1
|
Sobhy M, Cole E, Jabbehdari S, Valikodath NG, Al-Khaled T, Kalinoski L, Chervinko M, Cherwek DH, Chuluunkhuu C, Shah PK, K C S, Jonas KE, Scanzera A, Yap VL, Yeh S, Kalpathy-Cramer J, Chiang MF, Campbell JP, Chan RVP. Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework. Int Ophthalmol Clin 2023; 63:39-63. [PMID: 36598833 PMCID: PMC9839316 DOI: 10.1097/iio.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retinopathy of prematurity (ROP) is one of the leading causes of preventable pediatric blindness worldwide. ROP screening programs have been previously implemented in multiple low- and middle-income countries. On a global scale, it is crucial that evidence-based, standardized screening criteria are utilized in the early detection and treatment of ROP. In this review article, we utilize the National Public Health Performance Standards (NPHPS) Ten Essential Public Health Services Model organized by the core functions of assessment, policy development, and assurance to evaluate the barriers and successes of existing ROP screening programs. This framework can be applied to countries facing the third epidemic of ROP and can be used to establish a generalized model for eye care and screening worldwide.
Collapse
|
2
|
Neves LM, Haefeli LM, Zin AA, Steffen RE, Vasconcelos ZFM, Pinto M. Cost-Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil. Front Pediatr 2021; 9:757258. [PMID: 34976892 PMCID: PMC8716796 DOI: 10.3389/fped.2021.757258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate the cost-utility of wide-field imaging (WFI) as a complementary technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified Health System's perspective. Introduction: ROP is one of the leading causes of avoidable childhood blindness worldwide, especially in middle-income countries. The current ROP screening involves indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However, there is still insufficient ROP screening coverage. An alternative screening strategy is the combination of WFI with IBO. Methods: A cost-utility analysis was performed using a deterministic decision-tree simulation model to estimate incremental cost-utility for ROP care. Two screening strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population included preterm infants <32 weeks of gestational age or birth weight equal to or <1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to utility, and the health benefits were estimated on quality-adjusted life-years (QALY). Incremental cost per QALY gained was calculated from the health system perspective. Costs were estimated considering equipment, maintenance, consumables, and staff. A micro-costing approach was used for WFI. Two technician nurses were trained for imaging execution and had their time evaluated. Two ROP expert ophthalmologists had their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: Combined screening strategy resulted in a cost-effective program considering 90% ROP screening coverage. Costs per examination: (1) screening with IBO: US dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment: US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the infant's visual function. Incremental cost per QALY gained was US $1,746.99/QALY per infant screened with the combination strategy. One-way sensitivity analysis resulted in cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100% probability of combination being cost-effective in a willingness-to-pay threshold of US $1,800/QALY. Conclusion: The combined strategy for ROP screening was cost-effective. It enhances access for appropriate ROP care in middle-income countries and dminishes opportunity costs for ophthalmologists.
Collapse
Affiliation(s)
- Luiza M Neves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lorena M Haefeli
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andrea A Zin
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ricardo E Steffen
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Medicina, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janerio, Brazil
| | - Zilton F. M Vasconcelos
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Márcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Al-Khaled T, Valikodath NG, Patel SN, Cole E, Chervinko M, Douglas CE, Tsai ASH, Wu WC, Campbell JP, Chiang MF, Paul Chan RV. Addressing the Third Epidemic of Retinopathy of Prematurity Through Telemedicine and Technology: A Systematic Review. J Pediatr Ophthalmol Strabismus 2021; 58:261-269. [PMID: 34288773 DOI: 10.3928/01913913-20210223-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The rising prevalence of retinopathy of prematurity (ROP) in low- and middle-income countries has increased the need for screening at-risk infants. The purpose of this article was to review the impact of tele-medicine and technology on ROP screening programs. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed using PubMed, Pro-Quest, and Google Scholar bibliographic search engine. Terms searched included retinopathy of prematurity, telemedicine, and tele-ophthalmology. Data regarding internet access and gross domestic product per capita were obtained from the World Bank. Information was also obtained about internet access, speeds, and costs in low-income countries. There has been increasing integration of telemedicine and technology for ROP screening and management. Low-income countries are using available internet options and information and communications technology for ROP screening, which can aid in addressing the unique challenges faced by low-income countries. This provides a promising solution to the third epidemic of ROP by expanding and improving screening and management. Although telemedicine systems may serve as a cost-effective approach to facilitate delivery of health care, programs (especially in lowand middle-income countries) require national support to maintain its infrastructure. [J Pediatr Ophthalmol Strabismus. 2021;58(4):261-269.].
Collapse
|
4
|
Abstract
Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.
Collapse
|
5
|
Sim SS, Yip MY, Wang Z, Tan ACS, Tan GSW, Cheung CMG, Chakravarthy U, Wong TY, Teo KYC, Ting DS. Digital Technology for AMD Management in the Post-COVID-19 New Normal. Asia Pac J Ophthalmol (Phila) 2021; 10:39-48. [PMID: 33512827 DOI: 10.1097/apo.0000000000000363] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has put strain on healthcare systems and the availability and allocation of healthcare manpower, resources and infrastructure. With immediate priorities to protect the health and safety of both patients and healthcare service providers, ophthalmologists globally were advised to defer nonurgent cases, while at the same time managing sight-threatening conditions such as neovascular Age-related Macular Degeneration (AMD). The management of AMD patients both from a monitoring and treatment perspective presents a particular challenge for ophthalmologists. This review looks at how these pressures have encouraged the acceptance and speed of adoption of digitalization. DESIGN AND METHODS A literature review was conducted on the use of digital technology during COVID-19 pandemic, and on the transformation of medicine, ophthalmology and AMD screening through digitalization. RESULTS In the management of AMD, the implementation of artificial intelligence and "virtual clinics" have provided assistance in screening, diagnosis, monitoring of the progression and the treatment of AMD. In addition, hardware and software developments in home monitoring devices has assisted in self-monitoring approaches. CONCLUSIONS Digitalization strategies and developments are currently ongoing and underway to ensure early detection, stability and visual improvement in patients suffering from AMD in this COVID-19 era. This may set a precedence for the post COVID-19 new normal where digital platforms may be routine, standard and expected in healthcare delivery.
Collapse
Affiliation(s)
- Shaun Sebastian Sim
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Michelle Yt Yip
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Zhaoran Wang
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Anna Cheng Sim Tan
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Usha Chakravarthy
- Queen's University of Belfast Royal Victoria Hospital, Belfast, Ireland
| | - Tien Yin Wong
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kelvin Yi Chong Teo
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Daniel Sw Ting
- Singapore National Eye Centre
- Singapore Eye Research Institute
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| |
Collapse
|
6
|
Antaki F, Bachour K, Kim TN, Qian CX. The Role of Telemedicine to Alleviate an Increasingly Burdened Healthcare System: Retinopathy of Prematurity. Ophthalmol Ther 2020; 9:449-464. [PMID: 32562242 PMCID: PMC7406614 DOI: 10.1007/s40123-020-00275-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 12/23/2022] Open
Abstract
Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.
