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Jungbauer WN, Gudipudi R, Brennan E, Melvin CL, Pecha PP. The Cost Impact of Telehealth Interventions in Pediatric Surgical Specialties: A Systematic Review. J Pediatr Surg 2023; 58:1527-1533. [PMID: 36379748 PMCID: PMC10121966 DOI: 10.1016/j.jpedsurg.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Telehealth is a rapidly expanding care modality in the United States. Pediatric surgical patients often require complex care which can incur significant expenses, some of which may be alleviated by telehealth. We performed a systematic review comparing telehealth and in-person visits, and telehealth's impacts on the cost of healthcare across pediatric surgical specialties. METHODS A systematic review was performed using the following databases: PubMed (MEDLINE), Scopus (Elsevier), and CINAHL (EBSCOHost), searched from inception to July 10th, 2022. Studies were included per the following criteria: (1) investigated a telehealth intervention for pediatric surgical care and (2) provided some metric of telehealth cost compared to an in-person visit. Non-English or studies conducted outside of the U.S. were excluded. RESULTS Fourteen manuscripts met inclusion criteria and presented data on 7992 visits, including patients with a weighted average age of 7.5 ± 3.5 years. Most (11/14) studies used telehealth in a synchronous, or "real-time" context. Of the studies which calculated dollar cost savings for telehealth visits compared to in-person appointments we found a substantial range of savings per visit, from $48.50 to $344.64. Cost savings were frequently realized in terms of reduced travel expenditures, lower opportunity costs (e.g. lost wages), and decreased hospital labor requirements. CONCLUSIONS This review suggests that telehealth provides cost incentives to pediatric surgical care in many scenarios, including post-operative visits and some routine clinic visits. Future work should focus on standardizing the metrics by which cost impacts are analyzed and detailing which visits are most appropriately facilitated by telehealth. LEVEL OF EVIDENCE V.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Rachana Gudipudi
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States
| | - Emily Brennan
- Department of Research and Education Services, Medical University of South Carolina, Charleston, SC, United States
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, United States.
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Hennein L, Jastrzembski B, Shah AS. Use of Telemedicine in Pediatric Ophthalmology in the Underserved Population. Semin Ophthalmol 2023; 38:116-123. [PMID: 36529958 DOI: 10.1080/08820538.2022.2152703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Access to pediatric eye care is critical in diagnosing and treating eye disease promptly to prevent visual impairment. The demand for pediatric ophthalmology is high, even in developed countries, and significant socioeconomic disparities exist in access to care. The purpose of this article is to summarize the current literature on the use of telemedicine in pediatric ophthalmology in the underserved population and to identify areas of opportunity. A detailed literature review was performed in PubMed and Google Scholar on October 1, 2021. All articles in English that described the use of telemedicine in pediatric ophthalmology, with particular attention to the underserved pediatric population, were included. There is a paucity of literature on the visual outcomes from pediatric teleophthalmology alone, and even less in underserved populations specifically. Literature supports its use in subacute to chronic eye disease, return and postoperative visits, and screening for retinopathy in prematurity in particular. Collaboration between pediatric optometrists and pediatric ophthalmologists for both asynchronous and synchronous care delivery models has shown promise in several studies. It is essential to operate within the limits of pediatric teleophthalmology and utilize this valuable service for its strengths. Telemedicine may expand access to pediatric ophthalmologists in underserved populations and may reduce the burden of eye disease.
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Affiliation(s)
- Lauren Hennein
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
| | - Benjamin Jastrzembski
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
| | - Ankoor S Shah
- Departments of Ophthalmology, Boston Children's Hospital, Massachusetts Eye & Ear, and Harvard Medical School, Boston, MA, USA
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Cunha LP, Cavalcante Costa MAA, Miranda HA, Reis Guimarães J, Aihara T, Ludwig CA, Rosenblatt T, Callaway NF, Pasricha M, Al‐Moujahed A, Vail D, Ji MH, Kumm J, Moshfeghi DM. Comparison between wide-field digital imaging system and the red reflex test for universal newborn eye screening in Brazil. Acta Ophthalmol 2021; 99:e1198-e1205. [PMID: 34032022 DOI: 10.1111/aos.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. METHODS Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. CONCLUSION While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.
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Affiliation(s)
| | | | | | | | - Teruo Aihara
- Irmandade Santa Casa de Misericórdia de São Paulo São Paulo Brazil
| | - Cassie A. Ludwig
- Stanford University Byers Eye Institute Palo Alto CA USA
- Retina Service Department of Ophthalmology Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | | | | | | | | | - Daniel Vail
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Marco H. Ji
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Jochen Kumm
- Stanford University Byers Eye Institute Palo Alto CA USA
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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.].
