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Wood EH, Moshfeghi DM, Capone A, Williams GA, Blumenkranz MS, Sieving PA, Harper CA, Hartnett ME, Drenser KA. A Literary Pediatric Retina Fellowship With Michael T. Trese, MD. Ophthalmic Surg Lasers Imaging Retina 2023; 54:701-712. [PMID: 38113364 DOI: 10.3928/23258160-20231020-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Michael T. Trese, MD (1946-2022), a vitreoretinal surgeon, made significant contributions to the field of retina. Although most known for his work in pediatric retina surgery, he was a pioneer in areas such as medical retina, translational research, and telemedicine. This article reviews his major contributions to spread his knowledge more widely to vitreoretinal trainees and specialists. We discuss six areas where Trese made a lasting impact: lens-sparing vitrectomy, familial exudative vitreoretinopathy, congenital X-linked retinoschisis, autologous plasmin enzyme, regenerative medicine, and telemedicine. [Ophthalmic Surg Lasers Imaging Retina 2023;54:701-712.].
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Eckart F, Kaufmann M, Rüdiger M, Birdir C, Mense L. [Telemedical support of feto-neonatal care in one region - Part II: Structural requirements and areas of application in neonatology]. Z Geburtshilfe Neonatol 2023; 227:87-95. [PMID: 36702135 DOI: 10.1055/a-1977-9102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Telemedical infrastructure for patient assessment, care and follow-up as well as interdisciplinary exchange can contribute to ensuring patient care that is close to home and meets the highest quality standards, even outside specialised centres. In neonatology, synchronous audio-visual communication across institutions has been used for many years, especially in the Anglo-American countries. Areas of application include extended neonatal primary care and resuscitation, specific diagnostic applications, e.g. ROP screening and echocardiography, as well as parental care, regular telemedical ward rounds and further training of medical staff, especially using simulation training. For the implementation of such telemedical infrastructures, certain organisational, medical-legal and technical requirements for hardware, software and structural and process organisation must be met. The concrete realisation of a telemedical infrastructure currently being implemented for the region of Eastern Saxony is demonstrated here using the example of the Saxony Center for feto/neonatal Health (SCFNH). Within the framework of feto-neonatal competence networks such as the SCFNH, the quality of medical care, patient safety and satisfaction in a region can be increased by means of a comprehensive, well-structured and established telemedical infrastructure.
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Affiliation(s)
- Falk Eckart
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Maxi Kaufmann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Mario Rüdiger
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Cahit Birdir
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Lars Mense
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
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Abstract
Over a century of innovations in technology and medical care have led to the current day capabilities in telemedicine. In this chapter, we discuss the evolution of telemedicine over the last century and highlight various applications in neonatal care. We hope this chapter demonstrates the exponential adoption of telemedicine, particularly in neonatology, and the breadth and depth of the technology being used.
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Moshfeghi DM, Trese MT. Reducing Blindness Resulting from Retinopathy of Prematurity Using Deep Learning. Ophthalmology 2021; 128:1077-1078. [PMID: 34154724 DOI: 10.1016/j.ophtha.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
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Abstract
Nonconfocal ultra-widefield scanning laser ophthalmoscopes produce foveal polarization artifacts that require normal Henle layer structure and are suppressed by center-involving diabetic macular edema. Polarization sensitivity is insufficient for the artifacts to be reliable clinical screening biomarkers. Purpose: Bowtie-shaped polarization artifacts are often present in nonconfocal ultra-widefield scanning laser ophthalmoscope (SLO) images. We studied these artifacts and evaluated their potential value as clinical biomarkers in screening for center-involving diabetic macular edema (DME). Methods: We performed a retrospective, observational, cohort study on 78 diabetic adult patients (143 eyes) who had spectral domain optical coherence tomography and nonmydriatic nonconfocal ultra-widefield SLO testing on the same day. Scanning laser ophthalmoscope green-only (532 nm), red-only (635 nm), and composite pseudocolor (532 plus 635 nm) images were examined for the presence of a foveal bowtie polarization artifact. Results: Polarization artifacts were absent in all but one eye with center-involving DME (32 of 33 eyes). Polarization artifacts were also absent in many eyes without center-involving DME (49 of 110 eyes in pseudocolor images). As clinical biomarkers of center-involving DME, artifact absence has high specificity (99, 100, and 98% for green, red, and pseudocolor images, respectively) but poor sensitivity (49, 31, and 40% for green, red, and pseudocolor images, respectively). Conclusion: Foveal bowtie-shaped polarization artifacts occur routinely in nonconfocal ultra-widefield SLO images. Their presence indicates preserved foveal Henle fiber layer structure. Contemporary nonconfocal ultra-widefield SLO images lack the sensitivity for their bowtie artifacts to serve as reliable biomarkers in screening for center-involving DME.
