Objective:To determine the accuracy and reliability of retinopathy of prematurity(ROP)diagnosis using remote review of digital images by 3 masked ophthalmologist readers.Methods:An atlaswas compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera.All the images were independently reviewed by 3 readers,and the diagnosis in each eye was classified into 1 of 4 ordinal categories:no ROP,mild ROP,type 2 prethreshold ROP,or ROP requiring treatment.Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist.Results:Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader,0.816/0.955 for the second reader,and 0.864/0.493 for the third reader.Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader,0.850/0.973 for the second reader,and 0.900/0.953 for the third reader.When ROP was classified into ordinal categories,the overall weighted κ for interreader reliability was 0.743.Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers.Conclusion:The accuracy,interreader reliability,and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial. Objective: To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using digital review by 3 masked ophthalmologist readers. Methods: An atlaswas compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were conducted by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist. Results: Sensitivities / specificities of the diagnosis of any ROP were 0.845 / 0.910 for the first reader, 0.816 / 0.955 for the second reader, and 0.864 /0.493 for the third reader. Sensitivities / specificities of the diagnosis of ROP requiring treatment were 0.850 / 0.960 for the first reader, 0.850 / 0.973 for the second reader, and 0.900 / 0.953 for the third reader. Who ROP was classified into ordinal categories, the overall weighted κ for interreader reliability was 0.743.Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers. Confclusion: The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.