May 2007
Volume 48, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2007
Inter-Expert Agreement of Plus Disease Diagnosis in Retinopathy of Prematurity
Author Affiliations & Notes
  • M. F. Chiang
    Columbia University, New York, New York
    Ophthalmology,
    Biomedical Informatics,
  • L. Jiang
    Columbia University, New York, New York
    Ophthalmology,
  • R. Gelman
    Columbia University, New York, New York
    Ophthalmology,
  • Y. E. Du
    Epidemiology and Public Health, Albert Einstein College of Medicine, New York, New York
  • J. T. Flynn
    Columbia University, New York, New York
    Ophthalmology,
  • Footnotes
    Commercial Relationships M.F. Chiang, None; L. Jiang, None; R. Gelman, None; Y.E. Du, None; J.T. Flynn, None.
  • Footnotes
    Support Research to Prevent Blindness Career Development Award (MFC), NIH Grant EY13972 (MFC).
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 3096. doi:
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      M. F. Chiang, L. Jiang, R. Gelman, Y. E. Du, J. T. Flynn; Inter-Expert Agreement of Plus Disease Diagnosis in Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3096.

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

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Abstract

Purpose:: To measure agreement of plus disease diagnosis among retinopathy of prematurity (ROP) experts.

Methods:: A set of 34 wide-angle retinal photographs from infants with ROP was compiled on a secure website, and interpreted independently by 22 recognized ROP experts. Diagnostic agreement was analyzed using 3-level ("plus," "pre-plus," "neither") and 2-level ("plus," "not plus") categorizations.

Results:: In the 3-level categorization, all experts agreed on the same diagnosis in 4 (11.8%) of the 34 images, and the mean weighted kappa for each expert compared to all others was between 0.21-0.40 (fair agreement) in 7 (31.8%) experts, and 0.41-0.60 (moderate agreement) in 15 (68.2%) experts. In the 2-level categorization, all experts who provided a diagnosis agreed in 7 (20.6%) of the 34 images, and the mean kappa for each expert compared to all others was between 0-0.20 (slight agreement) in 1 (4.5%) expert, 0.21-0.40 (fair agreement) in 3 (13.6%) experts, 0.41-0.60 (moderate agreement) in 12 (54.5%) experts, and 0.61-0.80 (substantial agreement) in 6 (27.3%) experts.

Conclusions:: Inter-expert agreement of plus disease diagnosis is imperfect. This may have important implications for clinical ROP management, continued refinement of the international ROP classification system, development of computer-based diagnostic algorithms, and implementation of ROP telemedicine systems.

Keywords: retinopathy of prematurity • imaging/image analysis: clinical • clinical (human) or epidemiologic studies: health care delivery/economics/manpower 
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