Influence of serial retinal images on the diagnosis and management of retinopathy of prematurity (ROP)

Abstract

Purpose : Wide-angle digital retinal imaging is currently being utilized for retinopathy of prematurity (ROP) telemedicine programs. Digital imaging has allowed serial comparison of vascular change over time, which anecdotally many clinicians describe as being informative. This study examines the influence of serial retinal images on ROP diagnosis and management.

Methods : Seven ROP examiners interpreted 30 sets (15 images of single image and 15 images of serial images) from 15 eyes with ROP. Images were independently reviewed on a secure website and a three-level plus disease diagnosis and management plan (follow-up interval or treatment) for each index case were recorded, first based on a single retinal photograph, and then based on a series of three images over time with the index image as the third image. Changes in diagnosis and management in ROP using single and serial images were determined. Intra and inter-grader reliability was calculated using the kappa statistics.

Results : When viewing the serial retinal images, graders changed their diagnosis in 24 (22.9%) and management in 32 (30.5%) of total 105 image pairs. Of the 24 changes in determining plus disease after viewing serial images, 18 responses (75.0%) were changes toward more severe and 6 responses (25.0%) were toward less severe disease. Intra-grader agreement between single and serial image assessment was variable (Cohen’s kappa ranged from 0.17 to 1.0). Inter-grader agreement was moderate for single image analysis (Fleiss’ kappa=0.48, 95% CI 0.40-0.57) and fair for serial image analysis (Fleiss' kappa=0.31, 95% CI 0.23-0.39)

Conclusions : Analyzing a progression of serial retinal images enables direct comparison of vascular changes over time in ROP. The findings in this study suggest a potential effect of using serial images to diagnose plus disease, as opposed to using a single image at a single point in time. The implication of this change requires further study. More objective and quantitative techniques may assist in providing a more consistent and precise identification of retinal vascular progression.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.