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Michael F. Chiang, MD, MA; Lei Jiang, BA; Rony Gelman, MD; Yunling E. Du, PhD; John T. Flynn, MD

Arch Ophthalmol. 2007;125(7):875-880.

Objective  To measure agreement of plus disease diagnosis among retinopathy of prematurity (ROP) experts.

Methods  A set of 34 wide-angle retinal photographs from infants with ROP was compiled on a secure Web site and was interpreted independently by 22 recognized ROP experts. Diagnostic agreement was analyzed using 3-level (plus, pre-plus, or neither) and 2-level (plus or not plus) categorizations.

Results  In the 3-level categorization, all experts agreed on the same diagnosis in 4 of 34 images (12%), and the mean weighted statistic for each expert compared with all others was between 0.21 and 0.40 (fair agreement) for 7 experts (32%) and between 0.41 and 0.60 (moderate agreement) for 15 experts (68%). In the 2-level categorization, all experts who provided a diagnosis agreed in 7 of 34 images (21%), and the mean statistic for each expert compared with all others was between 0 and 0.20 (slight agreement) for 1 expert (5%), between 0.21 and 0.40 (fair agreement) for 3 experts (14%), between 0.41 and 0.60 (moderate agreement) for 12 experts (55%), and between 0.61 and 0.80 (substantial agreement) for 6 experts (27%).

Conclusions  Interexpert agreement of plus disease diagnosis is imperfect. This may have important implications for clinical ROP management, continued refinement of the international ROP classification system, development of computer-based diagnostic algorithms, and implementation of ROP telemedicine systems.

Author Affiliations: Departments of Ophthalmology (Drs Chiang, Gelman, and Flynn and Mr Jiang) and Biomedical Informatics (Dr Chiang), Columbia University College of Physicians and Surgeons, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine (Dr Du), New York, New York.

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Flawed Study Design in Report on Interexpert Agreement of Plus Disease Diagnosis in Retinopathy of Prematurity
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