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Stewart C, Coffey-Sandoval J, Reid MW, Ho TC, Lee TC, Nallasamy S. Reliability of telemedicine for real-time paediatric ophthalmology consultations. Br J Ophthalmol 2021; 106:1157-1163. [PMID: 33722800 PMCID: PMC9340009 DOI: 10.1136/bjophthalmol-2020-318385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/30/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
Background/aims To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions. Methods Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies. Results 210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%). Conclusion Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
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Affiliation(s)
- Carly Stewart
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Mark W Reid
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Tiffany C Ho
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Thomas C Lee
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles, Los Angeles, California, USA .,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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6
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Ho T, Lee TC, Choe JY, Nallasamy S. Evaluation of real-time video from the digital indirect ophthalmoscope for telemedicine consultations in retinopathy of prematurity. J Telemed Telecare 2020; 28:502-507. [DOI: 10.1177/1357633x20958240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction This study aimed to evaluate the validity of using real-time video indirect ophthalmoscopy for telemedicine consultations for paediatric retinal findings, using retinopathy of prematurity (ROP) as a model disease. Methods An ophthalmologist simultaneously performed and recorded routine ROP screenings on enrolled premature infants (aged ≤30 weeks and weighing <1500 g) using the Keeler digital indirect ophthalmoscope. Examinations were graded as no ROP, mild, type 1 or type 2. Masked to clinical findings, another ophthalmologist reviewed and graded streamed video feed transmitted at 4096 kbps. We compared the sensitivity and specificity of diagnosing ROP via streamed and stored-and-forwarded video clips to the gold-standard in-person examination. Results A total of 150 examinations of individual eyes from 34 babies were included. The median postmenstrual age (PMA) at delivery was 24 weeks (range 23–34 weeks), the median birth weight was 630 g (range 455–1530 g) and the median PMA at examination was 37 weeks (range 31–54 weeks). Of those infants with any ROP, the sensitivity and specificity of streamed examinations were 100% and 70.6%, respectively. For type 2 or worse ROP, the sensitivity and specificity were 92.5% and 86.1%, respectively. For type 1 ROP, the sensitivity and specificity were 100% and 99.3%, respectively. Sensitivities (unless already 100%) and specificities were slightly higher for store-and-forward evaluations. Discussion Streamed video feed from the digital indirect ophthalmoscope can be utilised to diagnose clinically significant ROP accurately, though store-and-forward video review yielded slightly better results.
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Affiliation(s)
- Tiffany Ho
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
| | - Thomas C Lee
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
- Keck School of Medicine, University of Southern California, USA
| | - Ja-Yoon Choe
- Keck School of Medicine, University of Southern California, USA
| | - Sudha Nallasamy
- USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USA
- The Vision Center at Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA
- Keck School of Medicine, University of Southern California, USA
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7
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Seely KR, Wang KL, Tai V, Prakalapakorn SG, Chiu SJ, Viehland C, Grace S, Izatt JA, Freedman SF, Toth CA. Auto-Processed Retinal Vessel Shadow View Images From Bedside Optical Coherence Tomography to Evaluate Plus Disease in Retinopathy of Prematurity. Transl Vis Sci Technol 2020; 9:16. [PMID: 32879772 PMCID: PMC7442872 DOI: 10.1167/tvst.9.9.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose To describe the creation of en face retinal vessel shadow view (RVSV) optical coherence tomography (OCT) images and assess the feasibility of using these for evaluating vascular disease in preterm infants at risk for retinopathy of prematurity (ROP). Methods In this exploratory study, we selected images from eyes with a range of ROP vascular disease, prospectively acquired from preterm infants using an investigational, noncontact, handheld, bedside swept-source OCT. We autosegmented OCT volumes using custom infant-specific software, extracted RVSV-OCT images from volumetric data bracketed around the retinal pigment epithelium, and automontaged the resulting RVSV-OCT images. Three masked ophthalmologists graded the RVSV-OCT montages as plus, pre-plus, or neither and ranked them by relative vascular disease severity. Results We selected images from 17 imaging sessions (7 plus, 4 pre-plus, 6 neither on clinical examination). On review, 15/17 (88%) RVSV-OCT montages were gradable for plus, pre-plus, or neither and all 17 montages were rankable for relative severity. Intergrader agreement for plus, pre-plus, or neither grading was good (κ, 0.67; 95% confidence interval, 0.42–0.86) and for relative severity ranking was excellent (intraclass correlation coefficient, 0.98; 95% confidence interval, 0.96–0.99). Conclusions Our novel automatic processing method can create RVSV-OCT montages optimized for retinal vessel visualization for ROP screening. Although our data support the feasibility of using RVSV-OCT montages for ranking relative vascular disease severity, there is room for improved OCT image capture and processing methods in preterm infants screened for ROP. Translational Relevance Creation and grading of RVSV-OCT images could eventually be integrated into an alternative method for ROP screening.
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Affiliation(s)
- Kai R Seely
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Kira L Wang
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Vincent Tai
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | | | | | | | - Sara Grace
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Joseph A Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, NC, USA.,Department of Biomedical Engineering, Duke University, Durham, NC, USA
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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.
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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
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Greenwald MF, Danford ID, Shahrawat M, Ostmo S, Brown J, Kalpathy-Cramer J, Bradshaw K, Schelonka R, Cohen HS, Chan RVP, Chiang MF, Campbell JP. Evaluation of artificial intelligence-based telemedicine screening for retinopathy of prematurity. J AAPOS 2020; 24:160-162. [PMID: 32289490 PMCID: PMC7508795 DOI: 10.1016/j.jaapos.2020.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/01/2022]
Abstract
Retrospective evaluation of a deep learning-derived retinopathy of prematurity (ROP) vascular severity score in an operational ROP screening program demonstrated high diagnostic performance for detection of type 2 or worse ROP. To our knowledge, this is the first report in the literature that evaluated the use of artificial intelligence for ROP screening and represents a proof of concept. With further prospective validation, this technology might improve the accuracy, efficiency, and objectivity of diagnosis and facilitate earlier detection of disease progression in patients with potentially blinding ROP.
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Affiliation(s)
- Miles F Greenwald
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Ian D Danford
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Malika Shahrawat
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - James Brown
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston
| | | | - Kacy Bradshaw
- Department of Pediatrics, Salem Hospital, Salem, Oregon
| | - Robert Schelonka
- Department of Pediatrics, Oregon Health & Science University, Portland
| | | | - R V Paul Chan
- Department of Ophthalmology, University of Illinois-Chicago
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.
