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David Nasrazadani, David K Wallace, Sharon F. Freedman, Sasapin Grace Prakalapakorn; Development of a scale for grading pre-plus and plus disease using retinal images: a pilot study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5547.
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© ARVO (1962-2015); The Authors (2016-present)
The diagnosis of plus and pre-plus disease is important in the classification of retinopathy of prematurity (ROP). Even among experts in the field, the diagnosis is subjective. The aims of this study are to 1) create a pictoral scale to standardize the grading of pre-plus and plus disease in retinal images based on expert perception of vessel tortuosity and dilation seen in the images and 2) evaluate how well the ordering of these images correlates with the ROPtool measures of vessel tortuosity and dilation of these images.
We created a pictoral scale for grading pre-plus and plus disease using narrow-field retinal images of prematurely-born infants screened for ROP. Using a consensus of three fellowship-trained pediatric ophthalmologists, we ordered these images based on degree of vessel tortuosity and dilation. We then used ROPtool to analyze these images for the vessel characteristics of tortuosity and dilation and compared our pictoral scale to the ROPtool indices of overall tortuosity and dilation measured in these images.
Compared to the perceived level of tortuosity seen in the retinal images, the ROPtool measure of tortuosity index increased within each level of vessel dilation, with overall values ranging from 1.5 to 13.3. The ROPtool measure of dilation index increased from the lowest to the highest level of perceived level of dilation seen in the retinal images, with overall values ranging from 8.4-11.4. However, the dilation index did not consistently increase within each level of perceived vessel tortuosity.
Our pictoral grading scale of vessel tortuosity and dilation correlated well with the ROPtool measure of tortuosity at each dilation level, but did not correlate well with the ROPtool measure of dilation at each level of tortuosity. Our pictoral scale of increasing vessel tortuosity and dilation may decrease the subjectivity of grading pre-plus and plus disease in retinal images, thereby leading to more accurate recognition and diagnosis of plus disease to help guide management of ROP.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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