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
Redd TK, Campbell JP, Chiang MF. Is This the Right Reference Standard Diagnosis for Retinopathy of Prematurity?—Reply. JAMA Ophthalmol. 2018;136(12):1429–1430. doi:10.1001/jamaophthalmol.2018.4181
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