Accuracy of fluorescein angiography (FA) based diagnosis for retinopathy of prematurity: Expert versus non expert graders evaluation

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Abstract

Purpose

To evaluate accuracy and inter-rater reliability of RetCam fundus images and digital camera fluorescein angiography (FA) images in acute retinopathy of prematurity (ROP) by comparing diagnoses given by trainee ophthalmologists with those provided by expert ophthalmologists.

Methods

We conducted a multicentre retrospective observational study of diagnostic data from 60 eyes of 30 premature infants (average gestational age was 27 weeks, average birth weight 803 g) with classical ROP, stage II evaluated by RetCam 3 (Clarity, Pleasanton, CA) and fluorescein angiography. A staging grid with ocular fundus divided into 3 concentric zones and into 24 of 15° sectors centred around optic papilla was superimposed on 360° retina photomontages (Photoshop) acquired from RetCam and FA images. Non-expert agreement with expert diagnoses was measured for each sector by means of Cohen’s kappa (Fleiss, 1981).

Results

A high degree of concordance was found.Inter-rater agreement expert versus non-expert interpretations was really greater for fluorangiographic images than for RetCam ones with 0.61< k <1 for 58,5% of RetCam examined sectors and for 89,9% of FA examined sectors.

Conclusion

FA images appear to be really clearer to interpret than RetCam images also by non-expert ophthalmologists. Our result confirme than FA is very good examination technique with a high degree of reliability, even where trainee pratitioners are involved. ROP management can be improved by entrusting diagnostic responsibilities to trainee ophthalmologists, in order to extend access to correct diagnoses, recognition of threshold lesions and prompt treatment.

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