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• W2101232132 abstract "Gschließer and associates, in their article in this issue of the American Journal of Ophthalmology entitled “Inter-expert and Intra-expert Agreement on the Diagnosis and Treatment of Retinopathy of Prematurity,” question the efficacy of photographic screening for retinopathy of prematurity (ROP) based on inter- and intrascreening variability by experienced readers for ROP. 1 Gschließer A. Stifter E. Neumayer T. et al. Inter-expert and intra-expert agreement on the diagnosis and treatment of retinopathy of prematurity. Am J Ophthalmol. 2015; 160: 553-560 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar This issue has been addressed by several studies looking at the grading of photographic images vs a bedside examination. It has been found in several studies that photographic screening can detect treatment- or referral-warranted ROP at a rate that is safe and comparable to live screening. 2 Ells A. Holmes J. Astle W. et al. Telemedicine approach to screening for severe retinopathy of prematurity. Ophthalmology. 2003; 110: 2113-2117 Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar , 3 Photographic Screening for Retinopathy of Prematurity (Photo-ROP) Cooperative GroupThe Photographic Screening for Retinopathy of Prematurity Study (Photo-ROP): primary outcomes. Retina. 2008; 28: S47-54 Crossref PubMed Scopus (97) Google Scholar , 4 Daniel E. Quinn G.E. Hildebrand P.L. et al. the e-ROP Cooperative GroupValidated system for centralized grading of retinopathy of prematurity: telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study. JAMA Ophthalmol. 2015; 133: 675-681 Crossref PubMed Scopus (56) Google Scholar , 5 Fijalkowski N. Zheng L.L. Henderson M.T. et al. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): five years of screening with telemedicine. Ophthalmic Surg Lasers Imaging Retina. 2014; 45: 106-113 Crossref PubMed Scopus (63) Google Scholar The interpretation of an isolated image at one point in a progressive, but time-sensitive, disease such as ROP does not mean that treatment would not be provided in a timely fashion. The really important question this paper raises is, can we reduce subjectivity for ROP screening? The areas that are most likely to benefit from such a change are the determination of zone 1 disease and the determination of plus disease, both of which have treatment implications. The variability between “experts” or even averagely trained screeners is expected, given the use of clinical data, whether it is photographic or from bedside examinations. This type of variability has been true even in the bedside examinations of the CRYO-ROP study. Recently it has been shown by Chiang that doctors are poor at determining zone 1 based on live examinations, but very good at identifying the center of the macula on photographs, critical to determining the radius of zone 1. 6 Trese M.T. It is time to bring retinopathy of prematurity monitoring into the 21st century [Editorial]. Graefes Arch Clin Exp Ophthalmol. 2015; 253: 179 Crossref PubMed Scopus (2) Google Scholar , 7 Chiang M.F. Aggressive posterior retinopathy of prematurity: a pilot study of quantitative analysis of vascular features. Graefes Arch Clin Exp Ophthalmol. 2015; 253: 181-187 Crossref PubMed Scopus (19) Google Scholar In addition, the determination of plus disease has been shown by this paper and others to be variable. 8 Chiang M.F. Gelman R. Jiang L. et al. Plus disease in retinopathy of prematurity: an analysis of diagnostic performance. Trans Am Ophthalmol Soc. 2007; 105 (discussion 84–85): 73-84 PubMed Google Scholar Without the benefit of a photograph, which allows the image to be studied, the subjectivity of a live examination may be even greater with the doctor's personal interpretation and then written comments; subjectivity is unavoidable." @default.
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• W2101232132 date "2015-09-01" @default.
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• W2101232132 title "Subjectivity in Retinopathy of Prematurity Screening" @default.
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• W2101232132 doi "https://doi.org/10.1016/j.ajo.2015.07.015" @default.
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