Telemedical retinopathy of prematurity diagnosis: Accuracy, reliability, and image quality

Michael F. Chiang*, Lu Wang, Mihai Busuioc, Yunling E. Du, Patrick Chan, Steven A. Kane, Thomas C. Lee, David J. Weissgold, Audina M. Berrocal, Osode Coki, John T. Flynn, Justin Starren

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

153 Scopus citations


Objective: To prospectively measure accuracy, reliability, and image quality of telemedical retinopathy of prematurity (ROP) diagnosis. Methods: Two-hundred forty-eight eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks' and/or 35 to 37 weeks' postmenstrual age (PMA) using a standard protocol. Data were uploaded to a Web-based telemedicine system and interpreted by 3 expert retinal specialist graders who provided a diagnosis (no ROP, mild ROP, type 2 prethreshold ROP, treatment-requiring ROP) and an evaluation of image quality for each eye. Findings were compared with a reference standard of indirect ophthalmoscopy by an experienced pediatric ophthalmologist. Results: At 35 to 37 weeks' PMA, sensitivity and specificity for diagnosis of mild or worse ROP were 0.908 and 1.000 for grader A, 0.971 and 1.000 for grader B, and 0.908 and 0.977 for grader C. Sensitivity and specificity for diagnosis of type 2 prethreshold or worse ROP were 1.000 and 0.943 for grader A, 1.000 and 0.930 for grader B, and 1.000 and 0.851 for grader C. At 35 to 37 weeks' PMA, weighted κ for intergrader reliability was 0.791 to 0.889, and κ for intragrader reliability for detection of type 2 prethreshold or worse ROP was 0.769 to 1.000. Image technical quality was rated as "adequate" or "possibly adequate" for diagnosis in 93.3% to 100% of eyes. Conclusion: A telemedicine system using nurse-captured retinal images has the potential to improve existing shortcomings of ROP management, particularly at later PMAs.

Original languageEnglish (US)
Pages (from-to)1531-1538
Number of pages8
JournalArchives of ophthalmology
Issue number11
StatePublished - Nov 2007

ASJC Scopus subject areas

  • Ophthalmology


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