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Differing diagnoses of Plus disease show classification subjectivity
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NEW ORLEANS — A lack of consensus among experts diagnosing identical images of Plus disease highlights the unreliability of the current classification system, a physician said here.
Michael F. Chiang, MD, spoke at The Editors' Choices session of the annual American Academy of Ophthalmology meeting about a study examining the agreement of 22 experts in diagnosing Plus disease, the progression of retinopathy of prematurity (ROP).
Diagnosis of Plus disease dictates whether treatment for ROP is required and is determined by specific classification guidelines, Dr. Chiang said.
"Plus disease diagnosis is really critical to make accurate, in order to avoid cases of over-treating or under-treating babies," he said. "I think this raises a question of how good a gold standard we have for diagnosing Plus disease."
In Dr. Chiang and colleagues' study, retinal specialists and pediatric ophthalmologists used a secure Web site to examined 34 wide-angle retinal images for diagnosis of Plus disease. The researchers analyzed the experts' diagnoses agreement using a three-level approach of Plus, pre-Plus and neither, and a two-level approach, Plus or not Plus.
Dr. Chiang and colleagues found that in the three-level categorization, experts agreed on the same diagnosis in only four of 34 images, or 12%. In the two-level categorization, experts reached the same diagnosis in seven of 34 images, or 21%, Dr. Chiang said.
The study was published in the July 2007 edition of Archives of Ophthalmology.