Single grading vs double grading with adjudication in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study

Purpose To evaluate the sensitivity and specificity of single, independent, nonphysician trained reader (TR) gradings in the Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP) study. Methods Secondary analyses of image grading results from 1,235 infants of birth weights Results Of 7,808 double graded image sets, TR1 graded 5,165; TR2, 3,787; and TR3, 6,664. Compared to final grading for referral warranted retinopathy of prematurity (RW-ROP), two TRs had relatively lower sensitivity (TR1, 75% vs 79% [ P  = 0.03]; TR2, 73% vs 77% [ P  = 0.02]) and specificity (TR1, 80% vs 83% [ P P  = 0.09]). TR3 had similar sensitivity (83% vs 83% [ P  = 0.78]) and specificity (83% vs 84% [ P  = 0.02]). Compared to final grading, TR1 had lower sensitivity for zone I ROP (47% vs 56% [ P  = 0.04]) and stage ≥3 ROP (71% vs 77% [ P  = 0.002]); TR2 had lower sensitivity for stage ≥3 ROP (69% vs 77% [ P P P Conclusions There is a small but significant decrease in the sensitivity and specificity for RW-ROP when single-reader grading is compared to double adjudicated grading.