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An international comparison of retinopathy of prematurity grading performance within the Benefits of Oxygen Saturation Targeting II trials

Lookup NU author(s): Ayad Shafiq, David Cottrell



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. PurposeTo investigate whether the observed international differences in retinopathy of prematurity (ROP) treatment rates within the Benefits of Oxygen Saturation Targeting (BOOST) II trials might have been caused by international variation in ROP disease grading.MethodsGroups of BOOST II trial ophthalmologists in UK, Australia, and New Zealand (ANZ), and an international reference group (INT) used a web based system to grade a selection of RetCam images of ROP acquired during the BOOST II UK trial. Rates of decisions to treat, plus disease grading, ROP stage grading, ROP zone grading, inter-observer variation within groups and intra-observer variation within groups were measured.ResultsForty-two eye examinations were graded. UK ophthalmologists diagnosed treat-requiring ROP more frequently than ANZ ophthalmologists, 13.9 (3.49) compared to 9.4 (4.46) eye examinations, P=0.038. UK ophthalmologists diagnosed plus disease more frequently than ANZ ophthalmologists, 14.1 (6.23) compared to 8.5 (3.24) eye examinations, P=0.021. ANZ ophthalmologists diagnosed stage 2 ROP more frequently than UK ophthalmologists, 20.2 (5.8) compared to 12.7 (7.1) eye examinations, P=0.026. There were no other significant differences in the grading of ROP stage or zone. Inter-observer variation was higher within the UK group than within the ANZ group. Intra-observer variation was low in both groups.ConclusionsWe have found evidence of international variation in the diagnosis of treatment-requiring ROP. Improved standardisation of the diagnosis of treatment-requiring ROP is required. Measures might include improved training in the grading of ROP, using an international approach, and further development of ROP image analysis software.

Publication metadata

Author(s): Fleck BW, Williams C, Juszczak E, Cocker K, Stenson BJ, Darlow BA, Dai S, Gole GA, Quinn GE, Wallace DK, Ells A, Carden S, Butler L, Clark D, Elder J, Wilson C, Biswas S, Shafiq A, King A, Brocklehurst P, Fielder AR, Cottrell DG, Altaie R, Essex RW, Lam GC, Forrest M, Shah S, Smith J, Smith J, Taranath D, O'Keefe M

Publication type: Article

Publication status: Published

Journal: Eye

Year: 2018

Volume: 32

Issue: 1

Pages: 74-80

Print publication date: 01/01/2018

Online publication date: 28/07/2017

Acceptance date: 21/06/2017

Date deposited: 22/01/2018

ISSN (print): 0950-222X

ISSN (electronic): 1476-5454

Publisher: Nature Publishing Group


DOI: 10.1038/eye.2017.150


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