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Sosa Lockward JA, Abreu Arbaje N, García Méndez M, Juan A, Sosa Peña JA, Batlle Pichardo JF. Telemedicine in retinopathy of prematurity: Crossing borders in pediatric vision health. TELEROP study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:543-548. [PMID: 36038486 DOI: 10.1016/j.oftale.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
GENERAL OBJECTIVE To evaluate the accuracy and validity of images with smartphone compared to the RetCam® system for the diagnosis of retinopathy of prematurity (ROP). METHODOLOGY Observational, longitudinal and masked study carried out at the Dr. Elías Santana hospital. Infants with birth weight ≤1500 g, gestational age ≤30 weeks and/or patients exposed to risk factors or complications linked to ROP were included. These subjects were screened using images with smartphone or RetCam®, both compared to conventional fundoscopy. The ICROP classification was used for staging. The main results analyzed were sensitivity, specificity, positive predictive values and kappa index. RESULTS 915 images (n = 121) were obtained, distributed in smartphone group (50.4%) and RetCam® group (49.6%) between August 2020 and March 2021. Subjects with ROP had lower gestational age (30.2 sem ± 2.8), birth weight (1361 g ± 398), and greater exposure to oxygen therapy (12.8 days ± 11.3). The RetCam® group presented sensitivity = 80%, specificity = 78%, positive predictive value = 90% and kappa index = 0.70. The smartphone group presented sensitivity = 88%, specificity = 90%, positive predictive value = 93.75% and kappa index = 0.81. CONCLUSIONS Both diagnostic methods were accurate to identify ROP. The smartphone group obtained superior results with excellent resolution, representing a cost-effective method to create a global impact on reducing preventable blindness in the pediatric population.
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Affiliation(s)
- J A Sosa Lockward
- Servicio de Oftalmología, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic.
| | - N Abreu Arbaje
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - M García Méndez
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - A Juan
- Departamento de Retina y Vítreo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - J A Sosa Peña
- Servicio de Oftalmología Pediátrica y Estrabismo, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
| | - J F Batlle Pichardo
- Servicio de Retina y Vítreo y Servicio de Oftalmología, Hospital Dr. Elías Santana, Santo Domingo, Dominican Republic
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Li Y, Zhou H, Huang Q, Tan W, Cai Y, Wang Z, Zou J, Li B, Yoshida S, Zhou Y. Potential biomarkers for retinopathy of prematurity identified by circular RNA profiling in peripheral blood mononuclear cells. Front Immunol 2022; 13:953812. [PMID: 36081509 PMCID: PMC9447331 DOI: 10.3389/fimmu.2022.953812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aims to reveal the altered expression profiles of circular RNAs (circRNAs) in the peripheral blood mononuclear cells (PBMCs) of patients with retinopathy of prematurity (ROP), and to identify potential biomarkers for ROP diagnosis. Methods Differentially expressed circRNAs in PBMCs of five infants with ROP and five controls were identified using microarray analysis. Twelve altered circRNAs were validated using reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). Bioinformatic analyses were conducted to predict the circRNA/miRNA interactions, competing endogenous RNA (ceRNA) network, related biological functions, and signaling pathways. Four selected circRNAs in PBMCs were verified using RT-qPCR in another cohort, including 24 infants with ROP and 23 premature controls, and receiver operating characteristic (ROC) curves were used to estimate their potential as diagnostic biomarkers of ROP. Results A total of 54 and 143 circRNAs were significantly up- and down-regulated, respectively, in the PBMCs of patients with ROP compared with controls. Twelve of the significantly altered circRNAs were preliminarily validated by RT-qPCR, which confirmed the reliability of the microarray analysis. The circRNA/miRNA interactions and ceRNA network were displayed according to the altered circRNAs. Three circRNAs (hsa_circRNA_061346, hsa_circRNA_092369, and hsa_circRNA_103554) were identified as potential diagnostic biomarkers for ROP with certain clinical values. Conclusions CircRNAs were significantly altered in PBMCs of treatment-requiring ROP patients. CircRNAs may be used as potential biomarkers and possible therapeutic targets for ROP.