Collapse
Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Kenan Bachour
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tyson N Kim
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Cynthia X Qian
- Department of Ophthalmology, Centre Universitaire d'Ophtalmologie (CUO), Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.
| |
Collapse
|
7
|
Athikarisamy SE, Lam GC, Ross S, Rao SC, Chiffings D, Simmer K, Bulsara MK, Patole S. Comparison of wide field imaging by nurses with indirect ophthalmoscopy by ophthalmologists for retinopathy of prematurity: a diagnostic accuracy study. BMJ Open 2020; 10:e036483. [PMID: 32759245 PMCID: PMC7409991 DOI: 10.1136/bmjopen-2019-036483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina with the potential to cause irreversible blindness. Timely screening and treatment of ROP are critical. Neonatal nurses trained in wide field digital retinal photography (WFDRP) for screening may provide a safe and effective strategy to reduce the burden of ophthalmologists in performing binocular indirect ophthalmoscopy (BIO). The objective of the study was to determine the diagnostic accuracy of WFDRP in the diagnosis of referral warranting ROP (RWROP). DESIGN Prospective diagnostic accuracy study. SETTING A tertiary neonatal intensive care unit in Perth, Western Australia. PARTICIPANTS Preterm infants who fulfilled the Australian ROP screening criteria (gestational age (GA) <31 weeks, birth weight (BW) <1250 g). INTERVENTION Sets of 5-6 images per eye (index test) were obtained within 24-48 hours prior to or after the BIO (reference standard), and uploaded onto a secured server. A wide field digital camera (RetCam, Natus, Pleasanton, California, USA) was used for imaging. A paediatric ophthalmologist performed the BIO. The ophthalmologists performing BIO versus reporting the images were masked to each other's findings. PRIMARY OUTCOME The area under the receiver operating characteristic (ROC) curve was used as a measure of accuracy of WFDRP to diagnose RWROP. RESULTS A total of 85 infants (mean BW; 973.43 g, mean GA; 29 weeks) underwent a median of two sessions of WFDRP. There were 188 episodes of screening with an average of five images per eye. WFDRP identified RWROP in 7.4% (14/188 sessions) of examinations. In one infant, BIO showed bilateral plus disease and WFDRP did not pick up the plus disease. WFDRP image interpretation had a sensitivity of 80%, specificity of 94.5% for the detection of RWROP. The 'area under the ROC curve' was 88% when adjusted for covariates. CONCLUSIONS WFDRP by neonatal nurses was feasible and effective for diagnosing RWROP in our set up. TRIAL REGISTRATION NUMBER ACTRN12616001386426.
Collapse
Affiliation(s)
- Sam Ebenezer Athikarisamy
- Department of Neonatology, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey Christopher Lam
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Stuart Ross
- Department of Ophthalmology, Midland Swan Valley Clinic, Perth, Western Australia, Australia
| | - Shripada Cuddapah Rao
- Department of Neonatology, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Debbie Chiffings
- Department of Neonatology, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Karen Simmer
- Department of Neonatology, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Max K Bulsara
- Biostatistics, Institute for Health Research, University of Notre Dame, Perth, Western Australia, Australia
| | - Sanjay Patole
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
8
|
Horton MB, Brady CJ, Cavallerano J, Abramoff M, Barker G, Chiang MF, Crockett CH, Garg S, Karth P, Liu Y, Newman CD, Rathi S, Sheth V, Silva P, Stebbins K, Zimmer-Galler I. Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition. Telemed J E Health 2020; 26:495-543. [PMID: 32209018 PMCID: PMC7187969 DOI: 10.1089/tmj.2020.0006] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022] Open
Abstract
Contributors The following document and appendices represent the third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy. These guidelines were developed by the Diabetic Retinopathy Telehealth Practice Guidelines Working Group. This working group consisted of a large number of subject matter experts in clinical applications for telehealth in ophthalmology. The editorial committee consisted of Mark B. Horton, OD, MD, who served as working group chair and Christopher J. Brady, MD, MHS, and Jerry Cavallerano, OD, PhD, who served as cochairs. The writing committees were separated into seven different categories. They are as follows: 1.Clinical/operational: Jerry Cavallerano, OD, PhD (Chair), Gail Barker, PhD, MBA, Christopher J. Brady, MD, MHS, Yao Liu, MD, MS, Siddarth Rathi, MD, MBA, Veeral Sheth, MD, MBA, Paolo Silva, MD, and Ingrid Zimmer-Galler, MD. 2.Equipment: Veeral Sheth, MD (Chair), Mark B. Horton, OD, MD, Siddarth Rathi, MD, MBA, Paolo Silva, MD, and Kristen Stebbins, MSPH. 3.Quality assurance: Mark B. Horton, OD, MD (Chair), Seema Garg, MD, PhD, Yao Liu, MD, MS, and Ingrid Zimmer-Galler, MD. 4.Glaucoma: Yao Liu, MD, MS (Chair) and Siddarth Rathi, MD, MBA. 5.Retinopathy of prematurity: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD. 6.Age-related macular degeneration: Christopher J. Brady, MD, MHS (Chair) and Ingrid Zimmer-Galler, MD. 7.Autonomous and computer assisted detection, classification and diagnosis of diabetic retinopathy: Michael Abramoff, MD, PhD (Chair), Michael F. Chiang, MD, and Paolo Silva, MD.
Collapse
Affiliation(s)
- Mark B. Horton
- Indian Health Service-Joslin Vision Network (IHS-JVN) Teleophthalmology Program, Phoenix Indian Medical Center, Phoenix, Arizona
| | - Christopher J. Brady
- Division of Ophthalmology, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Jerry Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Michael Abramoff
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, and The University of Iowa, Iowa City, Iowa
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa
- Department of Ophthalmology, Stephen A. Wynn Institute for Vision Research, The University of Iowa, Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- IDx, Coralville, Iowa
| | - Gail Barker
- Arizona Telemedicine Program, The University of Arizona, Phoenix, Arizona
| | - Michael F. Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | - Seema Garg
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Siddarth Rathi
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Veeral Sheth
- University Retina and Macula Associates, University of Illinois at Chicago, Chicago, Illinois
| | - Paolo Silva
- Beetham Eye Institute, Joslin Diabetes Center, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kristen Stebbins
- Vision Care Department, Hillrom, Skaneateles Falls, New York, New York
| | | |
Collapse
|
9
|
Brady CJ, D'Amico S, Campbell JP. Telemedicine for Retinopathy of Prematurity. Telemed J E Health 2020; 26:556-564. [PMID: 32209016 DOI: 10.1089/tmj.2020.0010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Retinopathy of prematurity (ROP) is a disease of the retinal vasculature that remains a leading cause of childhood blindness worldwide despite improvements in the systemic care of premature newborns. Screening for ROP is effective and cost-effective, but in many areas, access to skilled examiners to conduct dilated examinations is poor. Remote screening with retinal photography is an alternative strategy that may allow for improved ROP care. Methods: The current literature was reviewed to find clinical trials and expert consensus documents on the state-of-the-art of telemedicine for ROP. Results: Several studies have confirmed the utility of telemedicine for ROP. In addition, several clinical studies have reported favorable long-term results. Many investigators have reinforced the need for detailed protocols on image acquisition and image interpretation. Conclusions: Telemedicine for ROP appears to be a viable alternative to live ophthalmoscopic examinations in many circumstances. Standardization and documentation afforded by telemedicine may provide additional benefits to providers and their patients. With continued improvements in image quality and affordability of imaging systems as well as improved automated image interpretation tools anticipated in the near future, telemedicine for ROP is expected to play an expanding role for a uniquely vulnerable patient population.
Collapse
Affiliation(s)
- Christopher J Brady
- Division of Ophthalmology, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Samantha D'Amico
- Division of Ophthalmology, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - J Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
10
|
Toslak D, Chau F, Erol MK, Liu C, Chan RVP, Son T, Yao X. Trans-pars-planar illumination enables a 200° ultra-wide field pediatric fundus camera for easy examination of the retina. BIOMEDICAL OPTICS EXPRESS 2020; 11:68-76. [PMID: 32010500 PMCID: PMC6968751 DOI: 10.1364/boe.11.000068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 05/18/2023]
Abstract
This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric fundus photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric fundus photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.
