Plus Disease in Retinopathy of Prematurity: More Than Meets the ICROP?

Area of Science:

• Ophthalmology
• Neonatology
• Medical Imaging

Background:

• Retinopathy of prematurity (ROP) is a significant cause of childhood blindness in premature infants.
• Plus disease, characterized by specific retinal vascular changes, is crucial for identifying ROP requiring treatment.
• Current diagnostic criteria for plus disease exhibit considerable variability in interpretation among experts.

Purpose of the Study:

• To investigate the reasons behind diagnostic variability in retinopathy of prematurity plus disease.
• To highlight the need for more precise definitions and objective diagnostic tools for ROP.

Main Methods:

• Analysis of factors contributing to inter- and intra-expert agreement on plus disease diagnosis.
• Review of proposed explanations for diagnostic inconsistencies, including vascular feature interpretation and image viewing parameters.

Main Results:

• Significant variability exists in the diagnostic process and outcomes for plus disease, leading to inconsistent expert agreement.
• Factors such as attention to undefined vascular features, field of view, digital image familiarity, and subjective cut-off points contribute to diagnostic discrepancies.
• Geographical and chronological differences in expert diagnostic consistency have been reported.

Conclusions:

• The current definition of plus disease in ROP, despite international acceptance, results in significant diagnostic variability.
• There is a critical need for a more precise definition of plus disease and the development of objective diagnostic methods for ROP.
• Improved diagnostic consistency is essential for effective clinical care, research, and education in managing ROP.