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Comment & Response
December 2018

Is This the Right Reference Standard Diagnosis for Retinopathy of Prematurity?—Reply

Author Affiliations
  • 1Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
  • 2Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
JAMA Ophthalmol. 2018;136(12):1429-1430. doi:10.1001/jamaophthalmol.2018.4181

In Reply We thank Dr Athikarisamy for his comments. Diagnosis of retinopathy of prematurity, like many ophthalmic conditions, requires interpretation of retinal morphology. In this study,1 we evaluated 2 methods of visualizing these changes, ophthalmoscopy and telemedicine, and found no significant difference between them for detecting clinically significant retinopathy of prematurity compared with a reference standard diagnosis (RSD). Development of this RSD involved first establishing a composite reference standard using the consensus of 3 independent telemedicine examinations by masked clinicians, combined with a single ophthalmoscopic examination.2 This was followed by a consensus panel review and adjudication of any cases in which there was a tie between the 4 independent observations. We have previously shown this approach reduces interexaminer variability compared with either telemedicine or ophthalmoscopy.3

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