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  • A Fundus Photograph–Based Rating Scale Could Help to Identify Plus-Like ROP Disease

    Pediatric Ophth/Strabismus, Retina/Vitreous

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    Review of: P-score: A reference-image-based clinical grading scale for vascular change in retinopathy of prematurity

    Binenbaum G, Stahl A, Coyner A, et al. Ophthalmology, in press 2024

    A “P-score” which reflects the spectrum of plus-like vascular change in retinopathy of prematurity (ROP) could potentially be used to supplement the current International Classification of Retinopathy of Prematurity Third Edition (ICROP 3) terms of ROP classification.

    Study Design

    Images were taken from the Imaging and Informatics in ROP (i-ROP) Consortium Repository to develop a reference imaging set of 9 standard fundus photographs, showing increasing degrees of Zone 1 vascular tortuosity and dilation (“plus like”) from none to severe plus change (P1–P9). These fundus photographs, along with a new set of 150 iROP Consortium Repository images, were then evaluated and graded by 30 ophthalmologists with expertise in ROP: 15 ICROP 3 committee members and 15 non-ICROP 3 members. Each grader reviewed the images via 2 different methods, separated by a 1-week washout period: 1) grading no plus/pre-plus/plus disease; and 2) grading based upon the closest P-score photograph. The main outcome measure was intergrader agreement, as measured by the intraclass correlation coefficient (ICC).

    Outcomes

    A higher level of consensus and intergrader agreement was reported when graders used the P-score photographs vs the grading designation of no plus/pre-plus/plus disease (ICC 0.75 vs ICC 0.67, respectively).

    Limitations

    One study limitation was using the ICC to measure outcome, since the degree of intergrader agreement grading was not consistent across the P1–P9 spectrum. Intergrader agreement was higher with P-scores for fundus photographs at the higher and lower ends of the spectrum than at the middle (P4–P6). However, the investigators evaluated this inconsistency and did not find significant vessel feature variability in the P4–P6 images.

    Clinical Significance

    For all ophthalmologists who evaluate infants with ROP, having this 9–fundus photograph reference set is important for making a more standardized detailed diagnosis. The specific designation of P1–P9, along with zone, stage, and plus, underscores a more comprehensive analysis of the spectrum of plus disease in ROP.

    Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.