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Kai B Kang, Lakshmi Swamy, Samir N Patel, Karyn Jonas, Susan Ostmo, Camila V. Ventura, Maria Ana Martinez-Castellanos, Rachelle Go Ang Sam Anzures, Michael F Chiang, Robison Vernon Paul Chan; Characterization of Errors in Retinopathy of Prematurity (ROP) Diagnosis by International Ophthalmology Residents. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
In middle-income countries, advancement in neonatal survival for preterm infants has led to a rise in the number of children at risk for ROP. Therefore, there is an increased need for skilled ophthalmologists to care for these children and education for ROP care is becoming a more significant issue. The purpose of this study is to describe common errors in ROP diagnosis made by ophthalmology trainees in middle-income countries.
Ophthalmology residents from three different countries were each presented 16 web-based cases consisting of wide-field retinal images of ROP. Residents were asked to diagnose plus disease, zone, stage, and category (none, mild, type-2 ROP or pre-plus, treatment-requiring) for each eye. Responses were compared to expert-consensus reference standards. The frequency and types of errors were analyzed with descriptive statistics and t-tests.
A total of 200 residents (22 from country A, 44 from country B, 134 from country C) completed the program. The error rate by all residents was 60% (60%, 66%, and 59% for residents from countries A, B, C) in detecting any categories of ROP and 36% (45%, 57%, 32% for countries A, B, C) for treatment-requiring ROP. Misdiagnoses of treatment-requiring ROP as type 2 ROP were most commonly associated with incorrectly identifying plus disease (overall plus disease error rate of 17% with correct category diagnosis and 67% when misdiagnosed, p<0.01). The error rate was the highest for type 2 disease (78% overall, 74%, 77%, 79% for country A, B, C), with a significant number of residents under-diagnosing type-2 disease (35% vs. 65% overall, p<0.01). PGY1 residents performed significantly worse than more senior residents in identification of category, APROP, plus disease, and stage in all three groups. There were no significant differences in error rates for zone among the residents.
International residents misdiagnosed ROP more than half of the time, with identification of plus disease and zone being the salient factors leading to incorrect diagnosis. Rates and reasons for misdiagnoses for each country were similar. This raises concerns for mismanagement by inexperienced examiners according to established guidelines. General ophthalmologists may provide ROP care; therefore, it is important to provide better access to ROP education and improve competency in ROP diagnosis by ophthalmology residents.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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