Inter- and intra-observer reliability among Retinopathy of Prematurity (ROP) screeners

Objective@#(1) To determine the inter and intra-observer reliability in diagnosing ROP in terms of the stage, zone, and presence of plus disease among local ROP screeners involved in the ROP Working Group; and (2) to determine the inter-observer reliability between 2 groups of subspecialties – retina specialists and pediatric ophthalmologists.@*Methods@#This is a prospective observational study that analyzed the inter- and intra-observer reliability in describing ROP in 3 key observations: stage, zone, and presence of plus disease. This study utilized a test with 32 sets of fundus images from 27 cases, five of which were repeated. Images from previously photographed infants with and without ROP were collated into a downloadable powerpoint test and tested against retina specialists and pediatric ophthalmologists of the ROP Working Group. Outcome measures included presence of variability in ROP diagnosis in terms of the stage, zone, and presence of plus disease among screeners, and reliability coefficient (intra-class coefficient or ICC) in 2 levels: (1) individual and 2-group inter-observer reliability, and (2) intra-observer reliability.@*Results@#There were 11 respondents: 5 retina specialists and 6 pediatric ophthalmologists. Seven (46%) reported prior experience with RetCam image review. There was high inter-observer reliability (ICC 1.0) in the staging of ROP, but poor reliability in the identification of zone (ICC 0.3) and plus disease (ICC 0.5). The group of retina specialists and pediatric ophthalmologists scored high reliability for diagnosis of stage (ICC 1.0 vs 0.9) and plus disease (ICC 0.9 vs 0.9), while both showed poor reliability in the identification of zone (ICC 0.5 vs 0.4). Majority had high intra-observer reliability with regard to the stage (55%) and zone (73%) of ROP and most (73%) had acceptable intra-observer reliability in identifying plus disease. None of the respondents had poor intra-observer reliability. @*Conclusion@#The diagnosis of the stage of ROP was consistently reliable for both inter- and intra-observer parameters. However, identification of zone of ROP and plus disease were sources of significant discrepancies.

Proposed new retinopathy of prematurity screening criteria: Evidence for including older and heavier Filipino premature babies

Objective@#(1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP.@*Methods@#This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria.@*Results@#Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.