• Pediatric Ophth/Strabismus, Retina/Vitreous

    In this secondary analysis of the Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) study, investigators examined the intereye agreement of ROP features and severity using trained nonphysician graders.

    Study design

    The NIH-funded e-ROP study evaluated the feasibility of telemedicine to identify infants with referral-warranted ROP, defined as the presence of stage 3 or above, plus disease, or zone I ROP.

    The cohort comprised 1,235 infants with acute-phase ROP who underwent a total of 3,918 serial imaging sessions in both eyes. All infants weighed less than 1,251 grams at birth and were monitored starting at 32 weeks postmenstrual age. Two trained nonphysician readers independently graded the images for ROP features and severity.

    Intereye agreement was assessed using percentage exact agreement and weighted kappa (Kw) for stage, zone, plus, referral warranted ROP and severity of ROP.


    Overall, there was high agreement among the masked readers for grading ROP features. The percent agreement and Kw between paired eyes were:

    • Stage of ROP: 75.3% (Kw = 0.65)
    • Zone of ROP: 82.3% (0.68)
    • Plus disease: 78.7% (0.51)
    • Referral warranted ROP: 84.7% (0.56)
    • Severity of ROP: 72.7% (0.63)


    It is unclear whether telemedicine screening should be used primarily to augment or supplant clinical ROP screening.

    Clinical significance

    As telemedicine platforms continue to improve, its use to follow babies at risk of developing ROP may become increasingly common. Telemedicine may be especially useful as a first-line tool in environments where an experienced ophthalmologist is unavailable. In other practice environments, telemedicine may have a role in augmenting the clinical examination or objectively documenting findings.

    These findings confirm that acute ROP is typically symmetrical, and they support within-subject comparison in ROP trials. The correlation of agreement found in this study was high and similar to previously reported intereye agreement in ROP from clinical examinations by ophthalmologists.