PLUS DISEASE DIAGNOSIS IN RETINOPATHY OF PREMATURITY: Vascular Tortuosity as a Function of Distance from Optic Disk

Purpose: To examine vascular tortuosity as a function of distance from the optic disk in infants with retinopathy of prematurity. Methods: Thirty-four wide-angle retinal images from infants with retinopathy of prematurity were reviewed by 22 experts. A reference standard for each image was defined as the diagnosis (plus vs. not plus) given by the majority of experts. Tortuosity, defined as vessel length divided by straight line distance between vessel end points, was calculated as a function of distance from the disk margin for arteries and veins using computer-based methods developed by the authors. Results: Mean cumulative tortuosity increased with distance from the disk margin, both in 13 images with plus disease (P = 0.007 for arterial tortuosity [n = 62 arteries], P < 0.001 for venous tortuosity [n = 58 veins] based on slope of best fit line by regression), and in 21 images without plus disease (P < 0.001 for arterial tortuosity [n = 94 arteries], P <0 .001 for venous tortuosity [n = 85 veins]). Images with plus disease had significantly higher vascular tortuosity than images without plus disease (P < 0.05), up to 7.0 disk diameters from the optic disk margin. Conclusion: Vascular tortuosity was higher peripherally than centrally, both in images with and without plus disease, suggesting that peripheral retinal features may be relevant for retinopathy of prematurity diagnosis.