Collapse
Affiliation(s)
- Devrim Toslak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Felix Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Changgeng Liu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Biolight Engineering LLC, Hinsdale, IL 60521-3181, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| |
Collapse
|
11
|
Maka E, Kovács G, Imre L, Gilbert C, Szabó M, Németh J, Nagy ZZ, Somogyvári Z. The validity of telemedicine-based screening for retinopathy of prematurity in the Premature Eye Rescue Program in Hungary. J Telemed Telecare 2019; 27:367-375. [PMID: 31645172 DOI: 10.1177/1357633x19880113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the validity of wide-field digital imaging (WFDI) and telemedicine-based screening compared with examination by binocular indirect ophthalmoscopy (BIO) and to present some of the results from the first five years of telemedicine-based screening in the Premature Eye Rescue Program in Hungary. METHODS We performed a retrospective analysis in two periods that aimed to assess (a) the validity of retinal digital imaging and (b) routine bedside screening. The validity was assessed in two neonatal intensive care units (NICUs), one in the First Department of Paediatrics and the other in the Second Department of Obstetrics and Gynaecology, Semmelweis University. The telemedicine-based WFDI (WFDI-TM) screening program was introduced in two phases. In the first phase (from 30 November 2009 to 8 August 2010), BIO and WFDI were performed by the same paediatric ophthalmologist (Group A). In the second phase (from 9 August 2010 to 29 March 2011), BIO was performed by the paediatric ophthalmologist, while retinal images were captured by a trained neonatal transport nurse practitioner (Group B). BIO screening was the reference method as a gold standard in both phases. RESULTS During the validity assessment period 634 examinations were performed in 153 preterm infants. Overall, 76 babies were screened in Group A and 80 were screened in Group B. We found lower sensitivity and specificity in cases of any ROP (sensitivity 86%, specificity 99%) compared with those of treatment-requiring retinopathy of prematurity (TR-ROP) (both sensitivity and specificity 100%).In the Premature Eye Rescue Program between 1April 2011 and 31 March 2016, we used WFDI in 3035 infants (4589 procedures). Over this five-year period, 100 (9.6%) infants were treated by laser, and no child who received care in any of the Semmelweis University NICUs became blind from ROP. CONCLUSIONS (a) WFDI-TM ROP screening is a useful and efficient approach, although it cannot completely replace BIO; (b) no ROP-related blindness developed among the screened preterm babies; and (c) WFDI-TM ROP screening can be implemented in the logistics of a neonatal emergency and ambulance team infrastructure with neonatal transport nurse practitioners as 'photographers'.
Collapse
Affiliation(s)
- Erika Maka
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Gábor Kovács
- Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary
| | - László Imre
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | - Miklós Szabó
- 1st Department of Paediatrics Semmelweis University, Hungary
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Hungary.,Department of Family Care Methodology, Semmelweis University, Hungary
| | - Zsolt Somogyvári
- Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary.,Department of Family Care Methodology, Semmelweis University, Hungary
| |
Collapse
|
12
|
Leng Y, Huang W, Ren G, Cai C, Tan Q, Liang Y, Yang W, Gao Z. The treatment and risk factors of retinopathy of prematurity in neonatal intensive care units. BMC Ophthalmol 2018; 18:301. [PMID: 30458733 PMCID: PMC6247707 DOI: 10.1186/s12886-018-0973-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background Retinopathy of prematurity (ROP) is a vascular proliferative disorder of the developing retina and a significant cause of childhood blindness around the world. The incidence of ROP is affected by many factors, and the incidence rate varies from country to country. The purpose of this study is to report the incidence and risk factors of ROP in neonatal intensive care unit (NICU) of Guangzhou First People’s Hospital in China. Methods A retrospective review was performed on 436 premature infants who were consecutive ROP screened in the NICU of Guangzhou First People’s Hospital from March 2013 to October 2017. The single-factor analysis and the logistic multivariate regression analysis were used to detect risk factors of ROP. Results Total 436 premature infants were consecutive ROP screened, 138 (31.65%) were found ROP, and 61(13.99%) were treated. The single-factor analysis revealed that the incidence of ROP was associated with multiple births, gestational age, birth weight, mechanical ventilation, intravascular hemolysis, the number of operations and blood culture results. The logistic multivariate regression analysis revealed that gestational age; birth weight, mechanical ventilation, minimum SaO2 and daily weight gain were independent risk factors for ROP onset. Forty-nine patients underwent retinal laser photocoagulation with recurrence 20 patients. Twelve patients underwent anti-VEGF drug (Ranibizumab) via intraocular injection with 5 patients of recurrence. Conclusions The incidence of ROP in NICU of Guangzhou China will match those in middle-income countries, but higher than high-income countries. Anti-VEGF drugs could be preferred as a good treatment method for zone 1 ROP and aggressive posterior ROP.
Collapse
Affiliation(s)
- Yunxia Leng
- Guangzhou First People's Hospital, Guangzhou city, China.,Second Affiliated Hospital of South China University of Technology, Guangzhou city, China
| | - Wenzhi Huang
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Guoliang Ren
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Cheng Cai
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Qingbiao Tan
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Yuqin Liang
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Weizhong Yang
- Guangzhou First People's Hospital, Guangzhou city, China
| | - Zongyin Gao
- Guangzhou First People's Hospital, Guangzhou city, China. .,Second Affiliated Hospital of South China University of Technology, Guangzhou city, China.
| |
Collapse
|
13
|
Moitry M, Zarca K, Granier M, Aubelle MS, Charrier N, Vacherot B, Caputo G, Mimouni M, Jarreau PH, Durand-Zaleski I. Effectiveness and efficiency of tele-expertise for improving access to retinopathy screening among 351 neonates in a secondary care center: An observational, controlled before-after study. PLoS One 2018; 13:e0206375. [PMID: 30365544 PMCID: PMC6203387 DOI: 10.1371/journal.pone.0206375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022] Open
Abstract
In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5-5.7] versus 2.0/10, range [1.0-3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed.
Collapse
Affiliation(s)
- Marie Moitry
- Laboratoire d’Épidémiologie et de Santé Publique, Strasbourg, France
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Kevin Zarca
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
- Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France
| | - Michèle Granier
- Service de réanimation néonatale, Hôpitaux Sud Francilien, Evry, France
| | - Marie-Stéphanie Aubelle
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
- DHU Risques et grossesse, Université Paris Descartes, Paris, France
| | | | - Brigitte Vacherot
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Georges Caputo
- Service d’ophtalmologie pédiatrique, Fondation Rothschild, Paris, France
| | - Maroua Mimouni
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
- DHU Risques et grossesse, Université Paris Descartes, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
- Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France
- Faculté de Médecine, Université Paris-Est & ECEVE UMRS, Créteil, France
| |
Collapse
|
14
|
Diagnostic accuracy of a digital fundus photographic system for detection of retinopathy of prematurity requiring treatment (ROP-RT). PLoS One 2018; 13:e0201544. [PMID: 30063746 PMCID: PMC6067727 DOI: 10.1371/journal.pone.0201544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives To evaluate the diagnostic accuracy of a digital fundus photographic system that consists of taking fundus photographs by a trained technician using a RetCam® shuttle and interpreting fundus images by an expert to detect Retinotapthy of Prematurity requiring treatment (ROP-RT) which defined as type I ROP according to the Early Treatment for ROP study (ETROP). Materials and methods One hundred infants were examined by (1) an expert ophthalmologist experienced in ROP care using indirect ophthalmoscopy; (2) digital wide-field imaging by a trained technician using a RetCam® shuttle and images were sent remotely for interpretation by two ophthalmologists experienced in ROP care (Reader A, and Reader B); and (3) local ophthalmologists using indirect ophthalmoscopy. The diagnostic acurracy consisting of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated. Agreement between all examiners and readers were evaluated. Results A total of 100 infants (mean gestational age 31.1 weeks, mean birth weight 1,511.1 grams) participated in the study. Nine infants were classified as ROP-RT. Reader A and B had very good agreement in detection of ROP- RT (Kappa 1.00, 95% CI 1.00, 1.00). For reader A, diagnostic performance parameters (95% confidence intervals) for detecting ROP-RT were; sensitivity 100.0% (66.4, 100.0), specificity 97.8% (92.1, 99.7), PPV 81.8% (48.2, 97.7), NPV 100.0% (95.8, 100.0), LR+ 44.5 (11.3, 175.2), and LR- 0.1 (0.0, 0.8). For reader B these were; sensitivity 100.0% (66.4, 100.0), specificity 95.6% (89.0, 98.8), PPV 69.2% (38.6, 90.9), NPV 100.0% (95.8, 100.0), LR+ 22.5 (8.6, 58.6), LR- 0.1 (0.0, 0.8). No adverse events were reported. Conclusions Diagnosis of ROP-RT from RetCam® images taken by trained technicians and evaluated remotely by an expert ophthalmologist had good diagnostic accuracy for screening purposes.
