SmartPlus: a computer-based image analysis method to predict continuous-valued vascular abnormality index in Retinopathy of Prematurity

Plus disease is characterized by abnormal changes in retinal vasculature of premature infants. Presence of Plus disease is an important criterion for identifying treatment-requiring cases in Retinopathy of Prematurity (ROP). However, diagnosis of Plus disease has been shown to be subjective and there is wide variability in the classification of Plus disease by ROP experts, which is mainly because experts have different cut-points for distinguishing the levels of vascular abnormality. This suggests that a continuous Plus disease severity score may reflect more accurately the behavior of expert clinicians and may better standardize the classification. The effect of using quantitative methods and computer-based image analysis to improve the objectivity of Plus disease diagnosis have been well established. Nevertheless, the current methods are based on categorical classifications of the disease severity and lack the compatibility with the continuous nature of the abnormal changes in retinal vasculatures. In this study, we developed a computer-based method that performs a quantitative analysis of vascular characteristics associated with Plus disease and utilizes them to build a regression model that outputs a continuous spectrum of Plus severity. We evaluated the proposed method against the consensus diagnosis made by four ROP experts on 76 posterior ROP images. The findings of our study indicate that our approach demonstrated a relatively acceptable level of accuracy in evaluating the severity of Plus disease, which is comparable to the diagnostic abilities of experts.