Evaluation of a novel retinopathy of prematurity severity scale applied by clinicians and deep learning.

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Abstract

To evaluate the clinical utility of a quantitative deep-learning derived vascular severity score for retinopathy of prematurity (ROP) by assessing its correlation with clinical ROP diagnosis and by measuring clinician agreement in applying a novel scale.
Analysis of existing database of posterior pole fundus images and corresponding ophthalmoscopic examinations using two methods of assigning a quantitative scale to vascular severity.
AND PARTICIPANTS: Images were from clinical exams of patients in the Imaging & Informatics in ROP consortium. 4 ophthalmologists and 1 study coordinator evaluated vascular severity on a 1-9 scale.
A quantitative vascular severity score (1-9) was applied to each image using a deep learning algorithm. A database of 499 images was developed for assessment of inter-observer agreement.
Distribution of deep learning derived vascular severity scores with the clinical assessment of zone (I,II,III), stage (0,1,2,3) and extent (<3, 3-6, >6 clock hours) of stage 3 evaluated using multivariable linear regression. Weighted kappa and Pearson correlation coefficients for inter-observer agreement on 1-9 vascular severity scale.
For deep learning analysis, a total of 6344 clinical examinations were analyzed. A higher deep learning derived vascular severity score was associated with more posterior disease, higher disease stage, and higher extent of stage 3 disease (P<.001 for all). For a given ROP stage, the vascular severity score was higher in zone I than zone II or III (P<.001). For a given number of clock hours of stage 3, the severity score was higher in zone I than zone II (P=.03 in zone I and P<.001 in zone II). Multivariable regression found zone, stage, and extent were all independently associated with the severity score (P<.001 for all). For inter-observer agreement, mean (±Standard Deviation [SD]) weighted kappa was 0.67 (±0.06) and Pearson Correlation coefficient (±SD) was 0.88 (±.04) on the use of a 1-9 vascular severity scale.
A vascular severity scale for ROP appears feasible for clinical adoption, corresponds with zone, stage, extent of stage 3, and plus disease, and facilitates the use of objective technology such as deep learning to improve consistency of ROP diagnosis.
Copyright © 2020. Published by Elsevier Inc.