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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.
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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
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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.
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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
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12
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Scruggs BA, Chan RVP, Kalpathy-Cramer J, Chiang MF, Campbell JP. Artificial Intelligence in Retinopathy of Prematurity Diagnosis. Transl Vis Sci Technol 2020; 9:5. [PMID: 32704411 PMCID: PMC7343673 DOI: 10.1167/tvst.9.2.5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. The diagnosis of ROP is subclassified by zone, stage, and plus disease, with each area demonstrating significant intra- and interexpert subjectivity and disagreement. In addition to improved efficiencies for ROP screening, artificial intelligence may lead to automated, quantifiable, and objective diagnosis in ROP. This review focuses on the development of artificial intelligence for automated diagnosis of plus disease in ROP and highlights the clinical and technical challenges of both the development and implementation of artificial intelligence in the real world.
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Affiliation(s)
- Brittni A Scruggs
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - R V Paul Chan
- Department of Ophthalmology, University of Illinois, Chicago, IL, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael F Chiang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - J Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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Scruggs BA, Chan RVP, Kalpathy-Cramer J, Chiang MF, Campbell JP. Artificial Intelligence in Retinopathy of Prematurity Diagnosis. Transl Vis Sci Technol 2020. [DOI: 10.1167/tvst.210.2.2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Brittni A. Scruggs
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - R. V. Paul Chan
- Department of Ophthalmology, University of Illinois, Chicago, IL, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael F. Chiang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - J. Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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14
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Bowe T, Ung C, Campbell JP, Yonekawa Y. Telemedicine for Retinopathy of Prematurity in 2020. JOURNAL OF VITREORETINAL DISEASES 2019; 3:452-458. [PMID: 34278186 PMCID: PMC8281828 DOI: 10.1177/2474126419867634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Purpose: Retinopathy of prematurity (ROP) is the leading cause of visual impairment in premature infants, and middle-income nations are currently experiencing the “third epidemic” of ROP. Screening programs are essential to prevent negative visual outcomes, but screening efforts require a great amount of resources from healthcare systems and are difficult to marshal, particularly in geographically isolated or resource-limited settings. Telemedical screening programs using remote digital fundus imaging (RDFI) systems hold the promise of alleviating many of the burdens that currently make screening for ROP logistically challenging. Methods: Literature review of the current evidence for RDFI telescreening for ROP, with editorial discussion and recommendations. Results: In this review, we summarize the robust body of literature regarding the efficacy of RDFI, the feasibility of telescreening programs, and experiences from current live telescreening programs. We discuss the strengths and limitations of the current evidence and of the screening programs and consider the best practices in developing de novo telemedical screening programs for ROP. The review concludes with a discussion of promising future areas of research and development. Conclusions: RDFI ROP screening programs can be accurate and reliable. They show promise in improving many current challenges in screening infants for ROP, may be able to improve some aspects of care, and have been demonstrated to be cost-effective.
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Affiliation(s)
- Theodore Bowe
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
- Pediatric Retina Service, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Cindy Ung
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Sciences University, Portland, OR
| | - Yoshihiro Yonekawa
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
- Pediatric Retina Service, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Mid Atlantic Retina, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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15
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Abstract
Until advances in retinal imaging over recent decades, detection of retinopathy of prematurity requiring treatment depended largely on indirect ophthalmoscopy by ophthalmologists with experience in examination of low birth weight, often fragile infants. Recent studies have added to our understanding of the pros and cons of using this technology to provide timely care for the increasing number of infants at risk for ROP blindness worldwide.
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Affiliation(s)
- Graham E Quinn
- Department of Ophthalmology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Wood Center, 1st Floor, Philadelphia, PA 19104, USA.
| | - Anand Vinekar
- Department of Pediatric Retina, KIDROP, Narayana Nethralaya Eye Institute, Bangalore, India
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16
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Begley BA, Martin J, Tufty GT, Suh DW. Evaluation of a Remote Telemedicine Screening System for Severe Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2019; 56:157-161. [PMID: 31116862 DOI: 10.3928/01913913-20190215-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the validity of remote telemedicine screening for retinopathy of prematurity (ROP) in a population of at-risk preterm infants in Iowa and South Dakota. METHODS The medical records for all preterm infants screened for ROP at neonatal intensive care units (NICUs) in Sioux City, Iowa, and Sioux Falls, South Dakota, from September 1, 2017, to July 31, 2018, were retrospectively reviewed. The RetCam Shuttle (Natus Medical Inc., Pleasanton, CA) was used to capture retinal images, which were posted on a secure server for evaluation by a pediatric ophthalmologist. Infants with suspected ROP approaching the criteria for treatment with anti-vascular endothelial growth factor (VEGF) medications were transferred to the Children's Hospital and Medical Center NICU in Omaha, Nebraska, where a comprehensive examination was performed and treatment was administered when indicated. The remaining infants received an outpatient comprehensive examination by one of two pediatric ophthalmologists within 2 weeks of discharge. RESULTS A total of 124 telemedicine examinations were performed on 35 infants during the study period. Remote telemedicine screening for referral-warranted ROP using the RetCam Shuttle had a sensitivity of 100%, specificity of 97%, positive predictive value of 66.7%, and negative predictive value of 100%. Of the three infants transferred for referral-warranted ROP, two required treatment with anti-VEGF medications. Good outcomes were noted in all cases, and no patients progressed beyond stage 3 ROP. CONCLUSIONS Telemedicine screening reliably detected referral-warranted ROP in at-risk premature infants at two remote sites, with no poor outcomes during the 11-month period. These results demonstrate the validity and utility of remote telemedicine screening for ROP. [J Pediatr Ophthalmol Strabismus. 2019;56(3):157-161.].
