Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity

Klufas, Michael A.; Patel, Samir N.; Ryan, Michaël; Gupta, Mrinali P.; Jonas, Karyn; Ostmo, Susan; Martinez-Castellanos, María A.; Berrocal, Audina M.; Chiang, Michael F.; Chan, Robison Vernon Paul

doi:10.1016/j.ophtha.2015.04.023

Cited by 65 publications

(40 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, most previous work has focused on plus disease 8,9,11,12,16 and zone classification. 7,19,20 In this study, the majority of discrepancies in stage classification were at the very mild ends of the disease spectrum (stage 0 vs. 1). However, the high frequency of discrepancy merits some consideration.…”

Section: Discussionmentioning

confidence: 54%

“…For example, the incorporation of fluorescein angiography may be able to improve the level of agreement. 19,20 In the future, as portable and widefield optical coherence tomography becomes more commonplace, this may be expected to improve diagnostic agreement as well. 32 Both of these modalities would add time and expense to the routine evaluation of infants, and fluorescein angiography adds a small risk of allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

“…5 Despite the development of a standardized nomenclature known as the International Classification of ROP (ICROP), 6 numerous studies have demonstrated imperfect inter-expert reliability in the diagnosis of ROP. 7–20 In the real world, this suggests that children with the same level of disease may be treated differently by different clinicians, and conversely children who are treated may not all meet clinical criteria to justify treatment. Even more troubling, ROP is one of the most costly medicolegal subjects within ophthalmology which has made it more challenging to find qualified clinicians willing to take on this area of practice.…”

mentioning

confidence: 99%

“…7,19,20 In addition, whether there are any differences between image-based and indirect ophthalmoscopic diagnosis (long considered the gold standard) has not been studied in detail. 23 Little research has examined the factors that contribute to which ICROP factors are most likely to be discordant between graders using different modalities, especially for zone and stage.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic Discrepancies in Retinopathy of Prematurity Classification

et al. 2016

Self Cite

View full text Add to dashboard Cite

Objective To identify the most common areas for discrepancy in retinopathy of prematurity (ROP) classification between experts. Design Prospective cohort study. Subjects, Participants, and/or Controls 281 infants were identified as part of a multi-center, prospective, ROP cohort study from 7 participating centers. Each site had participating ophthalmologists who provided the clinical classification after routine examination using binocular indirect ophthalmoscopy (BIO), and obtained wide-angle retinal images, which were independently classified by two study experts. Methods Wide-angle retinal images (RetCam; Clarity Medical Systems, Pleasanton, CA) were obtained from study subjects, and two experts evaluated each image using a secure web-based module. Image-based classifications for zone, stage, plus disease, overall disease category (no ROP, mild ROP, Type II or pre-plus, and Type I) were compared between the two experts, and to the clinical classification obtained by BIO. Main Outcome Measures Inter-expert image-based agreement and image-based vs. ophthalmoscopic diagnostic agreement using absolute agreement and weighted kappa statistic. Results 1553 study eye examinations from 281 infants were included in the study. Experts disagreed on the stage classification in 620/1553 (40%) of comparisons, plus disease classification (including pre-plus) in 287/1553 (18%), zone in 117/1553 (8%), and overall ROP category in 618/1553 (40%). However, agreement for presence vs. absence of type 1 disease was >95%. There were no differences between image-based and clinical classification except for zone III disease. Conclusions The most common area of discrepancy in ROP classification is stage, although inter-expert agreement for clinically-significant disease such as presence vs. absence of type 1 and type 2 disease is high. There were no differences between image-based grading and the clinical exam in the ability to detect clinically-significant disease. This study provides additional evidence that image-based classification of ROP reliably detects clinically significant levels of ROP with high accuracy compared to the clinical exam.

show abstract

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Discrepancies in Retinopathy of Prematurity Classification

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Появление современных педиатрических ретинальных цифровых камер, таких как RetCam-3 [1], которая оснащена специальным ангиографическим блоком, открыло для специалистов новые возможности использования методики ФАГ у недоношенных детей [2][3][4][5][6][7][8][9].…”

Section: Ophthalmology In Russia 2018;15(2s):24-30unclassified

Fluorescence Angiography to Determine the Features of Active Retinopathy of Prematurity Course

Trifanenkova¹,

Терещенко²

2018

Ophthalmology in Russia

View full text Add to dashboard Cite

The purposeis to determine the features of different stages of active retinopathy prematurely according to fluorescent angiography data.Patients and methods. In 2011–2017, 271 angiographic studies were performed in 207 premature infants born at 25– 33 weeks of gestation with 710–1980 grams weight at birth, with different stages of active ROP in age of live 3–12 weeks (30– 39 weeks of post-conceptual age). A voluntary informed consent to perform the examination was received from the legal representatives of all patients. FAG was performed using retinal pediatric digital video system «RetCam-3» with built-in angiographic unit under mask anesthesia, in the presence of anesthesiologist-resuscitator, under the monitor control of the respiratory and cardiovascular systems of the child.Results. Unfavorable types of active ROP are characterized by the specific manifestations that are not defined by the standard ophthalmologic methods: early flat neovascularization, the presence of small tortuous peripheral vessels with signs of leakage, reperfusion areas with an apparent lack of capillaries and shunts. This opens up the opportunities for early detection of stages of the disease requiring therapeutic measures. The aggressive posterior ROP is distinguished by a variety of angiographic patterns, the most important feature is the massive loss of the retinal capillary bed in the vascularized retina. FAG data about latent neovascularization and ischemic zones of the retina represent the particular value in the prediction of active ROP course.Conclusion. The obtained results could allow to make the most differentiated approach to the management of children with active ROP, timely and effectively predict the course of the disease and to performed adequate treatment based on objective indications.

show abstract

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

View full text Add to dashboard Cite

IMPORTANCEAs effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.OBJECTIVE To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013. DESIGN, SETTING, AND PARTICIPANTSA poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed. MAIN OUTCOMES AND MEASURESConsensus evaluation of discrepant image and examination findings for RW-ROP components. RESULTS Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G−/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E−). Among the sample of G−/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E− cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G−/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E− cases (95% CI, 67.3-72.8) for the presence of RW-ROP.CONCLUSIONS AND RELEVANCE This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.

show abstract

Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity

Cited by 65 publications

References 43 publications

Diagnostic Discrepancies in Retinopathy of Prematurity Classification

Diagnostic Discrepancies in Retinopathy of Prematurity Classification

Fluorescence Angiography to Determine the Features of Active Retinopathy of Prematurity Course

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

Contact Info

Product

Resources

About