TY - JOUR
T1 - P Score
T2 - A Reference Image-Based Clinical Grading Scale for Vascular Change in Retinopathy of Prematurity
AU - International Classification of Retinopathy of Prematurity Committee
AU - Binenbaum, Gil
AU - Stahl, Andreas
AU - Coyner, Aaron S.
AU - He, Jocelyn
AU - Ying, Gui shuang
AU - Ostmo, Susan
AU - Chan, R. V.Paul
AU - Toth, Cynthia
AU - Vinekar, Anand
AU - Campbell, J. Peter
AU - Chiang, Michael F.
AU - Quinn, Graham E.
AU - Fielder, Alistair R.
AU - Ostmo, Susan R.
AU - Berrocal, Audina
AU - Blair, Michael
AU - Capone, Antonio
AU - Chen, Yi
AU - Dai, Shuan
AU - Ells, Anna
AU - Fleck, Brian W.
AU - Good, William V.
AU - Hartnett, M. Elizabeth
AU - Holmstrom, Gerd
AU - Kusaka, Shunji
AU - Kychenthal, Andrés
AU - Lepore, Domenico
AU - Lorenz, Birgit
AU - Martinez-Castellanos, Maria Ana
AU - O¨zdek, Şengu¨l
AU - Ademola-Popoola, Dupe
AU - Reynolds, James D.
AU - Shah, Parag K.
AU - Shapiro, Michael
AU - Visser, Linda
AU - Wallace, David K.
AU - Wu, Wei Chi
AU - Zhao, Peiquan
AU - Zin, Andrea
AU - Baran, Francine
AU - Barry, Gerard
AU - Bhatt, Amit
AU - Davitt, Bradley
AU - de Alba Campomanes, Alejandra
AU - Eldib, Amgad
AU - Geddie, Brooke E.
AU - Haider, Kathryn
AU - Jensen, Anne
AU - Khitri, Monica
AU - Repka, Michael
N1 - Publisher Copyright:
© 2024 American Academy of Ophthalmology
PY - 2024/11
Y1 - 2024/11
N2 - Purpose: The International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), acknowledged that plus-like retinopathy of prematurity (ROP) vascular changes occurs along a spectrum. Historically, clinician-experts demonstrate variable agreement for plus diagnosis. We developed a 9-photograph reference image set for grading plus-like changes and compared intergrader agreement of the set with standard grading with no plus, preplus, and plus disease. Design: Retinal photographic grading and expert consensus opinion. Participants: The development set included 34 international ICROP3 committee members. The validation set included 30 ophthalmologists with ROP expertise (15 ICROP3 committee members and 15 non-ICROP3 members) Methods: Nine ROP fundus images (P1 through P9) representing increasing degrees of zone I vascular tortuosity and dilation, based on the 34 ICROP3 committee members’ gradings and consensus image reviews, were used to establish standard photographs for the plus (P) score. Study participants graded 150 fundus photographs 2 ways, separated by a 1-week washout period: (1) no plus, preplus, or plus disease and (2) choosing the closest P score image. Main Outcome Measures: Intergrader agreement measured by intraclass correlation coefficient. Results: Intergrader agreement was higher using the P score (intraclass correlation coefficient, 0.75; 95% confidence interval, 0.71–0.79) than no plus, preplus, or plus disease (intraclass correlation coefficient, 0.67; 95% confidence interval, 0.62–0.72). Mean ± standard deviation P scores for images with mode gradings of no plus, preplus, and plus disease were 2.5 ± 0.7, 4.8 ± 0.8, and 7.4 ± 0.8, respectively. Conclusions: Intergrader agreement of plus-like vascular change in ROP using the P score is high. We now incorporate this 9-image reference set into ICROP3 for use in clinician daily practice alongside zone, stage, and plus assessment. P score is not yet meant to replace plus diagnosis for treatment decisions, but its use at our institutions has permitted better comparison between examinations for progression and regression, communication between examiners, and documentation of vascular change without fundus imaging. P score also could provide more detailed ROP classification for clinical trials, consistent with the spectrum of plus-like change that is now formally part of the International Classification of Retinopathy of Prematurity. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
AB - Purpose: The International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), acknowledged that plus-like retinopathy of prematurity (ROP) vascular changes occurs along a spectrum. Historically, clinician-experts demonstrate variable agreement for plus diagnosis. We developed a 9-photograph reference image set for grading plus-like changes and compared intergrader agreement of the set with standard grading with no plus, preplus, and plus disease. Design: Retinal photographic grading and expert consensus opinion. Participants: The development set included 34 international ICROP3 committee members. The validation set included 30 ophthalmologists with ROP expertise (15 ICROP3 committee members and 15 non-ICROP3 members) Methods: Nine ROP fundus images (P1 through P9) representing increasing degrees of zone I vascular tortuosity and dilation, based on the 34 ICROP3 committee members’ gradings and consensus image reviews, were used to establish standard photographs for the plus (P) score. Study participants graded 150 fundus photographs 2 ways, separated by a 1-week washout period: (1) no plus, preplus, or plus disease and (2) choosing the closest P score image. Main Outcome Measures: Intergrader agreement measured by intraclass correlation coefficient. Results: Intergrader agreement was higher using the P score (intraclass correlation coefficient, 0.75; 95% confidence interval, 0.71–0.79) than no plus, preplus, or plus disease (intraclass correlation coefficient, 0.67; 95% confidence interval, 0.62–0.72). Mean ± standard deviation P scores for images with mode gradings of no plus, preplus, and plus disease were 2.5 ± 0.7, 4.8 ± 0.8, and 7.4 ± 0.8, respectively. Conclusions: Intergrader agreement of plus-like vascular change in ROP using the P score is high. We now incorporate this 9-image reference set into ICROP3 for use in clinician daily practice alongside zone, stage, and plus assessment. P score is not yet meant to replace plus diagnosis for treatment decisions, but its use at our institutions has permitted better comparison between examinations for progression and regression, communication between examiners, and documentation of vascular change without fundus imaging. P score also could provide more detailed ROP classification for clinical trials, consistent with the spectrum of plus-like change that is now formally part of the International Classification of Retinopathy of Prematurity. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
KW - ICROP
KW - ICROP3
KW - P score
KW - Plus disease
KW - Retinopathy of prematurity
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U2 - 10.1016/j.ophtha.2024.05.019
DO - 10.1016/j.ophtha.2024.05.019
M3 - Article
C2 - 38795976
AN - SCOPUS:85198171096
SN - 0161-6420
VL - 131
SP - 1297
EP - 1303
JO - Ophthalmology
JF - Ophthalmology
IS - 11
ER -