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    Computer-based image analysis promising for ROP

    Computers may make more reliable diagnoses of plus disease in retinopathy of prematurity than individual clinicians, a researcher reports.

    “We’re excited about it,” said J. Peter Campbell, MD, MPH, assistant professor, Casey Eye Institute, Oregon Health & Science University, Portland.

    While experts in retinopathy of prematurity agree on which cases are the most severe when shown images of babies with disease, they often disagree on which cases should be classified as plus disease.

    Although most cases of retinopathy of prematurity resolve on their own, the condition can cause blindness. The Early Treatment for Retinopathy of Prematurity multicenter clinical trial established plus disease as a key criterion for determining which infants need treatment.

    “The determination of plus disease is very important, but it’s very subjective,” said Dr. Campbell.

    ICROP protocol

    In the 1980s, the International Classification for Retinopathy of Prematurity (ICROP) established that venous dilation in the posterior pole was greater than that in a particular photograph published at the time as the standard for diagnosing plus disease.

    Since then, ICROP has established a pre-plus category, defined as retinal vascular abnormalities that are insufficient for plus disease, but have more arterial tortuosity and venous dilation than normal.

    To see how a computer algorithm compared to individuals and groups of clinicians, Dr. Campbell and his colleagues analyzed data on 1,553 patients.

    To establish a reference standard diagnosis for each patient, they combined three independent gradings of the images by three masked examiners with the clinical diagnosis made at bedside using indirect ophthalmoscopy.

    If the majority of the three examiners independently agreed with the clinical diagnosis, this consensus became the references standard diagnosis. If there was disagreement, the three examiners discussed the image until they reached a consensus for the reference standard diagnosis.

    No difference in diagnosis

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