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Affiliation(s)
- Radwan S Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas
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Abstract
Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.
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Affiliation(s)
- Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, New Delhi, India
| | - Parijat Chandra
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Sameera Nayak
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Kode Venkatadri Chowdhary Campus, Vijaywada, Andhra Pradesh, India
| | - Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Granthi Mallikarjun Rao Varalaksmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Li JPO, Liu H, Ting DSJ, Jeon S, Chan RVP, Kim JE, Sim DA, Thomas PBM, Lin H, Chen Y, Sakomoto T, Loewenstein A, Lam DSC, Pasquale LR, Wong TY, Lam LA, Ting DSW. Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective. Prog Retin Eye Res 2021; 82:100900. [PMID: 32898686 PMCID: PMC7474840 DOI: 10.1016/j.preteyeres.2020.100900] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.
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Affiliation(s)
- Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hanruo Liu
- Beijing Tongren Hospital; Capital Medical University; Beijing Institute of Ophthalmology; Beijing, China
| | - Darren S J Ting
- Academic Ophthalmology, University of Nottingham, United Kingdom
| | - Sohee Jeon
- Keye Eye Center, Seoul, Republic of Korea
| | | | - Judy E Kim
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Haotian Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Youxin Chen
- Peking Union Medical College Hospital, Beijing, China
| | - Taiji Sakomoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | | | - Dennis S C Lam
- C-MER Dennis Lam Eye Center, C-Mer International Eye Care Group Limited, Hong Kong, Hong Kong; International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tien Y Wong
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore
| | - Linda A Lam
- USC Roski Eye Institute, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore.
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Neves LM, Haefeli LM, Zin AA, Steffen RE, Vasconcelos ZFM, Pinto M. Cost-Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil. Front Pediatr 2021; 9:757258. [PMID: 34976892 PMCID: PMC8716796 DOI: 10.3389/fped.2021.757258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate the cost-utility of wide-field imaging (WFI) as a complementary technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified Health System's perspective. Introduction: ROP is one of the leading causes of avoidable childhood blindness worldwide, especially in middle-income countries. The current ROP screening involves indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However, there is still insufficient ROP screening coverage. An alternative screening strategy is the combination of WFI with IBO. Methods: A cost-utility analysis was performed using a deterministic decision-tree simulation model to estimate incremental cost-utility for ROP care. Two screening strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population included preterm infants <32 weeks of gestational age or birth weight equal to or <1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to utility, and the health benefits were estimated on quality-adjusted life-years (QALY). Incremental cost per QALY gained was calculated from the health system perspective. Costs were estimated considering equipment, maintenance, consumables, and staff. A micro-costing approach was used for WFI. Two technician nurses were trained for imaging execution and had their time evaluated. Two ROP expert ophthalmologists had their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: Combined screening strategy resulted in a cost-effective program considering 90% ROP screening coverage. Costs per examination: (1) screening with IBO: US dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment: US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the infant's visual function. Incremental cost per QALY gained was US $1,746.99/QALY per infant screened with the combination strategy. One-way sensitivity analysis resulted in cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100% probability of combination being cost-effective in a willingness-to-pay threshold of US $1,800/QALY. Conclusion: The combined strategy for ROP screening was cost-effective. It enhances access for appropriate ROP care in middle-income countries and dminishes opportunity costs for ophthalmologists.