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Karkhaneh R, Ahmadraji A, Riazi Esfahani M, Roohipour R, Farahani Dastjani A, Imani M, Khodabande A, Ebrahimiadib N, Ahmadabadi MN. The Accuracy of Digital Imaging in Diagnosis of Retinopathy of Prematurity in Iran: A Pilot Study. J Ophthalmic Vis Res 2019; 14:38-41. [PMID: 30820285 PMCID: PMC6388530 DOI: 10.4103/jovr.jovr_187_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To evaluate sensitivity and specificity of digital retinal image reading in the diagnosis of referral-warranted retinopathy of prematurity (ROP). Methods: Infants referred to the ROP clinic underwent fundus examination through indirect ophthalmoscopy. Fundus photographs were acquired using RetCam (shuttle 2; Clarity medical systems, Pleasanton, CA, USA). Four retinal specialists who were blind to patients’ information reviewed the RetCam fundus photographs. By comparing the results of photographs’ readings with that of indirect ophthalmoscopy as the gold standard, the sensitivity and specificity of telescreening was determined. Results: A total of 147 treatment-naïve patients met the inclusion criteria and were enrolled in the study. Mean gestational age (GA) was 28.6 ± 2.0 weeks. Digital retinal imaging had sensitivity of 85% and specificity of 35% in detecting referral-warranted ROP in our study. Positive predictive value of digital photography was 80%, and negative predictive value was 43%. Conclusion: Digital photography for diagnosis of ROP may show good potential as a screening modality in developing countries. It can facilitate early diagnosis, prevent unnecessary referrals, and be implemented for investigational purpose. However, the overall study result did not provide evidence to propose digital photography as a substitute for indirect ophthalmoscopy in the diagnosis of ROP.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ahmadraji
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin, Herbert Eye Institute, University of California, Irvine, California, USA
| | - Ramak Roohipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsar Farahani Dastjani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Nili Ahmadabadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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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.
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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
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19
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Isaac M, Isaranuwatchai W, Tehrani N. Cost analysis of remote telemedicine screening for retinopathy of prematurity. Can J Ophthalmol 2018; 53:162-167. [DOI: 10.1016/j.jcjo.2017.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/19/2017] [Accepted: 08/21/2017] [Indexed: 12/22/2022]
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20
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Bain LC, Kristensen-Cabrera AI, Lee HC. A Qualitative Analysis of Challenges and Successes in Retinopathy of Prematurity Screening. AJP Rep 2018; 8:e128-e133. [PMID: 29896443 PMCID: PMC5995725 DOI: 10.1055/s-0038-1660519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/24/2018] [Indexed: 01/14/2023] Open
Abstract
Objective The objective of this study is to identify characteristics of neonatal intensive care unit (NICU) practice that influence successful retinopathy of prematurity (ROP) screening. Study Design In this qualitative study, top, improved, and bottom performing NICUs in the California Perinatal Quality Care Collaborative were identified based on ROP screening rates and invited to participate. NICU personnel were interviewed using a semistructured questionnaire. Using thematic analysis, key factors that influence ROP screening were identified. Results Themes found in top performing hospitals include a commitment to quality improvement, a committed ophthalmologist, and a system of double checks. Improved NICUs had a common theme of utilizing telemedicine for exams and identification of eligible neonates on admission. The bottom performing hospital struggled with education and identification of eligible neonates and a lack of a dedicated ophthalmologist. Conclusion Structure, culture, education, and commitment all contribute to the success of ROP screening in the NICU.
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Affiliation(s)
- Lisa C Bain
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California
| | - Alexandria I Kristensen-Cabrera
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California
| | - Henry C Lee
- Department of Pediatrics, Neonatal and Developmental Medicine, School of Medicine, Stanford University, Palo Alto, California
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21
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Yu TY, Donovan T, Armfield N, Gole GA. Retinopathy of prematurity: the high cost of screening regional and remote infants. Clin Exp Ophthalmol 2018; 46:645-651. [DOI: 10.1111/ceo.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tzu-Ying Yu
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Tim Donovan
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Division of Neonatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Nigel Armfield
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Glen A Gole
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Ophthalmology; Lady Cilento Children's Hospital; Brisbane Queensland Australia
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22
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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.
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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
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Mohammadpour M, Heidari Z, Mirghorbani M, Hashemi H. Smartphones, tele-ophthalmology, and VISION 2020. Int J Ophthalmol 2017; 10:1909-1918. [PMID: 29259912 PMCID: PMC5733521 DOI: 10.18240/ijo.2017.12.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
Telemedicine is an emerging field in recent medical achievements with rapid development. The "smartphone" availability has increased in both developed and developing countries even among people in rural and remotes areas. Tele-based services can be used for screening ophthalmic diseases and also monitoring patients with known diseases. Electronic ophthalmologic records of the patients including captured images by smartphones from anterior and posterior segments of the eye will be evaluated by ophthalmologists, and if patients require further evaluations, they will be referred to experts in the relevant field. Eye diseases such as cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are the most common causes of blindness in many countries and beneficial use of teleophthalmology with smartphones will be a good way to achieve the aim of VISION 2020 all over the world. Numerous studies have shown that teleophthalmology is similar to the conventional eye care system in clinical outcomes and even provides more patient satisfaction as it saves time and cost. This review explains how teleophthalmology helps to improve patient outcomes through smartphones.
