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Arch Ophthalmol. 2007 Nov;125(11):1523-30.

Accuracy of ROPtool vs individual examiners in assessing retinal vascular tortuosity.

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  • 1Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina USA.



To prospectively determine if tortuosity assessment by a computer program (ROPtool) that traces retinal blood vessels and measures their tortuosity was more accurate than that of individual pediatric ophthalmologists.


One hundred eighty-five high-quality RetCam images from premature infants were circulated to 3 retinopathy of prematurity (ROP) experts and 3 other pediatric ophthalmologists ("examiners") who graded the tortuosity in each quadrant as normal, pre-plus, or plus. These same images were analyzed using ROPtool.


Using expert consensus as the standard, ROPtool's overall accuracy of 95% (175 of 185) for identifying tortuosity sufficient for plus disease was similar to that of examiner 1 (93%; 172 of 185; P = .50), examiner 2 (93%; 172 of 185; P = .50), and examiner 3 (91%; 168 of 185; P = .10). ROPtool's sensitivity of 97% (36 of 37) compared favorably with that of examiner 1 (65%; 24 of 37; P < .001), examiner 2 (70%; 26 of 37; P < .001), and examiner 3 (81%; 30 of 37; P = .06).


Computer-assisted analysis of retinal images can potentially reduce subjectivity in the diagnosis of plus disease and optimize timing of follow-up and treatment for ROP.

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