Collapse
|
15
|
Darwish D, Chee RI, Patel SN, Jonas K, Ostmo S, Campbell JP, Chiang MF, Chan RP. Anti-Vascular Endothelial Growth Factor and the Evolving Management Paradigm for Retinopathy of Prematurity. Asia Pac J Ophthalmol (Phila) 2018; 7:136-144. [PMID: 29808629 PMCID: PMC7880609 DOI: 10.22608/apo.201850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diagnosis and management of pediatric retinal conditions such as retinopathy of prematurity (ROP) have been evolving significantly with the availability of new technology and treatments. New imaging systems, telemedicine, tele-education, and anti‒vascular endothelial growth factor (VEGF) intravitreal pharmacotherapy are all changing the way we diagnose and deliver care to children with pediatric retinal disease. Fluorescein angiography and optical coherence tomography have the potential to improve our diagnosis and management of disease, and with improvements in retinal imaging, telemedicine is becoming more feasible. Telemedicine, tele-education, and computer-based image analysis may overcome many of the challenges we face in providing adequate care and access for children with pediatric retinal disease. Treatment options have also expanded with the use of anti-VEGF therapy. Although the use of intravitreal anti-VEGF for ROP has been documented in the literature for more than a decade, many questions still remain about its safety in the pediatric patient population. Several ongoing prospective studies are exploring the utility of anti-VEGF agents for ROP, with attention to the optimal dose of drug, systemic safety, and our understanding of recurrence of disease. This review aims to provide an update on current diagnostic and therapeutic modalities, focusing predominantly on the role of anti-VEGF therapy, for the management of ROP and other pediatric retinal vascular diseases.
Collapse
Affiliation(s)
- Dana Darwish
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Ru-Ik Chee
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Samir N. Patel
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Karyn Jonas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | - Michael F. Chiang
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
16
|
Single grading vs double grading with adjudication in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study. J AAPOS 2018; 22:32-37. [PMID: 29274372 PMCID: PMC5826856 DOI: 10.1016/j.jaapos.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/11/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the sensitivity and specificity of single, independent, nonphysician trained reader (TR) gradings in the Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP) study. METHODS Secondary analyses of image grading results from 1,235 infants of birth weights <1251 g. Two of three TRs independently graded image sets; discrepancies were adjudicated by the reading center director (an ophthalmologist) to reach final grading. Sensitivity and specificity of each TR grading and final grading was calculated by comparing gradings to clinical examination results. RESULTS Of 7,808 double graded image sets, TR1 graded 5,165; TR2, 3,787; and TR3, 6,664. Compared to final grading for referral warranted retinopathy of prematurity (RW-ROP), two TRs had relatively lower sensitivity (TR1, 75% vs 79% [P = 0.03]; TR2, 73% vs 77% [P = 0.02]) and specificity (TR1, 80% vs 83% [P < 0.001]; TR2, 82% vs 83% [P = 0.09]). TR3 had similar sensitivity (83% vs 83% [P = 0.78]) and specificity (83% vs 84% [P = 0.02]). Compared to final grading, TR1 had lower sensitivity for zone I ROP (47% vs 56% [P = 0.04]) and stage ≥3 ROP (71% vs 77% [P = 0.002]); TR2 had lower sensitivity for stage ≥3 ROP (69% vs 77% [P < 0.001]) and lower specificity for all three components (P < 0.001); TR3 had lower sensitivity for detecting plus disease (23% vs 35% [P < 0.001]) and similar sensitivity for zone I ROP and stage ≥3 ROP. CONCLUSIONS There is a small but significant decrease in the sensitivity and specificity for RW-ROP when single-reader grading is compared to double adjudicated grading.
Collapse
|
17
|
Abstract
With the increasing survival of preterm babies in the Asia-Pacific region, there has been an increase in the incidence of retinopathy of prematurity (ROP). There is also a lack of trained ophthalmologists to screen for this disease. New strategies for screening of ROP are required, wherein the load on the ophthalmologist can be reduced. Telemedicine is an excellent tool to address this need. This paper reviews the initial studies comparing digital imaging with indirect ophthalmoscopy, the current active ROP telescreening programs in the world, and ends with studies dealing with automated diagnosis of ROP.
Collapse
Affiliation(s)
- Parag K Shah
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Appanraj Ramya
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Venkatapathy Narendran
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| |
Collapse
|
18
|
Arnold RW, Grendahl RL, Kevin Winkle R, Jacob J. Outpatient, Wide-Field, Digital Imaging of Infants With Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2017; 48:494-497. [DOI: 10.3928/23258160-20170601-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/22/2017] [Indexed: 12/19/2022]
|
19
|
Rogers DL, Bremer DL, Fellows RR, Baumritter A, Daniel E, Pastilli M, Ying GS, Quinn GE. Comparison of strategies for grading retinal images of premature infants for referral warranted retinopathy of prematurity. J AAPOS 2017; 21:141-145. [PMID: 28336472 PMCID: PMC5502683 DOI: 10.1016/j.jaapos.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the accuracy of identifying referral-warranted retinopathy of prematurity (RW-ROP, defined as any zone I ROP, stage 3 or worse, or plus disease) from retinal image sets using three grading protocols: a single optic disk-centered image, a set of 3 horizontal images, and a 5-image set. METHODS In this secondary analysis of images from the e-ROP study, a weighted sample of 250 image sets from 250 infants (125 with RW-ROP and 125 without RW-ROP) was randomly selected. The sensitivities and specificities for detecting RW-ROP and its components from a single disk center image, along with nasal and temporal retinal images, were calculated and compared with the e-ROP grading of RW-ROP of all 5 retinal images (disk center and nasal, temporal, superior, and inferior retinal images). RESULTS RW-ROP was identified with a sensitivity of 11.2% (95% CI, 6.79%-17.9%) using a single disk center image, with a sensitivity of 70.4% (95% CI, 61.9%-77.9%) using 3 horizontal images, and a statistically higher sensitivity of 82.4% (95% CI, 75.0%-89.0%) using all 5 images (P = 0.002). The specificities were 100%, 86.4%, and 90.4%, respectively. For grading using 3 horizontal images, sensitivity was 14.3% for plus disease, 25% for zone I ROP, and 71.2% for stage 3 or worse compared to 40.8%, 50%, and 79.8% for grading using 5-image sets, respectively. CONCLUSIONS Both a single, disk-centered, posterior pole image and 3 horizontal images were less effective than a 5-image set in determining the presence of RW-ROP on qualitative grading by trained readers.
Collapse
Affiliation(s)
- David L Rogers
- Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Don L Bremer
- Department of Ophthalmology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Rae R Fellows
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Agnieshka Baumritter
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Max Pastilli
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gui-Shang Ying
- Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Graham E Quinn
- Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | |
Collapse
|
20
|
Wood EH, Moshfeghi AA, Nudleman ED, Moshfeghi DM. Evaluation of Visunex Medical's PanoCam(TM) LT and PanoCam(TM) Pro wide-field imaging systems for the screening of ROP in newborn infants. Expert Rev Med Devices 2017; 13:705-12. [PMID: 27424884 DOI: 10.1080/17434440.2016.1208560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas. AREAS COVERED A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies' websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures. Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.
