| Author(s) | Michael F. Chiang, MD, MA, Jeremy D. Keenan, MD, Yunling E. Du, PhD,
William Schiff, MD, Gaetano Barile, MD, Joan Li, MD, Ditte J. Hess, CRA,
Rose Anne Johnson, RN, John T. Flynn, MD and Justin Starren, MD, PhD |
| Abstract | Telemedicine has potential to improve the delivery,
quality, and accessibility of ophthalmic care for
infants with Retinopathy of Prematurity (ROP).
Using a telemedicine screening strategy, three
potential diagnostic cutoffs may be used to define
disease that warrants ophthalmologic referral:
presence of any ROP, presence of moderate (“type-2
prethreshold”) ROP, or presence of severe ROP
requiring treatment. This study examines the
relationship between accuracy and reliability of
diagnosis by three masked ophthalmologist graders at
each of these diagnostic cutoffs. The sensitivity,
specificity, inter-grader reliability, and intra-grader
reliability showed significant variation depending on
the diagnostic cutoff, with best results at cutoffs of
type-2 prethreshold ROP or treatment-requiring ROP.
Before the large-scale adoption of telemedicine for
image-based screening of diseases such as ROP,
standards defining clinically-relevant referral cutoffs
must be established, and diagnostic accuracy and
reliability at these cutoffs must be characterized. |