Evolution of plus disease in retinopathy of prematurity: quantification by ROPtool

Abstract

Purpose: The primary indication for laser treatment in retinopathy of prematurity (ROP) is plus disease, or abnormal dilation and tortuosity of arterioles and venules. ROPtool is a computer program that traces retinal blood vessels and measures their width and tortuosity. Our purpose was to gain insight into the evolution of plus disease by applying ROPtool to RetCam images from eyes of infants who had serial photographs taken during their ROP screening period.

Methods: Serial images were collected from eyes of 62 infants screened for ROP as part of another study. Fifty-nine images of one eye of 7 infants who developed plus disease were selected and analyzed by ROPtool. The average tortuosity of the most tortuous blood vessel and the average width of the most dilated vessel in each quadrant were calculated for each image.

Results: Tortuosity increased from an average of 7.72 units at the first examination to 24.44 units at the examination with maximum tortuosity, or an increase of 217% over a mean time period of 6.2 weeks. Two eyes had an increase in tortuosity of more than 500% from the first examination. Vessel width increased from an average of 8.60 units at the first examination to 11.03 units at the examination with maximum blood vessel width, or an increase of 28% over a mean time period of 5.1 weeks.

Conclusions: ROPtool can measure changes in retinal vascular dilation and tortuosity in individual eyes over time. As plus disease develops, changes in tortuosity are sometimes very large, whereas changes in vessel width tend to be more subtle. Quantification of plus disease over time may help to improve our understanding of its mechanism and to monitor disease progression or response to treatment.

FIGURE 1.

Left eye of infant 1 at baseline examination (top left), 2 weeks later (top middle), and 5 weeks later (top right, just before laser treatment), with corresponding images after tracing of major vessels by ROPtool (bottom row, left, middle, and right). Tortuosity index (TI) and dilation index (DI) are shown for each quadrant, both based on the most abnormal vessel in the quadrant. (Images courtesy of the Antonio Capone, MD, and the Photo-ROP Study Group.)

FIGURE 2.

Left eye of infant 1 just before (top left) and approximately 1 week after (top right) laser treatment, with corresponding images after tracing of major vessels by ROPtool (bottom, left and right). Tortuosity index (TI) and dilation index (DI) are shown for each quadrant. (Images courtesy of the Antonio Capone, MD, and the Photo-ROP Study Group.)