and non-vascularized retina for each CI and FFA on 2 separate occasions at least 2 weeks apart. Images were assigned a value between 0 to 10 by each observer. The values assigned were collected by an independent observer and analyzed using mixed model analysis. ICC’s were used to measure reliability for both types of images.
When analyzed using a repeated measures mixed model, all 3 observers found they were better able to determine the demarcation line on the FFA than the CI as demonstrated by a higher score (p <0.0001). The higher scores for FFA were consistent across all 4 quadrants. The intra-observer reliability was between 0.97 and 0.99 for FFA compared to 0.78 to 0.91 for CI, indicating a more consistent rating across the observers when using FFA.
Analysis of wide-angle digital images of the retina has become a useful tool in documentation, assessment and appropriate management of ROP. In some areas with shortage of clinicians with expertise in management of ROP, examination for ROP is performed through remote analysis of images obtained from infants at risk of ROP. In our study clinicians were better able to judge the extent of retinal vascularization on FFA compared with CI in patients with type 1 ROP. The addition of FFA may better enable clinicians to grade extent of ROP and therefore allow a more accurate assessment of fundus images.
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