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Affiliation(s)
- Mehrdad Mohammadpour
- Farabi Eye Hospital, Ophthalmology Department and Eye Research Center, Tehran University of Medical Sciences, Tehran 1336616351, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1968653111, Iran
| | - Zahra Heidari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1968653111, Iran
- Department of Rehabilitation Science, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Masoud Mirghorbani
- Farabi Eye Hospital, Ophthalmology Department and Eye Research Center, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1968653111, Iran
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24
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Zhang X, Wang Y, Ulrich JN, Yang Y, Ding L, Yang Y, Xu D, Tarczy-Hornoch K, Cabrera MT. Evaluation of retinopathy of prematurity incidence with telemedicine confirmation in Gansu, China: a pilot study. Ophthalmic Epidemiol 2017; 25:120-125. [PMID: 29095074 DOI: 10.1080/09286586.2017.1368671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the incidence of retinopathy of prematurity (ROP) in Gansu, China by combining bedside examinations with remote RetCam (Clarity Medical Systems, Pleasanton, CA, USA) diagnosis. METHODS ROP screening via indirect ophthalmoscopy followed by RetCam imaging was performed from 2014 to 2015. Three ROP-experienced ophthalmologists interpreted images remotely. Incidence of ROP was determined by combining bedside and telemedicine diagnoses. RESULTS Of 139 examined infants and 137 complete records, 20 (14.6%) patients developed ROP, with 11 (8.0%) stage 1, six (4.4%) stage 2, and three (2.2%) stage 3 based on combined diagnoses. Perinatal asphyxia was significantly associated with ROP incidence (p = 0.01). ROP incidence by combined diagnosis (20/137 or 14.6%) versus clinician diagnosis alone (21/137 or 15.3%, p = 0.50) was similar. Telemedicine changed diagnoses in 4/21 (19.0%) ROP cases. CONCLUSIONS Telemedicine may be helpful in confirming ROP incidence and may serve as a training and support model for less experienced and professionally isolated ROP examiners.
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Affiliation(s)
- Xinxin Zhang
- a University of North Carolina School of Medicine , Chapel Hill , NC , USA
| | - Yuping Wang
- b Department of Ophthalmology , Second Hospital of Lanzhou University , Lanzhou , China
| | - J Niklas Ulrich
- c Department of Ophthalmology , University of North Carolina Kittner Eye Center , Chapel Hill , NC , USA
| | - Yi Yang
- b Department of Ophthalmology , Second Hospital of Lanzhou University , Lanzhou , China
| | - Leona Ding
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA
| | - Yi Yang
- a University of North Carolina School of Medicine , Chapel Hill , NC , USA.,e University of North Carolina Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Ding Xu
- f Department of Neonatology , Second Hospital of Lanzhou University , Lanzhou , China
| | - Kristina Tarczy-Hornoch
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA.,g Department of Ophthalmology , Seattle Children's Hospital , Seattle , WA , USA
| | - Michelle T Cabrera
- d Department of Ophthalmology , University of Washington , Seattle , WA , USA.,g Department of Ophthalmology , Seattle Children's Hospital , Seattle , WA , USA
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25
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Murchison AP, Haller JA, Mayro E, Hark L, Gower E, Huisingh C, Rhodes L, Friedman DS, Lee DJ, Lam BL. Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease. Curr Eye Res 2017; 42:963-970. [PMID: 28506091 DOI: 10.1080/02713683.2017.1297463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.
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Affiliation(s)
- Ann P Murchison
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Julia A Haller
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Eileen Mayro
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Lisa Hark
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Emily Gower
- b Wilmer Eye Institute , Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine , Baltimore , MD , USA.,c Department of Epidemiology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,d Department of Ophthalmology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Carrie Huisingh
- e Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Lindsay Rhodes
- e Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - David S Friedman
- b Wilmer Eye Institute , Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine , Baltimore , MD , USA.,d Department of Ophthalmology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - David J Lee
- f Departments of Public Health Sciences and Ophthalmology , Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Byron L Lam
- f Departments of Public Health Sciences and Ophthalmology , Miller School of Medicine, University of Miami , Miami , FL , USA
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Hartnett ME. Advances in understanding and management of retinopathy of prematurity. Surv Ophthalmol 2017; 62:257-276. [PMID: 28012875 PMCID: PMC5401801 DOI: 10.1016/j.survophthal.2016.12.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/16/2022]
Abstract
The understanding, diagnosis, and treatment of retinopathy of prematurity have changed in the 70 years since the original description of retrolental fibroplasia associated with high oxygenation. It is now recognized that retinopathy of prematurity differs in appearance worldwide and as ever smaller and younger premature infants survive. New methods are being evaluated to image the retina, diagnose severe retinopathy of prematurity, and determine windows of time for treatment to save eyes and improve visual and neural outcomes. New treatments to promote physiologic retinal vascular development, vascular repair, and inhibit vasoproliferation by regulating proteins involved in vascular endothelial growth factor, insulin-like growth factor, or erythropoietin signaling. Reducing excessive oxidative/nitrosative stress and understanding progenitor cells and neurovascular and glial vascular interactions are being studied.
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Affiliation(s)
- Mary Elizabeth Hartnett
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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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.
