Accuracy and reliability of remote retinopathy of prematurity diagnosis

Michael F. Chiang*, Jeremy D. Keenan, Justin Starren, Yunling E. Du, William M. Schiff, Gaetano R. Barile, Joan Li, Rose Anne Johnson, Ditte J. Hess, John T. Flynn

*Corresponding author for this work

Research output: Contribution to journalReview article

95 Scopus citations


Objective: To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using remote review of digital images by 3 masked ophthalmologist readers. Methods: An atlas was compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were independently reviewed by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist. Results: Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader, 0.816/0.955 for the second reader, and 0.864/0.493 for the third reader. Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader, 0.850/0.973 for the second reader, and 0.900/0.953 for the third reader. When ROP was classified into ordinal categories, the overall weighted κ for interreader reliability was 0.743. Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers. Conclusion: The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.

Original languageEnglish (US)
Pages (from-to)322-327
Number of pages6
JournalArchives of Ophthalmology
Issue number3
StatePublished - Mar 1 2006

ASJC Scopus subject areas

  • Ophthalmology

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    Chiang, M. F., Keenan, J. D., Starren, J., Du, Y. E., Schiff, W. M., Barile, G. R., Li, J., Johnson, R. A., Hess, D. J., & Flynn, J. T. (2006). Accuracy and reliability of remote retinopathy of prematurity diagnosis. Archives of Ophthalmology, 124(3), 322-327.