Collapse
Affiliation(s)
- Edward H Wood
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
| | - Andrew A Moshfeghi
- b USC Eye Institute, Department of Ophthalmology , University of Southern California Keck School of Medicine , Los Angeles , CA , USA
| | - Eric D Nudleman
- c Shiley Eye Institute, Department of Ophthalmology , University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Darius M Moshfeghi
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
| |
Collapse
|
21
|
Hansen RM, Moskowitz A, Akula JD, Fulton AB. The neural retina in retinopathy of prematurity. Prog Retin Eye Res 2017; 56:32-57. [PMID: 27671171 PMCID: PMC5237602 DOI: 10.1016/j.preteyeres.2016.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 12/26/2022]
Abstract
Retinopathy of prematurity (ROP) is a neurovascular disease that affects prematurely born infants and is known to have significant long term effects on vision. We conducted the studies described herein not only to learn more about vision but also about the pathogenesis of ROP. The coincidence of ROP onset and rapid developmental elongation of the rod photoreceptor outer segments motivated us to consider the role of the rods in this disease. We used noninvasive electroretinographic (ERG), psychophysical, and retinal imaging procedures to study the function and structure of the neurosensory retina. Rod photoreceptor and post-receptor responses are significantly altered years after the preterm days during which ROP is an active disease. The alterations include persistent rod dysfunction, and evidence of compensatory remodeling of the post-receptor retina is found in ERG responses to full-field stimuli and in psychophysical thresholds that probe small retinal regions. In the central retina, both Mild and Severe ROP delay maturation of parafoveal scotopic thresholds and are associated with attenuation of cone mediated multifocal ERG responses, significant thickening of post-receptor retinal laminae, and dysmorphic cone photoreceptors. These results have implications for vision and control of eye growth and refractive development and suggest future research directions. These results also lead to a proposal for noninvasive management using light that may add to the currently invasive therapeutic armamentarium against ROP.
Collapse
Affiliation(s)
- Ronald M Hansen
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - Anne Moskowitz
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - James D Akula
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - Anne B Fulton
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| |
Collapse
|
22
|
Daniel E, Quinn GE, Hildebrand PL, Ells A, Hubbard GB, Capone A, Martin ER, Ostroff CP, Smith E, Pistilli M, Ying GS. Validated System for Centralized Grading of Retinopathy of Prematurity: Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. JAMA Ophthalmol 2015; 133:675-82. [PMID: 25811772 DOI: 10.1001/jamaophthalmol.2015.0460] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Measurable competence derived from comprehensive and advanced training in grading digital images is critical in studies using a reading center to evaluate retinal fundus images from infants at risk for retinopathy of prematurity (ROP). Details of certification for nonphysician trained readers (TRs) have not yet been described. OBJECTIVE To describe a centralized system for grading ROP digital images by TRs in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. DESIGN, SETTING, AND PARTICIPANTS Multicenter observational cohort study conducted from July 1, 2010, to June 30, 2014. The TRs were trained by experienced ROP specialists and certified to detect ROP morphology in digital retinal images under supervision of an ophthalmologist reading center director. An ROP reading center was developed with standard hardware, secure Internet access, and customized image viewing software with an electronic grading form. A detailed protocol for grading was developed. Based on results of TR gradings, a computerized algorithm determined whether referral-warranted ROP (RW-ROP; defined as presence of plus disease, zone I ROP, and stage 3 or worse ROP) was present in digital images from infants with birth weight less than 1251 g enrolled from May 25, 2011, through October 31, 2013. Independent double grading was done by the TRs with adjudication of discrepant fields performed by the reading center director. EXPOSURE Digital retinal images. MAIN OUTCOMES AND MEASURES Intragrader and intergrader variability and monitoring for temporal drift. RESULTS Four TRs underwent rigorous training and certification. A total of 5520 image sets were double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP. For individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 (95% CI, 0.52-0.93) for RW-ROP, 0.57 (95% CI, 0.37-0.77) for plus disease, 0.43 (95% CI, 0.24-0.63) for zone I ROP, and 0.67 (95% CI, 0.47-0.88) for stage 3 or worse ROP. The weighted κ for grade-regrade agreement was 0.77 (95% CI, 0.57-0.97) for RW-ROP, 0.87 (95% CI, 0.67-1.00) for plus disease, 0.70 (95% CI, 0.51-0.90) for zone I ROP, and 0.77 (95% CI, 0.57-0.97) for stage 3 or worse ROP. CONCLUSIONS AND RELEVANCE These data suggest that the e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP with good intragrader and intergrader consistency and minimal temporal drift.
Collapse
Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Graham E Quinn
- Department of Ophthalmology, University of Pennsylvania, Philadelphia2Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Anna Ells
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - G Baker Hubbard
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Antonio Capone
- Associated Retinal Consultants, Royal Oak, Michigan7William Beaumont Hospital, Oakland University School of Medicine, Auburn Hills, Michigan
| | - E Revell Martin
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Candace P Ostroff
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Eli Smith
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Maxwell Pistilli
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | | |
Collapse
|
23
|
Wang SK, Callaway NF, Wallenstein MB, Henderson MT, Leng T, Moshfeghi DM. SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Can J Ophthalmol 2015; 50:101-6. [DOI: 10.1016/j.jcjo.2014.11.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 11/07/2014] [Indexed: 01/06/2023]
|
24
|
Prakalapakorn SG, Wallace DK, Dolland RS, Freedman SF. Evaluation of the accuracy of grading indirect ophthalmoscopy video images for retinopathy of prematurity screening. J Pediatr Ophthalmol Strabismus 2015; 52:85-92. [PMID: 25608280 PMCID: PMC4411041 DOI: 10.3928/01913913-20150114-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether digital retinal images obtained using a video indirect ophthalmoscopy system can be accurately graded for zone, stage of retinopathy of prematurity (ROP), and plus or pre-plus disease, and used to screen for type 1 ROP. METHODS Charts of 114 infants who had retinal video images acquired using the video indirect ophthalmoscopy system during routine ROP examinations were retrospectively reviewed. Two masked ophthalmologists (1 expert and 1 non-expert in ROP screening) graded the video images for image quality, zone, stage of ROP, and pre-plus or plus disease. The ophthalmologists' grades of the videos were compared to the clinical examination results, which served as the reference standard. The sensitivity and specificity of two predefined criteria for referral in detecting disease requiring treatment (ie, type 1 ROP) were then determined. RESULTS Of images the expert considered fair or good quality (n = 68), the expert and non-expert correctly identified zone (75% vs 74% of images, respectively), stage of ROP (75% vs 40% of images, respectively), and the presence of pre-plus or plus disease (79% of images). Expert and non-expert judgment of pre-threshold disease, pre-plus disease, or plus disease had 100% sensitivity and 75% versus 79% specificity, respectively, for detecting type 1 ROP. Expert and non-expert judgment of pre-plus or plus disease had 92% versus 100% sensitivity and 77% versus 82% specificity, respectively, for detecting type 1 ROP. CONCLUSIONS High-quality retinal video images can be read with high sensitivity and acceptable specificity to screen for type 1 ROP. Grading for pre-plus or plus disease alone may be sufficient for the purpose of ROP screening.
Collapse
|
25
|
Ossandón D, Zanolli M, López JP, Stevenson R, Agurto R, Cartes C. [Telemedicine correlation in retinopathy of prematurity between experts and non-expert observers]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:9-13. [PMID: 25443208 DOI: 10.1016/j.oftal.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the correlation between expert and non-expert observers in the reporting images for the diagnosis of retinopathy of prematurity (ROP) in a telemedicine setting. METHODS A cross-sectional, multicenter study, consisting of 25 sets of images of patients screened for ROP. They were evaluated by two experts in ROP and 1 non-expert and classified according to telemedicine classification, zone, stage, plus disease and Ells referral criteria. The telemedicine classification was: no ROP, mild ROP, type 2 ROP, or ROP that requires treatment. Ells referral criteria is defined as the presence at least one of the following: ROP in zone I, Stage 3 in zone I or II, or plus+ For statistical analysis, SPSS 16.0 was used. For correlation, Kappa value was performed. RESULTS There was a high correlation between observers for the assessment of ROP stage (0.75; 0.54-0.88) plus disease (0.85; 0.71-0.92), and Ells criteria (0.89; 0.83-1.0). However, inter-observer values were low for zone (0.41; 0.27-0.54) and telemedicine classification (0.43; 0.33-0.6). CONCLUSIONS When evaluating telemedicine images by examiners with different levels of expertise in ROP, the Ells criteria gave the best correlation. In addition, stage of disease and plus disease have good correlation among observers. In contrast, the correlation between observers was low for zone and telemedicine classification.