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Affiliation(s)
- Luiza M Neves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lorena M Haefeli
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andrea A Zin
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ricardo E Steffen
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Departamento de Medicina, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janerio, Brazil
| | - Zilton F M Vasconcelos
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Márcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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13
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Maka E, Kovács G, Imre L, Gilbert C, Szabó M, Németh J, Nagy ZZ, Somogyvári Z. The validity of telemedicine-based screening for retinopathy of prematurity in the Premature Eye Rescue Program in Hungary. J Telemed Telecare 2019; 27:367-375. [PMID: 31645172 DOI: 10.1177/1357633x19880113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the validity of wide-field digital imaging (WFDI) and telemedicine-based screening compared with examination by binocular indirect ophthalmoscopy (BIO) and to present some of the results from the first five years of telemedicine-based screening in the Premature Eye Rescue Program in Hungary. METHODS We performed a retrospective analysis in two periods that aimed to assess (a) the validity of retinal digital imaging and (b) routine bedside screening. The validity was assessed in two neonatal intensive care units (NICUs), one in the First Department of Paediatrics and the other in the Second Department of Obstetrics and Gynaecology, Semmelweis University. The telemedicine-based WFDI (WFDI-TM) screening program was introduced in two phases. In the first phase (from 30 November 2009 to 8 August 2010), BIO and WFDI were performed by the same paediatric ophthalmologist (Group A). In the second phase (from 9 August 2010 to 29 March 2011), BIO was performed by the paediatric ophthalmologist, while retinal images were captured by a trained neonatal transport nurse practitioner (Group B). BIO screening was the reference method as a gold standard in both phases. RESULTS During the validity assessment period 634 examinations were performed in 153 preterm infants. Overall, 76 babies were screened in Group A and 80 were screened in Group B. We found lower sensitivity and specificity in cases of any ROP (sensitivity 86%, specificity 99%) compared with those of treatment-requiring retinopathy of prematurity (TR-ROP) (both sensitivity and specificity 100%).In the Premature Eye Rescue Program between 1April 2011 and 31 March 2016, we used WFDI in 3035 infants (4589 procedures). Over this five-year period, 100 (9.6%) infants were treated by laser, and no child who received care in any of the Semmelweis University NICUs became blind from ROP. CONCLUSIONS (a) WFDI-TM ROP screening is a useful and efficient approach, although it cannot completely replace BIO; (b) no ROP-related blindness developed among the screened preterm babies; and (c) WFDI-TM ROP screening can be implemented in the logistics of a neonatal emergency and ambulance team infrastructure with neonatal transport nurse practitioners as 'photographers'.
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Affiliation(s)
- Erika Maka
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Gábor Kovács
- Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary
| | - László Imre
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK
| | - Miklós Szabó
- 1st Department of Paediatrics Semmelweis University, Hungary
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Hungary.,Department of Family Care Methodology, Semmelweis University, Hungary
| | - Zsolt Somogyvári
- Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary.,Department of Family Care Methodology, Semmelweis University, Hungary
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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] [What about the content of this article? (0)] [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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Greven MA, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): telemedicine-based examination after laser photocoagulation for treatment-warranted retinopathy of prematurity. Eye (Lond) 2019; 33:1347-1355. [PMID: 30867576 DOI: 10.1038/s41433-019-0392-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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16
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Abstract
PURPOSE To describe a framework for screening and treatment of retinopathy of prematurity (ROP) using telemedicine screening with laser and/or vascular endothelial growth factor inhibitor treatment strategies. DESIGN Literature review and perspective. METHODS Review of the literature and the author's experience. RESULTS Undetermined. CONCLUSIONS Telemedicine can be deployed on a national basis to provide quaternary-level screening for ROP. At-risk patients for treatment could then be directed to receive either laser photocoagulation or vascular endothelial growth factor inhibitor intravitreal injections followed at a later time by examination under anesthesia, fluorescein angiography, and diode laser photocoagulation as indicated.
