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Gschlieber, Andreas, MD*; Stifter, Eva, MD*; Neumayer, Thomas, MD*; Moser, Elisabeth, MD*; Papp, Andrea, MD*; Pircher, Niklas, MD*; Dorner, Guido, MD*; Egger, Stefan, MD; Vukojević, Nenad, MD; Oberacher-Velten, Isabel, MD§; Schmidt-Erfurth, Ursula, MD*

doi: 10.1097/IAE.0000000000001864
Original Study

Purpose: To evaluate the effect of patients' clinical information on experts' diagnoses of retinopathy of prematurity (ROP) and decisions to treat.

Methods: Seven experts assessed wide-field fundus photographs of eyes of 52 premature infants of ≤30 weeks' gestational age or ≤1,500 g birthweight (BW) for ROP diagnosis (stage, plus disease, and aggressive posterior ROP) and the necessity for treatment for 2 days. On Day 1, they were masked to all patient data. On Day 2, they were given information on gestational age and BW.

Results: A significant shift in the experts' ratings toward a less aggressive ROP grading stage (P = 0.006) and less frequent decision for intervention (P = 0.021) was observed after receipt of patients' clinical information. This was truer for heavier/less premature infants (gestational age ≥ 28 0/7 weeks or BW ≥ 900 g) than those with very low BWs/high prematurity (gestational age < 24 0/7 weeks or BW < 600 g) (ROP stage P = 0.009 vs. P = 0.399, treatment decision P = 0.022 vs. P = 0.648).

Conclusion: These results suggest knowledge of patients' clinical information influences the grading of ROP disease and decision for treatment. Retinopathy of prematurity staging seemed to be set at a lower level and the decision for treatment at a higher threshold for heavier/less premature babies. Our findings may have implications for further refinements in ROP assessment.

This study demonstrates the impact of knowledge of the patient's clinical background on experts' decisions in retinopathy of prematurity assessment. Experts, in general, tend to grade milder on retinopathy of prematurity stage and indication for treatment when they are provided with information on the patients' birthweight and gestational age.

*Department of Ophthalmology, Medical University of Vienna, Vienna, Austria;

Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria;

Department of Ophthalmology, University Hospital Rebro, Zagreb, Croatia; and

§Department of Ophthalmology, University Medical Centre Regensburg, Regensburg, Germany.

Reprint requests: Eva Stifter, MD, Department of Ophthalmology, Medical University of Vienna, Währinger Gürtel 18-20, A 1090 Vienna, Austria; e-mail:

U. Schmidt-Erfurth is a consultant for Bayer, Novartis, Genentech, and Boehringer. I. Oberacher-Velten has received payment for lectures from Bausch & Lomb and Santen. The remaining authors have no conflicting interests to disclose.

This multicenter study was performed at the Medical University of Vienna, Austria in collaboration with the Paracelsus Medical University, Salzburg, Austria, the University Hospital Rebro, Zagreb, Croatia and the University Medical Centre Regensburg, Germany.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

© 2018 by Ophthalmic Communications Society, Inc.