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. 2015 Feb;253(2):181-7.
doi: 10.1007/s00417-014-2857-2. Epub 2014 Nov 21.

Aggressive posterior retinopathy of prematurity: a pilot study of quantitative analysis of vascular features

Rany Woo  1 , R V Paul Chan, Anand Vinekar, Michael F Chiang
Affiliations

Aggressive posterior retinopathy of prematurity: a pilot study of quantitative analysis of vascular features

Rany Woo et al. Graefes Arch Clin Exp Ophthalmol. 2015 Feb.

Abstract

Purpose: To evaluate aggressive posterior retinopathy of prematurity (AP-ROP) with regard to inter-expert diagnostic agreement and quantitative vascular features.

Methods: Eight ROP experts interpreted 15 retinal images for AP-ROP and plus disease. Inter-expert agreement was calculated by absolute agreement for AP-ROP and plus, and kappa statistic for each expert was compared with others. Retinal vessels were analyzed by a computer-based system to calculate diameter and integrated curvature (IC). Consensus reference standards for images were developed, and quantitative parameters for arterioles and venules were compared among images with AP-ROP vs. not AP-ROP, plus vs. not plus, and AP-ROP vs. plus.

Results: Mean kappa for each expert in AP-ROP diagnosis ranged from -0.15 (no agreement) to 0.42 (moderate agreement). Nine (30 %) of 30 total AP-ROP diagnoses were also classified as not plus disease. Analysis of images with AP-ROP vs. plus showed that images with AP-ROP had higher venular IC (p = 0.04). Arteriolar IC was statistically significant between images with AP-ROP vs. not AP-ROP (p = 0.01) and plus vs. not plus (p = 0.00003). There were no statistically significant differences in diameter between image groups.

Conclusions: Inter-expert agreement with regard to AP-ROP diagnosis is imperfect. Venular curvature may be a distinguishing characteristic between AP-ROP and plus. Future studies involving quantitative features of AP-ROP will have benefits for clinical diagnosis and management.

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Conflict of interest statement

Conflicts of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, CA, USA).

Figures

Fig. 1
Fig. 1
Representative study images shown to eight expert participants. (a) was classified as AP-ROP by five (63 %) experts and plus by eight (100 %) experts. (b) was classified as AP-ROP by five (63 %) experts and not plus by six (75 %) experts. (c) was classified as not AP-ROP by eight (100 %) experts and not plus by eight (100 %) experts. (d) was classified as not AP-ROP by six (75 %) experts and plus by seven (88 %) experts
Fig. 2
Fig. 2
Agreement in AP-ROP and plus diagnosis, based on ranges of the mean kappa statistic for each of eight experts compared with all others. (a) The mean kappa statistic in AP-ROP categorization (AP-ROP, not AP-ROP). (b) The mean kappa statistic in plus categorization (plus, not plus). Boxes represent the range of kappa values, from minimum to maximum values
Fig. 3
Fig. 3
Quantitative arteriolar and venular integrated curvature (IC) values calculated by computer-based analysis in 15 wide-angle retinal images evaluated for presence of aggressive posterior retinopathy of prematurity (AP-ROP) and plus disease. Comparison between images with AP-ROP vs. plus, AP-ROP vs. not AP-ROP, and plus vs. not plus is displayed for (a) arteriolar IC, and (b) venular IC. Reference standard diagnoses were based on majority consensus of eight study experts
See this image and copyright information in PMC

Comment in

  • Experts contradict established classification.
    Shapiro MJ, Blair MP, Garcia-Gonzalez JM. Shapiro MJ, et al. Graefes Arch Clin Exp Ophthalmol. 2016 Jan;254(1):199. doi: 10.1007/s00417-015-3106-z. Epub 2015 Jul 21. Graefes Arch Clin Exp Ophthalmol. 2016. PMID: 26194405 No abstract available.
  • Science and art in retinopathy of prematurity diagnosis.
    Chiang MF, Chan RV, Vinekar A, Woo R. Chiang MF, et al. Graefes Arch Clin Exp Ophthalmol. 2016 Jan;254(1):201-2. doi: 10.1007/s00417-015-3107-y. Epub 2015 Jul 22. Graefes Arch Clin Exp Ophthalmol. 2016. PMID: 26198712 Free PMC article. No abstract available.

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