Related Experiment Video
Updated: May 14, 2026
Doppler Optical Coherence Tomography of Retinal Circulation
Published on: September 18, 2012
Multi-grader validation of the telemedicine retinopathy of prematurity severity score
Harrison W Pratt1,2, Sarthak V Shah1, Cindy S Zhao1
1Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
Insights
This study validated the Telemedicine ROP Severity Score (tROP-SS) for grading Retinopathy of Prematurity (ROP). High intergrader agreement confirms tROP-SS reliability for tracking ROP progression in infants.
Area of Science:
- Ophthalmology
- Neonatal care
- Medical imaging analysis
Background:
- Retinopathy of Prematurity (ROP) grading requires consistent expert evaluation.
- Intergrader variability can impact the reliability of ROP assessment.
- A validated scoring system is crucial for monitoring ROP progression.
Purpose of the Study:
- To statefully validate Retinopathy of Prematurity (ROP) grading using intergrader variability analysis.
- To assess the reliability of the Telemedicine ROP Severity Score (tROP-SS) in simulated, age-matched exams.
- To determine the consistency of expert grading over time for ROP assessment.
Main Methods:
- Prospective cohort study involving 20 patients with ROP.
- Twelve expert graders assessed five images per eye across six weekly visits.
- Graders evaluated Zone, Stage, and Plus, calculating the tROP-SS, while retaining prior assessment knowledge.
Main Results:
- Intergrader coefficient of variation (CoV) for Zone, Stage, Plus, and tROP-SS remained below 20% across visits.
- Zone showed the highest CoV changes (p < 0.001), with a minimum at week three (6.0%).
- Stage CoV was stable (9.2-13.1%), while Plus CoV gradually increased (p = 0.002) from 1.2% to 3.3%.
Conclusions:
- High intergrader agreement in a stateful dataset validates the tROP-SS.
- The tROP-SS is a reliable scoring system for capturing week-to-week ROP progression.
- This study supports the use of tROP-SS in clinical practice for ROP management.
Abstract:
We aimed to statefully validate Retinopathy of Prematurity (ROP) grading by evaluating intergrader variability over age-matched simulated exams. In a prospective retinal photographic grading cohort study, both eyes of twenty patients with five images per eye per visit were graded by twelve expert graders across six weekly visits. For each eye visit, ROP experts graded the Zone, Stage, and Plus, from which the Telemedicine ROP Severity Score (tROP-SS) was calculated. Graders retained knowledge of prior assessments for a given eye and followed International Classification of ROP rules. Intergrader coefficient of variation (CoV) for Zone, Stage, Plus, and tROP-SS remained below 20% across six weeks of age-matched visits. Zone showed the most changes in CoV (p < 0.001) with a minimum at week three of 6.0% (95% CI: 3.0-8.9%). Stage (9.2-13.1%) did not significantly vary over time. CoV of Plus gradually increased (p = 0.002) from week 1 (1.2%, 95% CI: 0.3-2.0%) to week 6 (3.3%, 95% CI: 1.7-4.9%). Agreement for tROP-SS varied over time (p < 0.001) and reached a local minimum at week three (10.5%, 95% CI: 7.3-13.8%). High intergrader agreement in a stateful data set validates the use of tROP-SS as a scoring system to capture week-to-week ROP progression.