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Affiliation(s)
- Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
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17
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Gadkari SS, Deshpande M. Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy. Indian J Ophthalmol 2017; 65:846-852. [PMID: 28905829 PMCID: PMC5621268 DOI: 10.4103/ijo.ijo_1_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose: We sought to document the difference in the vitreoretinal configuration of Stage 4 retinopathy of prematurity (ROP) in photocoagulated and treatment naive eyes undergoing vitrectomy and to correlate it with surgical complexity. Methods: Consecutive eyes posted for vitrectomy with Stage 4 ROP were documented preoperatively using a RetCam for the presence of peripheral traction (PT), presence of central traction just outside the arcades, and presence of traction extending to the lens. A note was made of the following intraoperative events: lensectomy, intraoperative bleeding, and iatrogenic breaks. Wilcoxon rank-sum test was used for analysis. Results: From a total of 46 eyes, 16 and 30 eyes were from the treated and treatment naive group, respectively. More eyes in the treated group had central (P < 0.0001) and lenticular traction (P = 0.022). More eyes in the untreated group had PT (P < 0.0001). A significant number of eyes without photocoagulation needed lensectomy (P = 0.042), and no difference in intraoperative bleeding (P = 0.94) was demonstrable. Iatrogenic retinotomy occurred in three eyes, all naive. Notably, age at surgery was more in the untreated group (P = 0.00008). Conclusion: Vasoproliferative activity in all retinopathies occurs at the junction of the ischemic and nonischemic retina. In the natural course of ROP, this takes place peripherally, at the ridge. In photocoagulated eyes, this junction is displaced posteriorly due to peripheral ablation. Treated eyes manifested with posterior proliferative changes and were more amenable to lens-sparing vitrectomy. Naive eyes were older when they underwent surgery to relieve PT with greater chances of lensectomy and iatrogenic breaks.
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Affiliation(s)
- Salil Sharad Gadkari
- Department of Vitreoretinal Surgery, PBMA's H V Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of Vitreoretinal Surgery, PBMA's H V Desai Eye Hospital, Pune, Maharashtra, India
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Todorich B, Thanos A, Yonekawa Y, Thomas BJ, Faia LJ, Chang E, Shulman J, Olsen KR, Blair MP, Shapiro MP, Ferrone P, Vajzovic L, Toth CA, Lee TC, Robinson J, Hubbard B, Kondo H, Besirli CG, Nudleman E, Wong SC, Kusaka S, Walsh M, Chan RVP, Berrocal A, Caputo G, Murray TG, Sears J, Schunemann R, Harper CA 3rd, Kychental A, Dorta P, Cernichiaro-Espinosa LA, Wu WC, Campbell JP, Martinez-Castellanos MA, Quiroz-Mercado H, Hayashi H, Quiram P, Amphornphruet A, Hartnett ME, Tsui I, Ells A, John V, Moshfeghi D, Capone A Jr, Drenser KA, Trese MT. Correspondence. Retina 2017; 37:e52-4. [PMID: 28358752 DOI: 10.1097/IAE.0000000000001602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Pathipati AS, Moshfeghi DM. Telemedicine Applications in Pediatric Retinal Disease. J Clin Med 2017; 6:E36. [PMID: 28333078 PMCID: PMC5406768 DOI: 10.3390/jcm6040036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022] Open
Abstract
Teleophthalmology is a developing field that presents diverse opportunities. One of its most successful applications to date has been in pediatric retinal disease, particularly in screening for retinopathy of prematurity (ROP). Many studies have shown that using telemedicine for ROP screening allows a remote ophthalmologist to identify abnormal findings and implement early interventions. Here, we review the literature on uses of telemedicine in pediatric retinal disease and consider future applications.
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Affiliation(s)
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, CA 94303, USA.
