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J. S. Myung, D. B. Granet, S. L. Williams, M. J. Espiritu, T. C. Lee, R. V. P. Chan, M. F. Chiang; Accuracy of Retinopathy of Prematurity Diagnosis by Pediatric Ophthalmology Fellows. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5924.
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© ARVO (1962-2015); The Authors (2016-present)
To measure accuracy of retinopathy of prematurity (ROP) diagnosis by pediatric ophthalmology fellows.
An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II; Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study website, from which an expert pediatric retinal specialist and four pediatric ophthalmology fellows independently provided a diagnosis (no ROP, mild ROP, type-2 ROP, or treatment-requiring ROP) for each eye. Sensitivity and specificity of each fellow were calculated compared to a reference standard of diagnosis by the expert pediatric retinal specialist.
For detection of mild ROP or worse, mean (range) sensitivity was 0.926 (0.838-0.962) and specificity was 0.874 (0.832-0.902). For detection of type-2 or worse ROP by fellows, mean (range) sensitivity was 0.637 (0.465-0.907) and specificity was 0.905 (0.732-0.985). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.750 (0.267-1.00) and specificity was 0.911 (0.764-1.00).
Pediatric ophthalmology fellows in this study generally demonstrated high diagnostic specificity in image-based ROP diagnosis. However, diagnostic sensitivity was lower, particularly for clinically-significant levels of disease. This raises concern for under-diagnosis of disease and suboptimal management of a potentially blinding disease. This has implications about the quality of ROP screening by fellows and other less experienced ophthalmologists, particularly when performed without supervision, and suggests a need for formalized training in ROP assessment.
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