Evaluation of Screening for Retinopathy of Prematurity by ROPtool or a Lay Reader

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• 作者：Ashkan M. Abbey ; MD¹ ; ² ; Cagri G. Besirli ; MD ; PhD³ ; David C. Musch ; PhD ; MPH³ ; ⁴ ; Chris A. Andrews ; PhD³ ; Antonio Capone Jr. ; MD¹ ; ² ; Kimberly A. Drenser ; MD ; PhD¹ ; ² ; David K. Wallace ; MD ; MPH⁵ ; Susan Ostmo ; MS⁶ ; Michael Chiang ; MD⁶ ; ⁷ ; Paul P. Lee ; MD ; JD³ ; Michael T. Trese ; MD¹ ; ² ; ^{mgjt46@aol.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ROC ; receiver operating characteristic ; ROP ; retinopathy of prematurity
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：123
• 期：2
• 页码：385-390
• 全文大小：674 K

文摘

To determine if (1) tortuosity assessment by a computer program (ROPtool, developed at the University of North Carolina, Chapel Hill, and Duke University, and licensed by FocusROP) that traces retinal blood vessels and (2) assessment by a lay reader are comparable with assessment by a panel of 3 retinopathy of prematurity (ROP) experts for remote clinical grading of vascular abnormalities such as plus disease.

Design

Validity and reliability analysis of diagnostic tools.

Participants

Three hundred thirty-five fundus images of prematurely born infants.

Methods

Three hundred thirty-five fundus images of prematurely born infants were obtained by neonatal intensive care unit nurses. A panel of 3 ROP experts graded 84 images showing vascular dilatation, tortuosity, or both and 251 images showing no evidence of vascular abnormalities. These images were sent electronically to an experienced lay reader who independently graded them for vascular abnormalities. The images also were analyzed using the ROPtool, which assigns a numerical value to the level of vascular abnormality and tortuosity present in each of 4 quadrants or sectors. The ROPtool measurements of vascular abnormalities were graded and compared with expert panel grades with a receiver operating characteristic (ROC) curve. Grades between human readers were cross-tabulated. The area under the ROC curve was calculated for the ROPtool, and sensitivity and specificity were computed for the lay reader.

Main Outcome Measures

Measurements of vascular abnormalities by ROPtool and grading of vascular abnormalities by 3 ROP experts and 1 experienced lay reader.

Results

The ROC curve for ROPtool's tortuosity assessment had an area under the ROC curve of 0.917. Using a threshold value of 4.97 for the second most tortuous quadrant, ROPtool's sensitivity was 91% and its specificity was 82%. Lay reader sensitivity and specificity were 99% and 73%, respectively, and had high reliability (κ, 0.87) in repeated measurements.

Conclusions

ROPtool had very good accuracy for detection of vascular abnormalities suggestive of plus disease when compared with expert physician graders. The lay reader's results showed excellent sensitivity and good specificity when compared with those of the expert graders. These options for remote reading of images to detect vascular abnormalities deserve consideration in the quest to use telemedicine with remote reading for efficient delivery of high-quality care and to detect infants requiring bedside examination.