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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
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Kelkar J, Agashe S, Kelkar A, Khandekar R. Mobile unit for retinopathy of prematurity screening and management at urban Neonatal Intensive Care Units: Outcomes and impact assessment. Oman J Ophthalmol 2017; 10:13-16. [PMID: 28298858 PMCID: PMC5338045 DOI: 10.4103/0974-620x.200684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To study the outcomes and impact of a mobile unit for retinopathy of prematurity (ROP) screening and management at urban Neonatal Intensive Care Units (NICUs). Study Design: Public health intervention study. Methods: This study was conducted in 2012. Staff of a mobile unit assessed all infants aged 32 weeks or less and/or weight 1250 g or less admitted in five NICUs between 2009 and 2011. An ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscopy. ROP was graded and managed as per the International Classification of ROP treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade, and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the mobile unit. Result: The study sample included 104 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32.7% (95% confidence intervals: 23.7–41.7). ROP Stage I was present in 75% of these eyes. The mobile unit could help in preventing/reducing visual disability in 5 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP, and addressing visual disability due to ROP was US $310, 950, and 6500, respectively. Conclusion: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention in urban areas with limited resources.
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Affiliation(s)
- Jai Kelkar
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Supriya Agashe
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya Kelkar
- Department of Pediatric Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Jiang JB, Strauss R, Luo XQ, Nie C, Wang YL, Zhang JW, Zhang ZW. Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study. BMJ Open 2017; 7:e013344. [PMID: 28119385 PMCID: PMC5278276 DOI: 10.1136/bmjopen-2016-013344] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy. DESIGN AND MAIN OUTCOME MEASURES Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation. RESULTS 97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12-16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group. CONCLUSIONS Topical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.
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Affiliation(s)
- Jing-bo Jiang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Randy Strauss
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Xian-qiong Luo
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Yan-li Wang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Jia-wen Zhang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Zhi-wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
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Maa AY, Patel S, Chasan JE, Delaune W, Lynch MG. Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases. Telemed J E Health 2017; 23:41-48. [DOI: 10.1089/tmj.2016.0039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- April Y. Maa
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Shivangi Patel
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
| | - Joel E. Chasan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - William Delaune
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia
| | - Mary G. Lynch
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Kelkar J, Kelkar A, Sharma S, Dewani J. A mobile team for screening of retinopathy of prematurity in India: Cost - effectiveness, outcomes, and impact assessment. Taiwan J Ophthalmol 2017; 7:155-159. [PMID: 29034155 PMCID: PMC5637381 DOI: 10.4103/tjo.tjo_48_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: To study the cost effectiveness, outcomes and impact of retinopathy of prematurity (ROP) screening and management model for urban neonatal intensive care units (NICUs). STUDY DESIGN: Public health intervention study. METHODS: This study was conducted in 2013. Staff of a mobile unit assessed all infants aged less than 34 weeks of Gestation age at birth and/or birth weight 1700 GM or less admitted in five NICUs between 2013 and 2015. A trained ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscope. ROP was graded and managed as per the International Classification of Retinopathy of Prematurity treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the model. RESULTS: The study sample included 102 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32% (95% Confidence Intervals (CI): 23.2–41.5). ROP stage I was present in 75% of these eyes. The model could help in preventing/reducing visual disability in 4 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP and addressing visual disability due to ROP was US $ 198.9, 596.7 and 4,137.4 respectively. CONCLUSION: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention for NICU in urban areas with limited resources.
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Affiliation(s)
- Jai Kelkar
- Department of Ophthalmology, National institute of Ophthalmology Pune, Maharashtra, India
| | - Aditya Kelkar
- Department of Ophthalmology, National institute of Ophthalmology Pune, Maharashtra, India
| | - Shubhangi Sharma
- Department of Ophthalmology, National institute of Ophthalmology Pune, Maharashtra, India
| | - Jaya Dewani
- Department of Ophthalmology, National institute of Ophthalmology Pune, Maharashtra, India
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Morrison D, Bothun ED, Ying GS, Daniel E, Baumritter A, Quinn G. Impact of number and quality of retinal images in a telemedicine screening program for ROP: results from the e-ROP study. J AAPOS 2016; 20:481-485. [PMID: 27702612 PMCID: PMC5156479 DOI: 10.1016/j.jaapos.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Telemedicine for the detection of retinopathy of prematurity (ROP) is becoming increasingly common; however, obtaining the required multiple retinal images from an infant can be challenging. This secondary analysis from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study evaluated the detection of referral-warranted ROP (RW-ROP) by trained readers when a full set of 5 retinal images could not be obtained. METHODS A total of 7,905 image sets from 1,257 infants in the study were evaluated. Retinal location of images and image quality were recorded. Sensitivity and specificity of RW-ROP detection by trained readers were calculated by comparing findings in incomplete image sets to the findings on standard eye examination. RESULTS The majority of image sets contained all 5 retinal images (92.8%). The disk center view was the image most likely to be present and to be of acceptable image quality (96.8%). The nasal retina was the most difficult to obtain with acceptable image quality (83.4%). Sensitivity of detection of RW-ROP was 82.1% when 5 retinal images of acceptable quality were submitted for grading, 67.2% when 4 acceptable images were submitted, and 66.7% for 3 or fewer acceptable images (P = 0.02), with corresponding specificity of 82.2%, 89.0%, and 81.7% respectively (P < 0.0001). When images of any quality were evaluated, sensitivity was not increased (P = 0.74). CONCLUSIONS The likelihood of detecting RW-ROP by telemedicine screening is decreased when a full set of retinal images is not obtained.
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Affiliation(s)
- David Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, Tennessee.
| | - Erick D Bothun
- Departments of Ophthalmology and Visual Neurosciences and Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | - Graham Quinn
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
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Chiang MF. Retinopathy of Prematurity: Imaging in retinopathy of prematurity: where are we, and where are we going? J AAPOS 2016; 20:474-476. [PMID: 27818193 PMCID: PMC5460759 DOI: 10.1016/j.jaapos.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/09/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Michael F Chiang
- Departments of Ophthalmology & Medical Informatics and Clinical Epidemiology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
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Thanos A, Yonekawa Y, Todorich B, Moshfeghi DM, Trese MT. Screening and treatments using telemedicine in retinopathy of prematurity. Eye Brain 2016; 8:147-151. [PMID: 28539810 PMCID: PMC5398746 DOI: 10.2147/eb.s94440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Several studies have validated the role of telemedicine as a new powerful screening and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.
