Interobserver Reliability of Digital Retinal Photography in Telemedicine Screening for Referral Warranted Rop

Abstract

Abstract: : Purpose: Digital retinal photography has been suggested as a tool for ROP screening with potential application to telemedicine. We studied the interobserver reliability of digital photography for detection of "referral warranted ROP" during the longitudinal course of a cohort of premature infants Methods: 64 eyes of 32 infants were screened longitudinally, at standard intervals, using indirect ophthalmoscopy (gold standard) and digital photography using a Retcam 120 equipped with an infant ROP lens. Photographs were graded remotely in a masked manner by three independent observers. "Referral warranted ROP" was defined as either ICROP zone 1, "plus" or any stage 3. Results: Complete longitudinal data were available for 61 of 64 eyes for analysis. "Referral warranted ROP" was found in 18 eyes by the gold standard indirect ophthalmoscopic examination over their clinical course. Sensitivity and specificity of remote assessment of digital photographs for detecting "referral warranted ROP" was 100% and 95% for observer 1, 94% and 77% for observer 2 and 94% and 84% for observer 3. Conclusions: Digital retinal photography for longitudinal ROP screening, using the RetCam 120 equipped with an infant ROP lens, is feasible in the smallest and sickest premature infants. Remote interpretation of digital photographs for detection of "referral warranted ROP" shows good agreement between independent readers and high sensitivity and specificity. Digital photography shows great promise for widespread application to telemedicine screening for referral warranted ROP.

Keywords: retinopathy of prematurity • clinical (human) or epidemiologic studies: sys • clinical (human) or epidemiologic studies: hea