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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

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