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Affiliation(s)
- Aristomenis Thanos
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI.,Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Bozho Todorich
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael T Trese
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
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Suelves AM, Shulman JP. Current screening and treatments in retinopathy of prematurity in the US. Eye Brain 2016; 8:37-43. [PMID: 28539800 PMCID: PMC5398742 DOI: 10.2147/eb.s94439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a complex disease characterized by an aberrant developmental retinal angiogenesis in preterm infants and can carry significant visual morbidity, including retinal detachment and blindness. Though large scale, randomized clinical trials have improved our understanding of the pathophysiology and progression of the disease, the management of ROP remains a challenge for ophthalmologists. This review addresses the up-to-date screening approach, diagnosis, and treatment guidelines for ROP in the US.
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Affiliation(s)
- Ana M Suelves
- Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| | - Julia P Shulman
- Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
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Abstract
Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes.
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Sim DA, Mitry D, Alexander P, Mapani A, Goverdhan S, Aslam T, Tufail A, Egan CA, Keane PA. The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening. J Diabetes Sci Technol 2016; 10:308-17. [PMID: 26830492 PMCID: PMC4773982 DOI: 10.1177/1932296816629983] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions.
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Affiliation(s)
- Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, Croydon University Hospital, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Danny Mitry
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Philip Alexander
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adam Mapani
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Srini Goverdhan
- University of Southampton, Southampton Eye Unit, Southampton, UK
| | - Tariq Aslam
- Manchester University, Manchester Royal Eye Hospital, Manchester, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
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Kemper AR, Prosser LA, Wade KC, Repka MX, Ying GS, Baumritter A, Quinn GE. A Comparison of Strategies for Retinopathy of Prematurity Detection. Pediatrics 2016; 137:peds.2015-2256. [PMID: 26672022 PMCID: PMC4702020 DOI: 10.1542/peds.2015-2256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Delayed detection of type 1 retinopathy of prematurity (ROP) can lead to permanent visual impairment. Providing ROP examinations is challenging because of the limited ophthalmology workforce. This study compares digital imaging-based ROP detection strategies versus serial ROP examinations. METHODS We conducted an individual-level microsimulation study of a hypothetical cohort of 650 infants with gestational age from 23 to 30 weeks. Infants were evaluated by using strategies based on indirect ophthalmoscopy or digital imaging beginning at 32 weeks' postmenstrual age (PMA) and continuing to discharge, transfer, or 40 weeks' PMA. ROP status and the accuracy of digital imaging were based on the e-ROP (Telemedicine Approaches to Evaluating Acute-Phase ROP) study, which enrolled high-risk infants. RESULTS Within the hypothetical NICU, the strategy of ROP examinations identified an average of 45.8 cases of type 1 ROP by discharge, transfer, or 40 weeks' PMA, and another 1.9 cases were included in the group of infants recommended to have later follow-up. Digital imaging with an ROP examination at discharge identified all 47.7 cases of type 1 ROP. On average, the ROP examination-only strategy required 1745.7 ROP examinations, whereas digital imaging with a discharge examination required 1065.5 ROP examinations and 1786.2 digital imaging sessions. CONCLUSIONS Although digital imaging decreased the number of ROP examinations per infant, there was an increase in the total number of interventions (ie, ROP examinations and imaging sessions). Providing an ROP examination at the time of NICU discharge can significantly reduce the number of infants who require follow-up.
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Affiliation(s)
- Alex R. Kemper
- Duke Clinical Research Institute, Durham, North Carolina
| | - Lisa A. Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Kelly C. Wade
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael X. Repka
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gui-shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Graham E. Quinn
- Division of Pediatric Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
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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.
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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
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Quinn GE, Ying GS, Daniel E, Hildebrand PL, Ells A, Baumritter A, Kemper AR, Schron EB, Wade K. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA Ophthalmol 2014; 132:1178-84. [PMID: 24970095 PMCID: PMC4861044 DOI: 10.1001/jamaophthalmol.2014.1604] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy. OBJECTIVE To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist. DESIGN, SETTING, AND PARTICIPANTS An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013. INTERVENTIONS Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements. MAIN OUTCOMES AND MEASURES The validity of grading retinal image sets was based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination. RESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2% of eyes (19.4% of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95% CI, 77.4-85.6) and specificity of 90.1% (95% CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0% (95% CI, 85.4-93.5), with specificity of 87.0% (95% CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5% at the observed RW-ROP rate of 19.4%. CONCLUSIONS AND RELEVANCE When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01264276.
