Longitudinal Assessment of Retinopathy of Prematurity (LONGROP) Study: Impacts of Viewing Time and Ability to Compare on Detection of Change

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-24 DOI:10.1016/j.ajo.2024.10.015

TATIANA R. ROSENBLATT MD , HASHEM H GHORABA MD , MARCO H. JI MD , CAROLINE R. BAUMAL MD , AUDINA M. BERROCAL MD , CAGRI G. BESIRLI MD, PhD , KIMBERLY A. DRENSER MD, PhD , ANNA L. ELLS MD , C. ARMITAGE HARPER III MD , G. BAKER HUBBARD III MD , ERIC D. NUDLEMAN MD, PhD , POLLY A. QUIRAM MD, PhD , IRENA TSUI MD , YOSHIHIRO YONEKAWA MD , EDWARD H. WOOD , JOCHEN KUMM , DARIUS M. MOSHFEGHI

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引用次数: 0

Abstract

Purpose

This study compared two imaging grading techniques to assess the utility of longitudinal image-based analysis in retinopathy of prematurity (ROP) screening: (1) time-limited without image comparison (a proxy for bedside indirect ophthalmoscopy, termed sBIO) and time-unlimited with image comparison (for telemedicine grading, termed TELE) screening. We tested two hypotheses: (1) H1: TELE was superior to sBIO for the detection of change (Tempo)—same, better, or worse and (2) H2: granular data of change (e.g., at the image and feature level) is integrated by graders to achieve the Tempo assessment.

Design

Prospective reliability analysis.

Methods

Gold standard reference (GS) was a published curated ROP image database consisting of both Tempo and granular level changes (image and components) from 40 patients in 2 sets. Graders were divided into 2 cohorts. There were two screening techniques: (1) sBIO with time limited review of 10 minutes/patient, access to prior notes and drawings and (2) TELE with unlimited review time, access to prior weeks’ images, notes and schematics. Graders switched techniques and sets after 6 weeks. H1 outcome was comparison of graders’ weekly Tempo scores to GS-Gestalt and for H2 was Tempo score compared to GS-View and GS-Component.

Results

H1 demonstrated no difference–accuracy of sBIO and TELE compared to GS was 51.7% and 51.9% respectively (P = .95). Highest agreement occurred when all exams exhibited no change (91.5% sBIO vs 93.5% TELE, P = .46) and worst agreement was when exams always demonstrated worsening (46.5% sBIO vs 47.1% TELE, P = .93). Both sets of graders did worse in weeks 7-12, irrespective of technique. H2 demonstrated that Tempo assessment did not correlate with granular data changes in the GS for View level and Component level assessments—overall agreement dropped to 31.4% for Tempo vs GS-VIEW (31.2% for sBIO, 31.5% for TELE) and 4.6% for Tempo vs GS-COMPONENT (4.9% for sBIO, 4.3% for TELE).

Conclusions

Detection of ROP Tempo was independent of screening technique by expert pediatric retina graders. Both groups did significantly better in the first half of the study, indicative of a fatigue factor. This is the first study in ROP history to demonstrate that graders integrate image and retinal features in various ways that can be in contradiction of their assessment of overall disease progression.

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早产儿视网膜病变纵向评估（LONGROP）研究：观察时间和比较能力对检测变化的影响。

目的：本研究比较了两种成像分级技术，以评估纵向图像分析在早产儿视网膜病变（ROP）筛查中的实用性：1）无图像对比的限时筛查（替代床旁间接眼底镜检查，称为 sBIO）和有图像对比的限时筛查（用于远程医疗分级，称为 TELE）。我们测试了两个假设：1）H1：在检测变化（Tempo）方面，TELE优于sBIO--相同、更好或更差；2）H2：分级人员整合变化的细粒度数据（如图像和特征级别）以实现Tempo评估：设计：前瞻性可靠性分析：金标准参考（GS）是一个已发表的ROP图像数据库，包括两组40名患者的Tempo和颗粒级变化（图像和成分）。分级者分为两组。有两种筛查技术：1）sBIO，每名患者限时 10 分钟，可查阅之前的笔记和图纸；2）TELE，查阅时间不受限制，可查阅前几周的图像、笔记和示意图。评分员在 6 周后更换技术和套餐。H1 的结果是将评分者的每周 Tempo 分数与 GS 格式塔进行比较，H2 的结果是将 Tempo 分数与 GS-View 和 GS-Component 进行比较：H1结果显示没有差异--sBIO和TELE与GS相比的准确率分别为51.7%和51.9%（P=0.95）。当所有检查均无变化时，一致性最高（91.5% sBIO vs. 93.5% TELE，p=0.46），当检查始终显示恶化时，一致性最差（46.5% sBIO vs. 47.1% TELE，p=0.93）。两组评分者在第 7-12 周的评分结果都较差，与技术无关。H2表明，Tempo评估与GS中视图级和组件级评估的颗粒数据变化不相关--Tempo与GS-VIEW的总体一致性降至31.4%（sBIO为31.2%，TELE为31.5%），Tempo与GS-COMPONENT的总体一致性降至4.6%（sBIO为4.9%，TELE为4.3%）：结论：Tempo 检测 ROP 与儿科视网膜分级专家的筛查技术无关。两组在研究的前半部分均有明显改善，表明存在疲劳因素。这是 ROP 历史上的第一项研究，它证明了分级者以不同的方式整合图像和视网膜特征，这可能与他们对整体疾病进展的评估相矛盾。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.