Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Impact of image enhancement on grading agreement of plus disease features in retinopathy of prematurity.
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Catania Fiammetta, Barjol Amandine, Gallardo Mathias, Metge Florence, Sénicourt Lucile, Albanese Giuseppe Maria, Abdel Massih Youssef, Caputo Georges, Chapron Thibaut
Аннотация
BACKGROUND: To determine whether targeted image enhancement improves intergrader agreement in assessing vascular features of plus disease in retinopathy of prematurity (ROP), and to identify which specific features and clinical subgroups benefit most.
METHODS: This prospective image grading study included 48 eyes from preterm infants undergoing ROP screening at a tertiary care center. All eyes were imaged with the RetCam Envision system. For each eye, five fundus images centered on the optic disc were selected and underwent standardized enhancement combining blue-channel attenuation and CLAHE-based contrast optimization. Five pediatric ophthalmologists with varying ROP experience independently evaluated raw and enhanced image sets in two grading rounds, one month apart. For each quadrant, graders recorded the presence or absence of arterial and venous tortuosity and dilation. Intergrader agreement was quantified using unweighted and weighted Fleiss' kappa and overall percentage agreement.
RESULTS: Image enhancement significantly improved intergrader agreement (mean weighted agreement: 61.5% for raw vs. 67.8% for enhanced images, p < 0.05). The greatest improvements were observed for arterial tortuosity (+ 11.9%) and vein tortuosity (+ 6.5%). Nasal quadrants showed the most pronounced benefit. Subgroup analyses revealed larger improvements in borderline pre-plus cases and in eyes that had previously received treatment.
CONCLUSIONS: Targeted image enhancement improves intergrader agreement in the evaluation of plus disease in ROP, especially for diagnostically challenging features and regions. The strongest effect is seen in borderline and treated cases, supporting the integration of standardized preprocessing techniques to enhance diagnostic objectivity for both clinicians and AI-assisted systems.
METHODS: This prospective image grading study included 48 eyes from preterm infants undergoing ROP screening at a tertiary care center. All eyes were imaged with the RetCam Envision system. For each eye, five fundus images centered on the optic disc were selected and underwent standardized enhancement combining blue-channel attenuation and CLAHE-based contrast optimization. Five pediatric ophthalmologists with varying ROP experience independently evaluated raw and enhanced image sets in two grading rounds, one month apart. For each quadrant, graders recorded the presence or absence of arterial and venous tortuosity and dilation. Intergrader agreement was quantified using unweighted and weighted Fleiss' kappa and overall percentage agreement.
RESULTS: Image enhancement significantly improved intergrader agreement (mean weighted agreement: 61.5% for raw vs. 67.8% for enhanced images, p < 0.05). The greatest improvements were observed for arterial tortuosity (+ 11.9%) and vein tortuosity (+ 6.5%). Nasal quadrants showed the most pronounced benefit. Subgroup analyses revealed larger improvements in borderline pre-plus cases and in eyes that had previously received treatment.
CONCLUSIONS: Targeted image enhancement improves intergrader agreement in the evaluation of plus disease in ROP, especially for diagnostically challenging features and regions. The strongest effect is seen in borderline and treated cases, supporting the integration of standardized preprocessing techniques to enhance diagnostic objectivity for both clinicians and AI-assisted systems.