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Editorial |

It's Plus Disease, Isn't It?

Dale L. Phelps, MD
Arch Ophthalmol. 2007;125(7):963-964. doi:10.1001/archopht.125.7.963.
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Chiang and colleagues1 collected valuable, reliable data on between-examiner variations in the diagnosis of plus disease in retinopathy of prematurity (ROP). They found no “gold standard” in the traditional meaning of an accurate, diagnostic “truth.” Twenty-two experts had moderately high disagreement on the diagnosis of plus and pre-plus disease on 34 high-quality, wide-angle fundus photographs. This was disappointing because plus disease is the key defining characteristic in the decision to treat ROP with peripheral ablative surgery. They conclude that the disagreement has important implications for the clinical management, classification, and development of computer-based diagnostic algorithms and telemedicine systems.1

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