Collapse
Affiliation(s)
- D Ossandón
- Equipo Multicéntrico Retinopatía del Prematuro, Hospital de Niños Roberto del Río, Santiago, Chile
| | - M Zanolli
- Equipo Multicéntrico Retinopatía del Prematuro, Hospital de Niños Roberto del Río, Santiago, Chile.
| | - J P López
- Equipo Multicéntrico Retinopatía del Prematuro, Hospital de Niños Roberto del Río, Santiago, Chile
| | - R Stevenson
- Equipo Multicéntrico Retinopatía del Prematuro, Hospital de Niños Roberto del Río, Santiago, Chile
| | - R Agurto
- Equipo Multicéntrico Retinopatía del Prematuro, Hospital de Niños Roberto del Río, Santiago, Chile
| | - C Cartes
- Fundación Oftalmológica Los Andes, Santiago, Chile
| |
Collapse
|
26
|
Reliability of retinal imaging screening in retinopathy of prematurity. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
27
|
Navarro-Blanco C, Peralta-Calvo J, Pastora-Salvador N, Álvarez-Rementería L, Chamorro E, Sánchez-Ramos C. Fiabilidad en el cribado de la retinopatía del prematuro mediante el análisis de retinografías. An Pediatr (Barc) 2014; 81:149-54. [DOI: 10.1016/j.anpedi.2013.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022] Open
|
28
|
Prakalapakorn SG, Wallace DK, Freedman SF. Retinal imaging in premature infants using the Pictor noncontact digital camera. J AAPOS 2014; 18:321-6. [PMID: 25173892 PMCID: PMC4150087 DOI: 10.1016/j.jaapos.2014.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/04/2014] [Accepted: 02/09/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate, first, the feasibility of using Pictor, a new portable, noncontact digital fundus camera, to obtain high-quality retinal images of prematurely born infants and, second, the accuracy of grading these images for clinically significant posterior pole vascular changes, that is, pre-plus or plus disease, compared to indirect ophthalmoscopy. METHODS Pictor retinal images were obtained on a convenience sample of prematurely born infants during routine examinations for retinopathy of prematurity (ROP). Images were reviewed and graded by two ROP experts, who were masked to demographic and clinical examination findings. RESULTS A total of 96 eyes of 48 infants were included. The mean field of view was 5.0 × 6.1 disk diameters (DD). Grader 1 found quality to be fair or good in 96% of images; grader 2 in 97% of images. Grader 1 judged images as having at least 1 DD length of a major vessel in 3 or 4 quadrants in 80% of images; grader 2 in 86% of images. The sensitivity and specificity of grading pre-plus or plus disease on Pictor images was 100% and 79%, respectively, for grader 1, and 83% and 85%, respectively, for grader 2, compared to the reference standard of indirect ophthalmoscopy. CONCLUSIONS The Pictor fundus camera can capture digital retinal images of prematurely born infants that have quality sufficient for accurate expert grading in comparison to clinical examination. Pictor shows promise as an ROP screening tool.
Collapse
|
29
|
Athikarisamy SE, Patole S, Lam GC, Dunstan C, Rao S. Screening for retinopathy of prematurity (ROP) using wide-angle digital retinal photography by non-ophthalmologists: a systematic review. Br J Ophthalmol 2014; 99:281-8. [DOI: 10.1136/bjophthalmol-2014-304984] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
30
|
Abstract
PURPOSE Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE. METHODS The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights <1251 g. At each visit, ophthalmologists perform DEs and non-physician imagers obtain iris and five retinal images with the disc positioned in the center, right, left, up and down. Images are uploaded to a secure server for grading by non-physician readers for the detection of plus disease, stage 3 ROP and/or zone I disease, any of which indicates "referral-warranted ROP" (RW-ROP). Images from all infants with RW-ROP and a random sample of infants without RW-ROP (based on DEs) are selected for grading. Gradings are compared to DEs to determine the validity and evaluate reliability, feasibility, safety, and cost-effectiveness of the telemedicine system. RESULTS e-ROP is conducted in 12 Clinical Centers in the US and Canada with Study Headquarters, the Data Coordinating Center and the Image Reading Center in Philadelphia and the ROP Data Center in Oklahoma City. A total of 27 study center coordinators, 34 ophthalmologists, 26 imagers, and 4 readers have been certified. All study data are submitted using a secure web-based system. CONCLUSION The design and findings of this study will be useful to conduct other ROP studies or evaluate telemedicine for other diseases.
Collapse
|
31
|
Evaluation of an indirect ophthalmoscopy digital photographic system as a retinopathy of prematurity screening tool. J AAPOS 2014; 18:36-41. [PMID: 24568980 PMCID: PMC3971732 DOI: 10.1016/j.jaapos.2013.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/28/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether digital retinal images obtained from an indirect ophthalmoscopy imaging system (Keeler) can be accurately graded for clinically significant retinopathy of prematurity (ROP) by masked experts. METHODS The medical records of infants screened for ROP who had posterior pole images acquired using the Keeler system during routine ROP examinations were retrospectively reviewed. Two reviewers, masked to patient demographics and clinical examination findings, graded the images for: (1) quality (good, fair, poor); (2) number of gradable quadrants, from 0 to 4; and (3) posterior pole disease (none, pre-plus, plus). The accuracy of grading Keeler images for clinically significant ROP (defined as pre-plus or plus disease) was compared to results of clinical examination. RESULTS One eye each of 253 infants was included. The mean postmenstrual age at examination was 35 weeks (range, 30-42). Grader 1 found the quality of 94% of images to be fair or good; grader 2, 83% of images. Grader 1 judged 87% of images to have ≥3 gradable quadrants; grader 2, 77% of images. The sensitivity and specificity of grading pre-plus or worse disease on Keeler images were 100% and 86%, respectively, for grader 1, and 94% and 89%, respectively, for grader 2. CONCLUSIONS Digital retinal images obtained by the Keeler system can be read with high sensitivity and specificity to screen for clinically important ROP. The Keeler system may be a valuable tool for ROP screening at remote locations (ie, via telemedicine).
Collapse
|
32
|
Vinekar A, Gilbert C, Dogra M, Kurian M, Shainesh G, Shetty B, Bauer N. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting. Indian J Ophthalmol 2014; 62:41-9. [PMID: 24492500 PMCID: PMC3955069 DOI: 10.4103/0301-4738.126178] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/15/2013] [Indexed: 12/16/2022] Open
Abstract
AIM To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. MATERIALS AND METHODS KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shuttle (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). RESULTS 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs. Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively. CONCLUSIONS This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.
Collapse
Affiliation(s)
- Anand Vinekar
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mangat Dogra
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mathew Kurian
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | | | - Bhujang Shetty
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Noel Bauer
- Maastricht University Medical Center, Maastricht, Netherlands
| |
Collapse
|
33
|
Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res 2013; 74 Suppl 1:35-49. [PMID: 24366462 PMCID: PMC3873709 DOI: 10.1038/pr.2013.205] [Citation(s) in RCA: 477] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a leading cause of potentially avoidable childhood blindness worldwide. We estimated ROP burden at the global and regional levels to inform screening and treatment programs, research, and data priorities. METHODS Systematic reviews and meta-analyses were undertaken to estimate the risk of ROP and subsequent visual impairment for surviving preterm babies by level of neonatal care, access to ROP screening, and treatment. A compartmental model was used to estimate ROP cases and numbers of visually impaired survivors. RESULTS In 2010, an estimated 184,700 (uncertainty range: 169,600-214,500) preterm babies developed any stage of ROP, 20,000 (15,500-27,200) of whom became blind or severely visually impaired from ROP, and a further 12,300 (8,300-18,400) developed mild/moderate visual impairment. Sixty-five percent of those visually impaired from ROP were born in middle-income regions; 6.2% (4.3-8.9%) of all ROP visually impaired infants were born at >32-wk gestation. Visual impairment from other conditions associated with preterm birth will affect larger numbers of survivors. CONCLUSION Improved care, including oxygen delivery and monitoring, for preterm babies in all facility settings would reduce the number of babies affected with ROP. Improved data tracking and coverage of locally adapted screening/treatment programs are urgently required.
