Multi-grader validation of the telemedicine retinopathy of prematurity severity score
We aimed to statefully validate Retinopathy of Prematurity (ROP) grading by evaluating intergrader variability over age-matched simulated exams. In a prospective retinal photographic grading cohort study, both eyes of twenty patients with five images per eye per visit were graded by twelve expert graders across six weekly visits. For each eye visit, ROP experts graded the Zone, Stage, and Plus, from which the Telemedicine ROP Severity Score (tROP-SS) was calculated. Graders retained knowledge of prior assessments for a given eye and followed International Classification of ROP rules. Intergrader coefficient of variation (CoV) for Zone, Stage, Plus, and tROP-SS remained below 20% across six weeks of age-matched visits. Zone showed the most changes in CoV (p < 0.001) with a minimum at week three of 6.0% (95% CI: 3.0-8.9%). Stage (9.2-13.1%) did not significantly vary over time. CoV of Plus gradually increased (p = 0.002) from week 1 (1.2%, 95% CI: 0.3-2.0%) to week 6 (3.3%, 95% CI: 1.7-4.9%). Agreement for tROP-SS varied over time (p < 0.001) and reached a local minimum at week three (10.5%, 95% CI: 7.3-13.8%). High intergrader agreement in a stateful data set validates the use of tROP-SS as a scoring system to capture week-to-week ROP progression.
Authors
- Cagri G. Besirli (ORCID: https://orcid.org/0000-0001-7154-2024)
- Arthur R Brant
- Sarthak Shah (ORCID: https://orcid.org/0000-0002-6979-1416)
- Cindy S. Zhao (ORCID: https://orcid.org/0000-0001-9925-2985)
- Darius M. Moshfeghi (ORCID: https://orcid.org/0000-0003-2254-292X)
- Jochen Kumm (ORCID: https://orcid.org/0000-0002-3681-6859)
- Eric Nudleman (ORCID: https://orcid.org/0000-0002-9467-1563)
- C. Armitage Harper
- Caroline R. Baumal (ORCID: https://orcid.org/0000-0002-3651-8210)
- K. A. Drenser
- Harrison W Pratt
- Anna L. Ells
- Audina M. Berrocal
- G. Baker Hubbard
- Edward Wood
- Polly Quiram
- Irena Tsui
- Tatiana Rosenblatt
- Yoshihiro Yonekawa
Institutions
- Massachusetts Eye and Ear Infirmary (US)
- Tufts Medical Center (US)
- Harvard University (US)
- University of Miami (US)
- Thomas Jefferson University (US)
- Emory University (US)
- Duke University (US)
- Oakland University (US)
- University of Michigan (US)
- University of California San Diego (US)
- California Retina Consultants (US)
- Emory Eye Center (US)
- Doheny Eye Institute (US)
- Retina Associates (US)
- Apellis Pharmaceuticals (United States) (US)
- Beaumont Hospital, Royal Oak (US)
- Stanford Medicine (US)
- Smith-Kettlewell Eye Research Institute (US)
- Trinity College (US)
- Smith-Kettlewell Eye Research Institute (US)
- Wills Eye Hospital (US)
- Stanford University (US)
Publication Details
- Journal
- Scientific Reports
- Published
- 2026-05-12
- DOI
- https://doi.org/10.1038/s41598-026-51824-0
- Primary Topic
- Retinopathy of Prematurity Studies
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Research to Prevent Blindness
- Alexion Pharmaceuticals
- University of Miami
- Regeneron Pharmaceuticals
- Akebia Therapeutics
- Genentech
- National Eye Institute