Influence of Serial Retinal Images on the Diagnosis and Management of Retinopathy of Prematurity (ROP)
Shin Hae Park; Kai Kang; Sang Jin Kim; Karyn Jonas; Susan Ostmo; John Peter Campbell; Michael F. Chiang; V. Paul Chan
University of Illinois at Chicago (UIC), Department of Ophthalmology and Visual Science
Chicago, IL, USA
Introduction: Wide-angle digital retinal imaging is currently being utilized for retinopathy of prematurity (ROP) telemedicine programs. Digital imaging has allowed serial comparison of vascular change over time, which anecdotally many clinicians describe as being informative. This study examines the influence of serial retinal images on ROP diagnosis and management.
Methods: Seven ROP examiners interpreted 15 sets of wide-angle retinal images from infants with ROP. Images were independently reviewed on a secure website and a three-level plus disease diagnosis and management plan (follow-up interval or treatment) for each index case were recorded, first based on a single retinal photograph, and then based on a series of three images over time with the index image as the third image.
Results: When viewing the serial retinal images, examiners changed plus disease diagnosis in 24 of 105 (22.9%) responses. Changes in management occurred in 32 of 105 (30.5%) responses.
Discussion: Analyzing a progression of serial retinal images enables direct comparison of vascular changes over time in ROP. The findings in this study suggest a potential effect of using serial images to diagnose plus disease, as opposed to using a single image at a single point in time. The implication of this change requires further study. More objective and quantitative techniques may assist in providing a more consistent and precise identification of retinal vascular progression.
Conclusion: There is variability in diagnosis and management of ROP if presented with serial retinal images. This may have implications for how image based diagnosis is utilized in clinical practice.
References: 1.Chiang MF, Melia M, Buffenn AN, et al. Detection of clinically significant retinopathy of prematurity using wide-angle digital retinal photography: a report by the American Academy of Ophthalmology. Ophthalmology 2012;119:1272-80.
Myung JS, Gelman R, Aaker GD, et al. Evaluation of vascular disease progression in retinopathy of prematurity using static and dynamic images. Am J Ophthalmol 2012;153:544-51.