Plus Disease in Retinopathy of Prematurity: Diagnostic Trends in 2016 Versus 2007

Chace Moleta, J. Peter Campbell, Jayashree Kalpathy-Cramer, R. V Paul Chan, Susan Ostmo, Karyn Jonas, Michael F. Chiang, Michael F. Chiang, Susan Ostmo, Kemal Sonmez, J. Peter Campbell, R. V Paul Chan, Karyn Jonas, Jason Horowitz, Osode Coki, Cheryl Ann Eccles, Leora Sarna, Audina Berrocal, Catherin Negron, Kimberly DenserKristi Cumming, Tammy Osentoski, Tammy Check, Mary Zajechowski, Thomas Lee, Evan Kruger, Kathryn McGovern, Charles Simmons, Raghu Murthy, Sharon Galvis, Jerome Rotter, Ida Chen, Xiaohui Li, Kent Taylor, Kaye Roll, Jayashree Kalpathy-Cramer, Deniz Erdogmus, Stratis Ioannidis, Maria Ana Martinez-Castellanos, Samantha Salinas-Longoria, Rafael Romero, Andrea Arriola, Francisco Olguin-Manriquez, Miroslava Meraz-Gutierrez, Carlos M. Dulanto-Reinoso, Cristina Montero-Mendoza, & Informatics in ROP Research Consortium Imaging & Informatics in ROP Research Consortium, & Informatics in ROP Research Consortium Imaging & Informatics in ROP Research Consortium

Research output: Contribution to journalArticle

3 Scopus citations


Purpose To identify any temporal trends in the diagnosis of plus disease in retinopathy of prematurity (ROP) by experts. Design Reliability analysis. Methods ROP experts were recruited in 2007 and 2016 to classify 34 wide-field fundus images of ROP as plus, pre-plus, or normal, coded as “3,” “2,” and “1,” respectively, in the database. The main outcome was the average calculated score for each image in each cohort. Secondary outcomes included correlation on the relative ordering of the images in 2016 vs 2007, interexpert agreement, and intraexpert agreement. Results The average score for each image was higher for 30 of 34 (88%) images in 2016 compared with 2007, influenced by fewer images classified as normal (P < .01), a similar number of pre-plus (P = .52), and more classified as plus (P < .01). The mean weighted kappa values in 2006 were 0.36 (range 0.21–0.60), compared with 0.22 (range 0–0.40) in 2016. There was good correlation between rankings of disease severity between the 2 cohorts (Spearman rank correlation ρ = 0.94), indicating near-perfect agreement on relative disease severity. Conclusions Despite good agreement between cohorts on relative disease severity ranking, the higher average score and classifications for each image demonstrate that experts are diagnosing pre-plus and plus disease at earlier stages of disease severity in 2016, compared with 2007. This has implications for patient care, research, and teaching, and additional studies are needed to better understand this temporal trend in image-based plus disease diagnosis.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalAmerican Journal of Ophthalmology
StatePublished - Apr 1 2017


ASJC Scopus subject areas

  • Ophthalmology

Cite this

Moleta, C., Campbell, J. P., Kalpathy-Cramer, J., Chan, R. V. P., Ostmo, S., Jonas, K., Chiang, M. F., Chiang, M. F., Ostmo, S., Sonmez, K., Campbell, J. P., Chan, R. V. P., Jonas, K., Horowitz, J., Coki, O., Eccles, C. A., Sarna, L., Berrocal, A., Negron, C., ... Imaging & Informatics in ROP Research Consortium, . I. I. ROP. R. C. (2017). Plus Disease in Retinopathy of Prematurity: Diagnostic Trends in 2016 Versus 2007. American Journal of Ophthalmology, 176, 70-76.