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Telemedicine approaches to evaluating acute-phase retinopathy of prematurity: study design
Insights
Telemedicine offers a promising alternative for detecting retinopathy of prematurity (ROP) in premature infants. The e-ROP study evaluates a telemedicine system for grading retinal images to identify ROP needing further examination.
Area of Science:
- Ophthalmology
- Medical Imaging
- Neonatology
Background:
- Detecting sight-threatening retinopathy of prematurity (ROP) traditionally requires in-person diagnostic examinations by ophthalmologists.
- Premature infants are at high risk for ROP, necessitating regular screening.
- Telemedicine presents a potential alternative for ROP screening and diagnosis.
Purpose of the Study:
- To evaluate the feasibility, reliability, validity, safety, and cost-effectiveness of a telemedicine system for detecting ROP.
- To assess the accuracy of grading retinal images for features indicating referral-warranted ROP (RW-ROP).
Main Methods:
- The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study enrolled 2000 infants with birth weights <1251 g.
- Ophthalmologists performed diagnostic examinations (DEs) while non-physician imagers captured retinal images.
- Images were uploaded for grading by non-physician readers to identify RW-ROP, with gradings compared to DEs.
Main Results:
- The e-ROP study involved 12 Clinical Centers across the US and Canada.
- Certified personnel included 27 coordinators, 34 ophthalmologists, 26 imagers, and 4 readers.
- A secure web-based system was utilized for all data submission.
Conclusions:
- The e-ROP study provides valuable insights into the design and implementation of telemedicine for ROP detection.
- Findings from this study can inform future ROP research and telemedicine evaluations for other medical conditions.
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.