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Affiliation(s)
- Graham E Quinn
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gui-shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - P Lloyd Hildebrand
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Anna Ells
- University of Calgary, Calgary, Alberta, Canada
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alex R Kemper
- Program on Pediatric Health Services Research, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Eleanor B Schron
- Division of Extramural Research, National Institutes of Health, Bethesda, Maryland
| | - Kelly Wade
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Abstract
INTRODUCTION OR BACKGROUND The last two decades have seen a revolution in ophthalmic imaging. In this review we present an overview of the breadth of ophthalmic imaging modalities in use today and describe how the role of ophthalmic imaging has changed from documenting abnormalities visible on clinical examination to the detection of clinically silent abnormalities which can lead to an earlier and more precise diagnosis. SOURCES OF DATA This review is based on published literature in the fields of ophthalmic imaging and with focus on most commonly used imaging modalities. AREAS OF AGREEMENT New imaging techniques enable non-invasive evaluation of ocular structures at a resolution of a few micrometres. This has led to a re-evaluation of diagnostic criteria for ocular disease, which were previously defined by clinical findings without significant reference to imaging. AREAS OF CONTROVERSY Lack of formal training and clinical guidelines regarding use of new imaging techniques in diagnosing and monitoring various ocular conditions. Lack of large normative databases and interchangeability issues between different commercial machines can hinder the detection of disease progression. GROWING POINTS Imaging devices are being constantly refined with improved image capture and image analysis tools. AREAS TIMELY FOR DEVELOPING RESEARCH Clinical applications of new techniques and devices have yet to be determined using systematic scientific research methods.
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Affiliation(s)
- Tomas Ilginis
- NIHR Moorfields Biomedical Research Centre (Moorfields Eye Hospital and UCL Institute of Ophthalmology), London, UK
| | - Jonathan Clarke
- NIHR Moorfields Biomedical Research Centre (Moorfields Eye Hospital and UCL Institute of Ophthalmology), London, UK
| | - Praveen J Patel
- NIHR Moorfields Biomedical Research Centre (Moorfields Eye Hospital and UCL Institute of Ophthalmology), London, UK
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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: 22] [Impact Index Per Article: 2.2] [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.
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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]
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Abdul Aziz AA, Isaac M, Tehrani NN. Using telemedicine to screen for retinopathy of prematurity. CMAJ 2014; 186:1012-4. [PMID: 24958841 DOI: 10.1503/cmaj.131357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ayman A Abdul Aziz
- Department of Ophthalmology and Vision Sciences (Aziz, Isaac, Tehrani), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences (Aziz, Tehrani), University of Toronto, Toronto, Ont
| | - Maram Isaac
- Department of Ophthalmology and Vision Sciences (Aziz, Isaac, Tehrani), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences (Aziz, Tehrani), University of Toronto, Toronto, Ont
| | - Nasrin Najm Tehrani
- Department of Ophthalmology and Vision Sciences (Aziz, Isaac, Tehrani), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences (Aziz, Tehrani), University of Toronto, Toronto, Ont.
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Telemedicine for genetic and neurologic evaluation in the neonatal intensive care unit. J Perinatol 2014; 34:234-40. [PMID: 24406740 PMCID: PMC3943754 DOI: 10.1038/jp.2013.159] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/27/2013] [Accepted: 11/06/2013] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Evaluate whether telemedicine can be used to perform dysmorphology and neurologic examinations in the neonatal intensive care unit (NICU) by determining the examination accuracy, limitations and optimized procedures. STUDY DESIGN Prospective evaluation of NICU patients referred for subspecialty consultation for dysmorphic features (n=10) or encephalopathy (n=10). A physician at bedside (bedside clinician) performed an in-person examination that was viewed in real time by a remote physician (remote consultant). Standardized examinations were recorded and compared. Subsequently, a qualitative approach established technique adjustments and optimization procedures necessary to improve visualization. RESULT Telemedicine examinations identified 81 of 87 (93%) dysmorphology examination abnormalities and 37 of 39 (92%) neurologic examination abnormalities. Optimization of remote consultant visualization required an active bedside clinician assisting in camera and patient adjustments. CONCLUSION Telemedicine can be used to perform accurately many components of the dysmorphology or neurologic examinations in NICU patients, but physicians must be mindful of specific limitations.
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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).
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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.
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Shah SP, Wu Z, Iverson S, Dai S. Specialist Nurse Screening for Retinopathy of Prematurity-A Pilot Study. Asia Pac J Ophthalmol (Phila) 2013; 2:300-4. [PMID: 26107033 DOI: 10.1097/apo.0b013e31829dc72b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the accuracy of retinopathy of prematurity (ROP) screening between nurse specialists and an expert pediatric ophthalmologist. DESIGN A comparative case series of ROP screening in a level 2 neonatal intensive care unit setting where there is a higher threshold for accepting very premature or unwell neonates. METHODS Trained specialist ROP nurses acquired wide-field digital images, graded ROP, and proposed a follow-up plan. This was compared with the findings by an ROP expert ophthalmologist. Outcomes include sensitivity, specificity, positive predictive value, and negative predictive value of ROP grading by trained ROP nurses. RESULTS Mean gestational age was 28.6 weeks, and mean birth weight was 1184 g of the 64 consecutive neonates included. A total 316 eye screens was performed. Image acquisition, grading, and a management plan by the ROP nurse were possible in all screens. In right eyes, the presence of any ROP (stage >0) was 15%. Sensitivity, specificity, positive predictive value, and negative predictive value of ROP grading were 91.7% (95% CI, 73%-99%), 80.6% (95% CI, 72.9%-86.9%), 45.8% (95% CI, 31.4%-60.80%), and 98.2% (95% CI, 93.6%-99.8%), respectively. Agreement on the management plan occurred in 84.8% of cases. In virtually all circumstances of disagreement, ROP nurses exaggerated the ROP grading present and/or recommended a repeat screen when discharge from service was more appropriate. CONCLUSIONS Our preliminary findings demonstrated good agreement between ROP nurses and the ROP expert ophthalmologist. Further research in expanding the role of utilizing nonphysician health workers in ROP screening is suggested.
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Affiliation(s)
- Shaheen P Shah
- From the *Department of Ophthalmology, Auckland, New Zealand, Auckland; and †International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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