Collapse
Affiliation(s)
- Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joy E. Lawn
- Centre for Maternal Reproductive & Child Health, London School of Hygiene and Tropical Medicine, London, UK
- Saving Newborn Lives/Save the Children, Washington, DC
| | | | | | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW To examine and review digital retinal imaging via telemedicine as an important screening and diagnostic tool in the management of retinopathy of prematurity (ROP). RECENT FINDINGS The use of wide-angle digital retinal photography to detect clinically significant ROP has been described in numerous reports since 2000. Comparisons with the gold standard of binocular indirect ophthalmoscopy have been favorable. Digital image capture can provide more objective information for disease detection, thereby facilitating internet consultation and retrospective analysis as part of the electronic medical record. As the presence of plus disease in ROP is now the most important criteria for determining the need for laser treatment, computer-based image analysis can potentially provide additional benefit to digital retinal imaging. Telemedicine screening also allows for the extension of diagnostic expertise to underserved areas in both the developed and third world. The role of telemedicine in ROP education will impact both screening efforts and traditional fellowship training in future years. SUMMARY As the worldwide incidence of ROP continues to rise, the use of telemedicine for screening, diagnostic and educational purposes will assume increasing importance in the delivery of healthcare for premature infants.
Collapse
|
35
|
Isetta V, Lopez-Agustina C, Lopez-Bernal E, Amat M, Vila M, Valls C, Navajas D, Farre R. Cost-effectiveness of a new internet-based monitoring tool for neonatal post-discharge home care. J Med Internet Res 2013; 15:e38. [PMID: 23419609 PMCID: PMC3636285 DOI: 10.2196/jmir.2361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/15/2012] [Accepted: 01/13/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The application of information and communication technologies in nursing care is becoming more widespread, but few applications have been reported in neonatal care. A close monitoring of newborns within the first weeks of life is crucial to evaluating correct feeding, growth, and health status. Conventional hospital-based postdischarge monitoring could be improved in terms of costs and clinical effectiveness by using a telemedicine approach. OBJECTIVE To evaluate the cost-effectiveness of a new Internet-based system for monitoring low-risk newborns after discharge compared to the standard hospital-based follow-up, with specific attention to prevention of emergency department (ED) visits in the first month of life. METHODS We performed a retrospective cohort study of two low-risk newborn patient groups. One group, born between January 1, 2011, and June 30, 2011, received the standard hospital-based follow-up visit within 48 hours after discharge. After implementing an Internet-based monitoring system, another group, born between July 19, 2011, and January 19, 2012, received their follow-up with this system. RESULTS A total of 18 (15.8%) out of 114 newborns who received the standard hospital-based follow-up had an ED visit in the first month of life compared with 5 (5.6%; P=.026) out of 90 infants who were monitored by the Internet-based system. The cost of the hospital-based follow-up was 182.1€ per patient, compared with 86.1€ for the Internet-based follow-up. CONCLUSION Our Internet-based monitoring approach proved to be both more effective and less costly than the conventional hospital-based follow-up, particularly through reducing subsequent ED visits.
Collapse
Affiliation(s)
- Valentina Isetta
- Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Weaver DT, Murdock TJ. Telemedicine detection of type 1 ROP in a distant neonatal intensive care unit. J AAPOS 2012; 16:229-33. [PMID: 22681938 DOI: 10.1016/j.jaapos.2012.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/26/2012] [Accepted: 01/31/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To demonstrate the feasibility of telemedicine screening for retinopathy of prematurity (ROP) by summarizing the results of our experience screening premature infants at a distant hospital in a rural location. METHODS Records of all premature infants remotely screened for ROP at a neonatal intensive care unit in Great Falls, Montana, from January 1, 2007 to June 30, 2011, were retrospectively reviewed. The RetCam II imaging system was used to capture retinal images, which were posted on a secure server for evaluation by one of two pediatric ophthalmologists. Infants suspected of having ROP approaching the criteria for laser treatment were transferred to a hospital, where a diagnostic examination was performed and treatment administered when indicated. All other infants received an outpatient diagnostic examination within 2 weeks of discharge. RESULTS A total of 582 telemedicine examinations were performed on 137 infants during the study period. Of 13 infants transferred for referral-warranted ROP, 9 ultimately required laser treatment. Good outcomes were noted in all cases, with none progressing to stage 4 or 5 ROP. CONCLUSIONS Telemedicine ROP screening detected patients at a remote site in need of laser treatment, allowing prompt transfer with no poor outcomes over a 4.5-year period. Our experience demonstrates the utility of remote screening for ROP.
Collapse
|
37
|
Cytomegalovirus retinitis associated with HIV in resource-constrained settings: systematic screening and case detection. Int Health 2012; 4:86-94. [DOI: 10.1016/j.inhe.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
38
|
Wilson CM, Wong K, Ng J, Cocker KD, Ells AL, Fielder AR. Digital image analysis in retinopathy of prematurity: a comparison of vessel selection methods. J AAPOS 2012; 16:223-8. [PMID: 22681937 DOI: 10.1016/j.jaapos.2011.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/17/2011] [Accepted: 11/23/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate vessel selection methods to distinguish between eyes with and without retinopathy of prematurity (ROP) and between different stages of ROP when quantifying the associated vessel changes in width and tortuosity semiautomatically from digital retinal images. METHODS Color digital images from 75 infants screened for ROP were cropped to a standardized diameter of 240 pixels and evaluated by semiautomated vessel analysis software, Computer-Aided Image Analysis of the Retina (CAIAR), to measure retinal vessel width and tortuosity. Two methods of vessel selection were used: (1) clinical observer selecting the most prominent arteriole or venule in each retinal quadrant (4-vessel analysis) and then separately the 4 most prominent arterioles and venules from each quadrant (8-vessel analysis); (2) CAIAR selecting, regardless of retinal quadrant, the 4 widest or most tortuous arterioles or venules. Selected vessels were measured by CAIAR for tortuosity and width. RESULTS When comparing ROP stages, whether observer or CAIAR selected and whether 4 or 8 vessels were analyzed, we found that arteriolar tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 2; stage 0 or 1 versus stage 3; stages 1+2 combined versus stage 3; and stage 0 versus 1+2+3 combined (P < 0.01). Venular tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 3 and stage 0 versus stages 1 and 2+3 combined (P < 0.01). Width parameters did not help us to distinguish between stages. CONCLUSIONS Distinguishing between arterioles and venules is not necessary to differentiate stage 0 ROP from stage 2 or 3 ROP when one is using CAIAR. Tortuosity shows more promise than width at providing a reliable vessel parameter for distinguishing between eyes without and with ROP.
Collapse
Affiliation(s)
- Clare M Wilson
- Department of Visual Science, UCL Institute of Ophthalmology, University College London, UK.
| | | | | | | | | | | |
Collapse
|
39
|
Wittenberg LA, Jonsson NJ, Chan RVP, Chiang MF. Computer-based image analysis for plus disease diagnosis in retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2012; 49:11-9; quiz 10, 20. [PMID: 21366159 PMCID: PMC4036800 DOI: 10.3928/01913913-20110222-01] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/01/2011] [Indexed: 12/21/2022]
Abstract
Presence of plus disease in retinopathy of prematurity (ROP) is an important criterion for identifying ROP requiring treatment. Plus disease is defined by a standard published photograph selected more than 20 years ago by expert consensus. However, diagnosis of plus disease has been shown to be subjective and qualitative. Computer-based image analysis using quantitative methods has potential to improve the objectivity of plus disease diagnosis. The objective was to review the published literature involving computer-based image analysis for ROP diagnosis. The PubMed and Cochrane library databases were searched for the keywords "retinopathy of prematurity" AND "image analysis" AND/OR "plus disease." Reference lists of retrieved articles were searched to identify additional relevant studies. All relevant English-language studies were reviewed. There are four main computer-based systems-ROPtool (area under the receiver operating characteristic curve [AUROC], plus tortuosity 0.95, plus dilation 0.87), RISA (AUROC, arteriolar TI 0.71, venular diameter 0.82), Vessel Map (AUROC, arteriolar dilation 0.75, venular dilation 0.96), and CAIAR (AUROC, arteriole tortuosity 0.92, venular dilation 0.91)-attempting to objectively analyze vessel tortuosity and dilation in plus disease in ROP. Some show promise for identification of plus disease using quantitative methods. This has potential to improve the diagnosis of plus disease and may contribute to the management of ROP using both traditional binocular indirect ophthalmoscopy and image-based telemedicine approaches.
