July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Characteristics of Plus Disease and Accuracy of Remote Image Grading for Plus Disease in Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating of Acute-Phase ROP (e-ROP) Study
Author Affiliations & Notes
  • Gui-Shuang Ying
    Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Graham E Quinn
    Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Wei Pan
    Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Ebenezer Daniel
    Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Agnieshka Baumritter
    Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Gui-Shuang Ying, Chengdu Kanghong Biotech co. Ltd (C), Ziemer Ophthalmic Systems AG (C); Graham Quinn, None; Wei Pan, None; Ebenezer Daniel, None; Agnieshka Baumritter, None
  • Footnotes
    Support  National Eye Institute of the National Institutes of Health, Department of Health and Human Services U10 EY017014 and R21EY025686.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2757. doi:
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      Gui-Shuang Ying, Graham E Quinn, Wei Pan, Ebenezer Daniel, Agnieshka Baumritter; Characteristics of Plus Disease and Accuracy of Remote Image Grading for Plus Disease in Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating of Acute-Phase ROP (e-ROP) Study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2757.

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

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Abstract

Purpose : Plus disease, defined as abnormal posterior pole retinal vessel dilation and tortuosity, is a major indicator for treatment of ROP. However, there is high subjectivity and variability in diagnosis of plus disease. This study is to describe the characteristics of plus disease and evaluate the accuracy of image grading for detecting plus disease in the e-ROP Study.

Methods : Secondary analyses of e-ROP data from 13 North American Centers. Infants underwent series diagnostic exams by an ophthalmologist and digital imaging by non-physician imager using a wide-field digital camera to capture images of the posterior pole and 4 peripheral quadrants. Two masked non-physician trained readers independently graded images for posterior pole vessel appearance (normal, preplus, plus) in each quadrant and the most dominant feature (dilation, tortuosity, equal). A reading supervisor adjudicated discrepancies. Using ophthalmologist exam as reference standard, the sensitivity and specificity from image grading for detecting plus disease were calculated.

Results : Among 1239 infants (mean birth weight 864g, mean gestational age 27 weeks), 129 (10%) had plus disease, and 97 (75%) of them were bilateral. When plus disease was first diagnosed in exam at median PMA of 36 weeks (range: 32-43) in 226 eyes, 96% of plus occurred in superior temporal quadrant, 94% in inferior temporal quadrant, 63% in superior nasal quadrant, 60% in inferior nasal quadrant, 42% eyes had plus in 2 quadrants, 4% in 3 quadrants, and 54% in 4 quadrants. The dominant feature of plus disease was dilation in 16% eyes, tortuosity in 11% eyes and equal in 73% eyes. Using plus disease from image grading as cutpoint, the sensitivity of image grading for plus disease was 0.38 to 0.45 with specificity 0.95 to 0.98, and the sensitivity was higher (0.50) in eyes with tortuosity as the dominant feature, or in eyes with plus present in 4 quadrants (0.48) (Table 2). Using preplus as cutpoint, the sensitivity improved 0.94 to 0.99 with specificity 0.54 to 0.73 (Table 1).

Conclusions : Among e-ROP infants, plus disease developed in 10% of infants at median PMA 36 weeks, with majority of plus being bilateral, and mostly in temporal quadrants. Non-physician image grading can detect almost all plus disease eyes with good specificity using preplus as the cutpoint.

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

 

 

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