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

Tatiana R Rosenblatt; Hashem H Ghoraba; Marco H Ji; Caroline R Baumal; Audina M Berrocal; Cagri G Besirli; Kimberly A Drenser; Anna L Ells; C Armitage Harper 3rd; G Baker Hubbard 3rd; Eric D Nudleman; Polly A Quiram; Irena Tsui; Yoshihiro Yonekawa; Edward H Wood; Jochen Kumm; Darius M Moshfeghi

doi:10.1016/j.ajo.2024.10.015

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

Am J Ophthalmol. 2024 Oct 24:271:31-37. doi: 10.1016/j.ajo.2024.10.015. Online ahead of print.

Authors

Tatiana R Rosenblatt¹, Hashem H Ghoraba², Marco H Ji³, Caroline R Baumal⁴, Audina M Berrocal⁵, Cagri G Besirli⁶, Kimberly A Drenser⁷, Anna L Ells⁸, C Armitage Harper 3rd⁹, G Baker Hubbard 3rd¹⁰, Eric D Nudleman¹¹, Polly A Quiram¹², Irena Tsui¹³, Yoshihiro Yonekawa¹⁴, Edward H Wood⁹, Jochen Kumm², Darius M Moshfeghi¹⁵

Affiliations

¹ From the Department of Ophthalmology, Byers Eye Institute, Stanford University (T.R.R., H.H.G., M.J., J.K., D.M.M.), Palo Alto, California, USA; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (T.R.R.), Boston, Massachusetts, USA.
² From the Department of Ophthalmology, Byers Eye Institute, Stanford University (T.R.R., H.H.G., M.J., J.K., D.M.M.), Palo Alto, California, USA.
³ From the Department of Ophthalmology, Byers Eye Institute, Stanford University (T.R.R., H.H.G., M.J., J.K., D.M.M.), Palo Alto, California, USA; Department of Ophthalmology, University of Arkansas for Medical Sciences (M.J.), Little Rock, Arkansas, USA.
⁴ Department of Ophthalmology, New England Eye Center, Tufts Medical Center (C.R.B.), Boston, Massachusetts, USA; Chief Medical Officer, Apellis (C.R.B.), Waltham, Massachusetts, USA.
⁵ Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami (A.M.B.), Miami, Florida, USA.
⁶ Department of Ophthalmology and Visual Sciences, University of Michigan (C.B.), Ann Arbor, Michigan, USA.
⁷ Department of Ophthalmology, William Beaumont Hospital, Oakland University (K.D.), Royal Oak, Michigan, USA.
⁸ Calgary Retina Consultants (A.E.), Calgary, Alberta, Canada.
⁹ Austin Retina Associates (C.A.H., E.H.W.), Austin, Texas, USA.
¹⁰ Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine (G.B.H.), Atlanta, Georgia, USA.
¹¹ Department of Ophthalmology, Shiley Eye Institute, University of California San Diego (E.N.), San Diego, California, USA.
¹² Retina Consultants of Minnesota (P.Q.), Edina, Minnesota, USA.
¹³ Department of Ophthalmology, Doheny Eye Institute and Stein Eye Institute, University of California Los Angeles (I.T.), Los Angeles, California, USA.
¹⁴ Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University (Y.Y.), Philadelphia, Pennsylvania, USA.
¹⁵ From the Department of Ophthalmology, Byers Eye Institute, Stanford University (T.R.R., H.H.G., M.J., J.K., D.M.M.), Palo Alto, California, USA. Electronic address: [email protected].

PMID: 39461403
DOI: 10.1016/j.ajo.2024.10.015

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.