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Affiliation(s)
- Yun Li
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Haixiang Zhou
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Qian Huang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Wei Tan
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Yuting Cai
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Zicong Wang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Jingling Zou
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Bingyan Li
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Yedi Zhou
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
- *Correspondence: Yedi Zhou,
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Development of 3D Printed Smartphone-Based Multi-Purpose Fundus Camera (MultiScope) for Retinopathy of Prematurity. Ann Biomed Eng 2021; 49:3323-3338. [PMID: 34773157 DOI: 10.1007/s10439-021-02885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Retinopathy of Prematurity (ROP) is a prominent source of low vision and blindness in preterm babies. Wide-Field Digital Retinal Imaging (WFDRI) systems acquire accurate digital images which are very useful for identification, documentation and transmitting the various retinal diseases. This telemedicine technique has potential for an alternative tool for Binocular Indirect Ophthalmoscopy (BIO) in ROP screening, but it is very expensive and accessibility for poor communities is limited. Capabilities of good illumination, high resolution camera and processing speed of the modern smartphones are being identified as a substitute. Potential applications of 3D printing is that it provides a severe impact in medical field, especially in ophthalmology sector. Competences of 3D printing are very useful for the development of retinal camera from any smartphone with the help of 3D printable devices. The primary aim of this study is to develop a handheld 3D printed smartphone-based multi-purpose fundus camera for ROP screening. The secondary aim is to check the feasibility and compare the digital fundus images obtained from the developed fundus camera against the commercial RetCam imaging. The proposed cost effective and remote reading device is an alternative to WFDRI for ROP screening and can improve the potential of ROP care for low resource communities.
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Validation of smartphone-based screening for retinopathy of prematurity in a low-resource setting. J AAPOS 2021; 25:274.e1-274.e5. [PMID: 34563697 DOI: 10.1016/j.jaapos.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To study the validity of smartphone-based screening to detect moderate-to-severe levels of retinopathy of prematurity (ROP) in a low-resource setting. METHODS In this observational validation study, all new patients at a single center who met screening criteria for ROP (birth weight of ≤1700 g and gestational age of ≤35 weeks) were examined by a pediatric ophthalmologist using indirect ophthalmoscopy. At the first ROP examination, a trained photographer captured fundus images using a smartphone fitted on an adapter, the Paxos Scope. The photographs were graded by two retina specialists masked to results of the gold standard examination. RESULTS A total of 100 children (200 eyes) were included. ROP was detected in 27.4% by indirect ophthalmoscopy, 16% of whom had moderate-to-severe ROP, defined as stage 3 in zone I or II, stage 2 in zone I or II, or pre-plus or plus disease. Sensitivity of fundus images reviewed by grader 1 against the gold standard in detecting moderate-to-severe ROP was 87.5%, and specificity was 82.1%. The positive predictive value was 48.3 %; the negative predictive value, 97.2%. The sensitivity of fundus images reviewed by grader 2 was 87.5%; the specificity, 81.6%. Positive predictive value was 47.5%; negative predictive value, 97.2%. The measured κ coefficient for intergrader agreement was 0.94. CONCLUSIONS Our study is one of the few studies on smartphone-based telescreening for ROP. The results suggest that smartphones may have potential as a screening tool for ROP in low-resource settings.
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Toslak D, Chau F, Erol MK, Liu C, Chan RVP, Son T, Yao X. Trans-pars-planar illumination enables a 200° ultra-wide field pediatric fundus camera for easy examination of the retina. BIOMEDICAL OPTICS EXPRESS 2020; 11:68-76. [PMID: 32010500 PMCID: PMC6968751 DOI: 10.1364/boe.11.000068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 05/18/2023]
Abstract
This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric fundus photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric fundus photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.
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Affiliation(s)
- Devrim Toslak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Felix Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07100, Turkey
| | - Changgeng Liu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Biolight Engineering LLC, Hinsdale, IL 60521-3181, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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Valikodath N, Cole E, Chiang MF, Campbell JP, Chan RVP. Imaging in Retinopathy of Prematurity. Asia Pac J Ophthalmol (Phila) 2019; 8:178-186. [PMID: 31037876 PMCID: PMC7891847 DOI: 10.22608/apo.201963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Barriers to ROP screening and difficulties with subsequent evaluation and management include poor access to care, lack of physicians trained in ROP, and issues with objective documentation. Digital retinal imaging can help address these barriers and improve our knowledge of the pathophysiology of the disease. Advancements in technology have led to new, non-mydriatic and mydriatic cameras with wider fields of view as well as devices that can simultaneously incorporate fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. Image analysis in ROP is also being employed through smartphones and computer-based software. Telemedicine programs in the United States and worldwide have utilized imaging to extend ROP screening to infants in remote areas and have shown that digital retinal imaging can be reliable, accurate, and cost-effective. In addition, tele-education programs are also using digital retinal images to increase the number of healthcare providers trained in ROP. Although indirect ophthalmoscopy is still an important skill for screening, digital retinal imaging holds promise for more widespread screening and management of ROP.
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Affiliation(s)
- N Valikodath
- From the Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States; and Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
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