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Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic
Zachary Tan1,2, Michael Isaacs2,3, Zhuoting Zhu1
1Centre for Eye Research Australia, University of Melbourne, Melbourne, Brisbane, Australia.
Insights
The rise of retinopathy of prematurity (ROP) necessitates improved screening. Teleophthalmology and artificial intelligence (AI) offer promising solutions to address ROP screening challenges globally.
Area of Science:
- Ophthalmology
- Neonatal Care
- Public Health
Background:
- Improved neonatal care has led to an increase in premature infants surviving, resulting in a rise in retinopathy of prematurity (ROP).
- Existing ROP screening infrastructure struggles to meet the growing global demand, posing a challenge to reducing ROP-associated visual impairment.
- Novel screening technologies are emerging to address these limitations.
Purpose of the Study:
- To review current retinopathy of prematurity (ROP) screening programs worldwide.
- To identify limitations in existing ROP screening infrastructure.
- To explore the potential of teleophthalmology and artificial intelligence (AI) in improving ROP screening.
Main Methods:
- A critical narrative review of selected literature on ROP screening programs in high-, middle-, and low-income countries.
- Analysis of screening inclusion criteria, frequency, duration, and modalities.
- Evaluation of published sensitivity and specificity data for different screening methods.
Main Results:
- Significant global heterogeneity exists in ROP screening inclusion criteria (age, birth weight).
- Binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology are primary screening modalities.
- Teleophthalmology and AI show potential to overcome limitations of BIO, such as interoperator variability, scalability, and geographical access.
Conclusions:
- Current ROP screening faces challenges with scalability, geographical access, and high screening burden relative to treatment yield.
- Increased adoption of teleophthalmology and AI technologies can address these limitations.
- Implementing novel ROP screening modalities is crucial given the rising global incidence of the condition.
Purpose:
Neonatal care in middle-income countries has improved over the last decade, leading to a "third epidemic" of retinopathy of prematurity (ROP). Without concomitant improvements in ROP screening infrastructure, reduction of ROP-associated visual loss remains a challenge worldwide. The emergence of teleophthalmology screening programs and artificial intelligence (AI) technologies represents promising methods to address this growing unmet demand in ROP screening. An improved understanding of current ROP screening programs may inform the adoption of these novel technologies in ROP care.
Methods:
A critical narrative review of the literature was carried out. Publications that were representative of established or emerging ROP screening programs in high-, middle-, and low-income countries were selected for review. Screening programs were reviewed for inclusion criteria, screening frequency and duration, modality, and published sensitivity and specificity.
Results:
Screening inclusion criteria, including age and birth weight cutoffs, showed significant heterogeneity globally. Countries of similar income tend to have similar criteria. Three primary screening modalities including binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology were identified and reviewed. BIO has documented limitations in reduced interoperator agreement, scalability, and geographical access barriers, which are mitigated in part by WFDRI. Teleophthalmology screening may address limitations in ROP screening workforce distribution and training. Opportunities for AI technologies were identified in the context of these limitations, including interoperator reliability and possibilities for point-of-care diagnosis.
Conclusion:
Limitations in the current ROP screening include scalability, geographical access, and high screening burden with low treatment yield. These may be addressable through increased adoption of teleophthalmology and AI technologies. As the global incidence of ROP continues to increase, implementation of these novel modalities requires greater consideration.