Collapse
Affiliation(s)
- Leah A Wittenberg
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | |
Collapse
|
40
|
Zepeda-Romero LC, Barrera-de-León JC, González-Bernal C, Marquez-Amezcua M, Diaz-Arteaga V, Angulo-Castellanos E, Gutiérrez-Padilla JA, Gallardo-Rincón H. The Utility of Non-ophthalmologist Examination of Eyes at Risk for Serious Retinopathy of Prematurity. Ophthalmic Epidemiol 2011; 18:264-8. [DOI: 10.3109/09286586.2011.602506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
41
|
Cheung CSY, Butty Z, Tehrani NN, Lam WC. Computer-assisted image analysis of temporal retinal vessel width and tortuosity in retinopathy of prematurity for the assessment of disease severity and treatment outcome. J AAPOS 2011; 15:374-80. [PMID: 21907122 DOI: 10.1016/j.jaapos.2011.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 05/02/2011] [Accepted: 05/09/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To quantify the severity of retinopathy of prematurity (ROP) through temporal retinal vessel diameter and tortuosity by the use semiautomated analysis and to evaluate the effects of laser treatment on retinal vessel measurements. METHODS A total of 176 RetCam digital fundus images from 63 infants diagnosed with ROP between January 2005 and December 2008 were retrospectively analyzed with Retinal Vessel Measurement V5.8 software. Patients were classified into 1 of 3 groups: stage 1 and 2 (Group 1), stage 3 not requiring treatment (Group 2), and stage 3 requiring treatment (Group 3). Diameter and tortuosity of the 4 major temporal retinal arteries and veins close to the optic disk were quantified. Tortuosity was measured as central (within 2 disk diameters from the center of the optic disk) and paracentral (from 2 to 4 disk diameters). For Group 3, measurements of vessels immediately before treatment and all follow-up post-treatment measurements of vessels were analyzed. RESULTS Differences in central and paracentral arteriolar tortuosity were pronounced. The average central arteriolar tortuosities were 1.12 ± 0.018 for Group 1, 1.13 ± 0.018 for Group 2, and 1.32 ± for Group 3; the paracentral arteriolar tortuosities were 1.11 ± 0.019 for Group 1, 1.12 ± 0.019 for Group 2, and 1.31 ± 0.02 for Group 3. In the post-treatment analysis of Group 3 patients, significant reductions in all vascular measurements were observed compared to pre-treatment, except for central and paracentral vein tortuosity. CONCLUSIONS Computerized systems can be used to objectively assess differences in vascular parameters between ROP stages.
Collapse
Affiliation(s)
- Crystal S Y Cheung
- Department of Ophthalmology and Vision Science, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
42
|
Davis AM, James RL, Boles RE, Goetz JR, Belmont J, Malone B. The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability. MATERNAL AND CHILD NUTRITION 2011; 7:71-9. [PMID: 21108739 DOI: 10.1111/j.1740-8709.2010.00248.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables.
Collapse
Affiliation(s)
- Ann McGrath Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
| | | | | | | | | | | |
Collapse
|
43
|
Silva RA, Moshfeghi DM. Telemedicine as a tool for evaluation of retinopathy of prematurity. Int Ophthalmol Clin 2011; 51:33-48. [PMID: 21139476 DOI: 10.1097/iio.0b013e3182009a91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
44
|
Salcone EM, Johnston S, VanderVeen D. Review of the Use of Digital Imaging in Retinopathy of Prematurity Screening. Semin Ophthalmol 2010; 25:214-7. [DOI: 10.3109/08820538.2010.523671] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Prematuridad y visión. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
46
|
Wootton R, Bonnardot L. In what circumstances is telemedicine appropriate in the developing world? JRSM SHORT REPORTS 2010; 1:37. [PMID: 21103129 PMCID: PMC2984368 DOI: 10.1258/shorts.2010.010045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives To review papers reporting actual experience with telemedicine in developing countries and to summarize their findings, including the strength of the evidence. Design A retrospective review was conducted. Study quality was assessed. Setting Four commonly-used electronic databases. Main outcome measures Study quality scores. Results From a total of 202 potential articles, 38 relevant papers were identified. Thirty-four articles (89%) reported clinical experience and 14 articles (37%) reported the use of telemedicine for educational purposes. The quality of the reports was rather weak (median quality-score 3, on a scale 0–9); only one study, rated at 7, fell into the high quality score band. The fact that almost all studies reported positively in favour of telemedicine suggests a publication bias. Of the 38 articles, 15 (39%) reported the use of real-time telemedicine and 25 (66%) reported the use of asynchronous, or store-and-forward, telemedicine. Email was the most commonly reported modality (half of all studies). Conclusion Some of the longer established telemedicine operations have developed into substantial networks. The review suggests that great potential exists for telemedicine in the developing world. However, some caution is required in future telemedicine work if telemedicine exemplars are to be produced which can be widely copied.
Collapse
Affiliation(s)
- Richard Wootton
- National Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø , Norway
| | | |
Collapse
|
47
|
Richter GM, Williams SL, Starren J, Flynn JT, Chiang MF. Telemedicine for retinopathy of prematurity diagnosis: evaluation and challenges. Surv Ophthalmol 2009; 54:671-85. [PMID: 19665742 DOI: 10.1016/j.survophthal.2009.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/13/2009] [Indexed: 10/20/2022]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder affecting low birth weight infants. Although timely diagnosis and treatment can significantly reduce the risk of severe complications, ROP remains a leading cause of childhood blindness worldwide. Limitations of current disease management strategies include extensive travel and logistical coordination requirements for ophthalmologists and neonatologists, decreasing availability of adequately trained ophthalmologists at the point of care, variability in how retinal findings are diagnosed and documented, and a growing need for ROP care worldwide. Store-and-forward telemedicine is an emerging technology by which medical data are captured for subsequent interpretation by a remote expert. This has potential to improve accessibility, quality, and cost of ROP management. In this article, we summarize the current evaluation data on applications of telemedicine for ROP, particularly involving the diagnostic accuracy and reliability of remote image interpretation by experts. We also address challenges such as the cost-effectiveness of telemedicine, and highlight potential barriers to implementation of these systems. Understanding these principles is essential to determine future directions in research and development of telemedicine systems for ROP, as well as for other ophthalmic diseases.
Collapse
Affiliation(s)
- Grace M Richter
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
| | | | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW This review will discuss a potentially more effective treatment for retinopathy of prematurity (ROP) with fewer acute and long-term complications. Avastin (bevacizumab) therapy is a promising anti-vascular endothelial growth factor (anti-VEGF) administered directly into the vitreous. RECENT FINDINGS Recent reports detail the use of Avastin alone, and in combination with light amplification by stimulated emission of radiation (LASER) therapy and vitrectomy, for ROP stages 3, 4, and 5. Currently, one clinical trial is studying Avastin alone for acute vision-threatening ROP stage 3 in zone I and posterior zone II without LASER therapy. Another clinical trial is investigating Avastin following LASER therapy for recurrent ROP stages 4 and 5. SUMMARY Treatment for ROP has evolved from later, more destructive (cryotherapy) to earlier, less destructive (LASER therapy) peripheral retinal ablation. If evidence-based data supports early findings, the use of Avastin may be recommended without the need for ablative LASER therapy and before retinal detachment develops. Avastin will be especially useful for ROP stage 3 cases with hemorrhage decreasing retinal visualization, rigid pupils, intravitreal neovascularization with early or developing (minimal) fibrous membranes, or aggressive posterior retinopathy of prematurity (AP-ROP). These cases all continue to have poor outcomes with LASER therapy.
Collapse
|