Purpose: To evaluate accuracy and inter-rater reliability of RetCam fundus images and digital camera fluorangioscopic images in acute retinopathy of prematurity (ROP) by comparing diagnoses given by trainee ophthalmologists with those provided by expert ophthalmologists.
Methods: This is a multicenter retrospective observational study of diagnostic data from 48 eyes of 24 premature infants with classical ROP, stage II, as evaluated by RetCam 3 and fluorescein angiography (FA). Average gestational age was 25.4 weeks, average weight 804.7 g. A staging grid (with ocular fundus divided into 3 concentric zones) and 24 15° sectors centered around the optic papilla were superimposed on 360° retina photomontages (Photoshop) made from RetCam and FA images. Non expert vs expert diagnosis agreement was measured for each sector by means of Cohen kappa (Fleiss, 1981).
Results: A high degree of concordance was found. Inter-rater agreement between expert and non expert interpretations of retinal photomontages was greater for fluorangiographic images than for RetCam images, with κ = 0.61-1 for 120/152 (78.9%) sectors examined on the RetCam images and
κ = 0.61-1 for 168/198 (84.8%) sectors examined on the FA images.
Conclusions: The FA images appear to be easier to interpret than RetCam images, both by expert and non expert ophthalmologists. The results confirm that FA is a good examination technique with a high degree of reliability, even where trainee practitioners are involved. This suggests that retinopathy management can be improved by entrusting diagnostic responsibilities to trainee ophthalmologists, in order to extend access to correct diagnosis, recognition of threshold lesions, and prompt treatment.
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Article Synopsis
- Retinopathy of prematurity (ROP) is a sight-threatening condition affecting mainly premature infants, still a major cause of childhood blindness globally despite advances in care.
- This research presents a comprehensive dataset of 6,004 retinal images from 188 newborns, with details from ROP screenings in the Czech Republic, utilizing three different imaging camera systems.
- The study introduces an automated software tool, ReLeSeT, for segmenting retinal lesions and enhancing features in retinal images, along with pre-processing tools to improve classification and segmentation models for ROP analysis.
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