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Detection of Potentially Severe Retinopathy of Prematurity by Remote Image Grading
Graham E Quinn1,2,3, Gui-Shuang Ying3, Wei Pan3
1Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Insights
Telemedicine for retinopathy of prematurity (ROP) can detect serious ROP earlier than clinical exams. Standardized telemedicine protocols are crucial for widespread adoption and timely infant eye care.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Imaging
Background:
- Telemedicine for retinopathy of prematurity (ROP) offers timely care for at-risk infants.
- Early detection of ROP is critical to prevent severe visual impairment.
Purpose of the Study:
- To characterize eyes at risk for ROP.
- To determine which ROP types are most effectively detected early via image grading.
Main Methods:
- Secondary analysis of the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study data.
- Compared ROP detection times between image evaluation and clinical examination in premature infants.
Main Results:
- Image grading detected referral-warranted ROP (RW-ROP) earlier than clinical examination in 42.7% of eyes.
- Stage 3 or Zone I ROP constituted a significant proportion of RW-ROP.
- Findings in early-detected RW-ROP eyes were largely consistent with subsequent clinical examinations.
Conclusions:
- Telemedicine for ROP shows potential for earlier detection of critical ROP stages.
- Zone I and Stage 3 ROP are key indicators for RW-ROP.
- Standardized protocols are essential for effective ROP telemedicine implementation.
Importance:
Telemedicine in retinopathy of prematurity (ROP) has the potential for delivering timely care to premature infants at risk for serious ROP.
Objective:
To describe the characteristics of eyes at risk for ROP to provide insights into what types of ROP are most easily detected early by image grading.
Design, Setting, And Participants:
Secondary analysis of eyes with referral-warranted (RW) ROP (stage 3 ROP, zone I ROP, plus disease) on diagnostic examination from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study was conducted from May 1, 2011, to October 31, 2013, in 1257 premature infants with birth weights less than 1251 g in 13 neonatal units in North America. Data analysis was performed between February 1, 2016, and June 5, 2017.
Interventions:
Serial imaging sessions with concurrent diagnostic examinations for ROP.
Main Outcomes And Measures:
Time of detecting RW-ROP on image evaluation compared with clinical examination.
Results:
In the e-ROP study, 246 infants (492 eyes) were included in the analysis; 138 (56.1%) were male. A total of 447 eyes had RW-ROP on diagnostic examination. Image grading in 123 infants (mean [SD] gestational age, 24.8 [1.4] weeks) detected RW-ROP earlier than diagnostic examination (early) in 191 (42.7%) eyes by about 15 days and detected RW-ROP in 123 infants (mean [SD] gestational age, 24.6 [1.5] weeks) at the same time (same) in 200 (44.7%) eyes. Most of the early eyes (153 [80.1%]) interpreted as being RW-ROP positive on imaging evaluation agreed with examination findings when the examination subsequently documented RW-ROP. At the sessions in which RW-ROP was first found by examination, stage 3 or more in 123 infants (mean [SD] gestational age, 24.8 [1.4] weeks) ROP was noted earlier on image evaluation in 151 of 191 early eyes (79.1%) and in 172 of 200 of same eyes (86.0%) (P = .08); the presence of zone I ROP was detected in 57 of 191 (29.8%) early eyes vs 64 of 200 (32.0%) same eyes (P = .90); and plus disease was noted in 30 of 191 (15.7%) early eyes and 45 of 200 (22.5%) same eyes (P = .08).
Conclusions And Relevance:
In both early and same eyes, zone I and/or stage 3 ROP determined a significant proportion of RW-ROP; plus disease played a relatively minor role. In most early RW-ROP eyes, the findings were consistent with clinical examination and/or image grading at the next session. Because ROP telemedicine is used more widely, development of standard approaches and protocols is essential.
