Facilitated Versus Self-guided Training of Non-ophthalmologists for Grading Pre-plus and Plus Disease Using Fundus Images for Retinopathy of Prematurity Screening.

Journal Article (Journal Article)

PURPOSE: Retinopathy of prematurity (ROP) is an important cause of preventable blindness; barriers to screening necessitate novel approaches. Although trained non-ophthalmologists can accurately grade retinal images for ROP, effective training protocols are not established. This study compares the effectiveness of facilitated versus self-guided training of non-ophthalmologists for grading retinal images for pre-plus or plus disease in ROP. METHODS: Forty-eight undergraduate and graduate students were trained to grade retinal images for the presence of pre-plus or plus disease. Students were randomly assigned to one of two training protocols. Both used identical electronic slideshows: one was guided by an in-person facilitator and the other was self-guided. After completing their respective training, students proficient in grading pre-plus and plus disease graded images in a telemedicine screening scenario. Accuracy of grading was compared to the reference standard of clinical examination. RESULTS: Eighty-three percent (40 of 48) of trained students (91% in the facilitated vs 77% in the self-guided group, P = .26) were proficient and qualified to grade the ROP telemedicine screening scenario. Median accuracy for grading normal, pre-plus, or plus disease was 69% (70% in the facilitated vs 68% in the self-guided group, P = .91). When considering the designation of pre-plus or plus disease by graders as a screening test for detecting plus disease (confirmed on clinical examination), the median sensitivity and specificity of all students were 95% and 64%, respectively. CONCLUSIONS: Both facilitated and self-guided teaching protocols yielded similar performance in ROP image grading for pre-plus or plus disease. Self-guided training protocols may be adequate to train non-ophthalmologists to grade retinal images for pre-plus and plus disease with high sensitivity. [J Pediatr Ophthalmol Strabismus. 2016;53(3):179-185.].

Full Text

Duke Authors

Cited Authors

  • Raufi, NN; Morris, CK; Freedman, SF; Wallace, DK; Prakalapakorn, SG

Published Date

  • May 1, 2016

Published In

Volume / Issue

  • 53 / 3

Start / End Page

  • 179 - 185

PubMed ID

  • 27224953

Pubmed Central ID

  • PMC4963259

Electronic International Standard Serial Number (EISSN)

  • 1938-2405

Digital Object Identifier (DOI)

  • 10.3928/01913913-20160314-01


  • eng

Conference Location

  • United States