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Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study
Anna L Ells1, Jonathan M Holmes, William F Astle
1Department of Ophthalmology, Alberta Children's Hospital, Calgary, Canada.
Insights
Remote reading of digital retinal photos accurately detects severe retinopathy of prematurity (ROP). This method shows promise for telemedicine screening, offering high sensitivity and specificity in ROP diagnosis.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Imaging
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Early detection and treatment of severe ROP are crucial for preventing vision loss.
- Longitudinal screening is essential for monitoring ROP progression in premature infants.
Purpose of the Study:
- To evaluate the efficacy of remote reading of digital retinal photographs for diagnosing severe ROP.
- To assess the accuracy of digital photography compared to indirect ophthalmoscopy in ROP screening.
- To explore the potential of telemedicine for ROP management.
Main Methods:
- Prospective, longitudinal cohort study involving 44 premature infants at risk for ROP.
- Digital retinal images captured using the RetCam-120 system were read remotely by masked specialists.
- Indirect ophthalmoscopy served as the gold standard for ROP diagnosis.
Main Results:
- Digital photography demonstrated high accuracy with 100% sensitivity and 96% specificity for detecting referral-warranted ROP.
- The positive predictive value was 92%, and the negative predictive value was 100%.
- In 87% of cases, severe ROP was identified by digital photography concurrently with or prior to indirect ophthalmoscopy.
Conclusions:
- Remote reading of RetCam-120 digital photographs is a highly sensitive and specific method for detecting severe ROP.
- This approach shows significant promise for developing effective telemedicine strategies in ROP screening programs.
- Digital retinal imaging facilitates timely ROP diagnosis and management in premature infants.
Purpose:
To evaluate the use of remote reading of digital retinal photographs in the diagnosis of severe (referral-warranted) retinopathy of prematurity (ROP) during longitudinal screening for ROP.
Study Design:
Prospective, longitudinal cohort study.
Subjects:
Forty-four consecutive premature infants at risk for ROP.
Methods:
All infants were examined longitudinally, over a series of examinations, by indirect ophthalmoscopy (gold standard) and digital photography using the RetCam-120 Digital Retinal Camera (Massie Research Laboratories Inc., Dublin, CA) equipped with an ROP lens. Images were stored and read remotely by a masked reader. Referral-warranted ROP was defined as ROP in zone 1, the presence of plus disease or the presence of any stage 3 ROP. We determined whether and when referral-warranted ROP was diagnosed for each eye, of each infant, on each examination, during the course of each of the infant's screening.
Results:
Severe (referral-warranted) ROP was diagnosed in 23 eyes by indirect ophthalmoscopy during their series of examinations. Digital photography had a sensitivity of 100% and a specificity of 96% in detecting referral-warranted ROP. The positive predictive value of digital photography was 92%, and the negative predictive value was 100%. In 87% of eyes, referral-warranted ROP was diagnosed by digital photography before or at the same time as indirect ophthalmoscopy.
Conclusions:
Longitudinal remote reading of digital photographs using the RetCam-120 system has excellent specificity and sensitivity in detecting referral-warranted ROP. This pilot study has shown that remote reading of digital photographs has promise for telemedicine strategies in ROP screening.