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21
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Wood EH, Moshfeghi AA, Nudleman ED, Moshfeghi DM. Evaluation of Visunex Medical's PanoCam(TM) LT and PanoCam(TM) Pro wide-field imaging systems for the screening of ROP in newborn infants. Expert Rev Med Devices 2017; 13:705-12. [PMID: 27424884 DOI: 10.1080/17434440.2016.1208560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas. AREAS COVERED A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies' websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures. Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.
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Affiliation(s)
- Edward H Wood
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
| | - Andrew A Moshfeghi
- b USC Eye Institute, Department of Ophthalmology , University of Southern California Keck School of Medicine , Los Angeles , CA , USA
| | - Eric D Nudleman
- c Shiley Eye Institute, Department of Ophthalmology , University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Darius M Moshfeghi
- a Byers Eye Institute, Department of Ophthalmology , Stanford University School of Medicine , Palo Alto , CA , USA
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
PURPOSE To review the basic principles of ultra-widefield fundus imaging and discuss its clinical utility for a variety of retinal and choroidal disorders. METHODS A systematic review of the PubMed database was performed using the search terms Optos, optomap, panoramic, ultra-widefield, wide-angle, and ellipsoid mirror. This yielded 158 publications of which 128 were selected based on content and relevance. RESULTS A total of 128 articles pertaining to ultra-widefield imaging were cited in this review. CONCLUSION Optos ultra-widefield imaging has become an essential tool for the identification of peripheral retinal and vascular pathology. The high resolution and multimodal capabilities of this device are also providing new insights into a variety of disorders, even those that primarily involve the posterior pole. Although the presence of artifact and the need for clinical validation are significant hurdles to more widespread use, ultra-widefield is evolving to become the standard-of-care imaging modality for many diseases and is finding new clinical and research applications such as for screening and telemedicine.
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24
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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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26
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Abbey AM, Besirli CG, Musch DC, Andrews CA, Capone A, Drenser KA, Wallace DK, Ostmo S, Chiang M, Lee PP, Trese MT. Evaluation of Screening for Retinopathy of Prematurity by ROPtool or a Lay Reader. Ophthalmology 2015; 123:385-390. [PMID: 26681393 DOI: 10.1016/j.ophtha.2015.09.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if (1) tortuosity assessment by a computer program (ROPtool, developed at the University of North Carolina, Chapel Hill, and Duke University, and licensed by FocusROP) that traces retinal blood vessels and (2) assessment by a lay reader are comparable with assessment by a panel of 3 retinopathy of prematurity (ROP) experts for remote clinical grading of vascular abnormalities such as plus disease. DESIGN Validity and reliability analysis of diagnostic tools. PARTICIPANTS Three hundred thirty-five fundus images of prematurely born infants. METHODS Three hundred thirty-five fundus images of prematurely born infants were obtained by neonatal intensive care unit nurses. A panel of 3 ROP experts graded 84 images showing vascular dilatation, tortuosity, or both and 251 images showing no evidence of vascular abnormalities. These images were sent electronically to an experienced lay reader who independently graded them for vascular abnormalities. The images also were analyzed using the ROPtool, which assigns a numerical value to the level of vascular abnormality and tortuosity present in each of 4 quadrants or sectors. The ROPtool measurements of vascular abnormalities were graded and compared with expert panel grades with a receiver operating characteristic (ROC) curve. Grades between human readers were cross-tabulated. The area under the ROC curve was calculated for the ROPtool, and sensitivity and specificity were computed for the lay reader. MAIN OUTCOME MEASURES Measurements of vascular abnormalities by ROPtool and grading of vascular abnormalities by 3 ROP experts and 1 experienced lay reader. RESULTS The ROC curve for ROPtool's tortuosity assessment had an area under the ROC curve of 0.917. Using a threshold value of 4.97 for the second most tortuous quadrant, ROPtool's sensitivity was 91% and its specificity was 82%. Lay reader sensitivity and specificity were 99% and 73%, respectively, and had high reliability (κ, 0.87) in repeated measurements. CONCLUSIONS ROPtool had very good accuracy for detection of vascular abnormalities suggestive of plus disease when compared with expert physician graders. The lay reader's results showed excellent sensitivity and good specificity when compared with those of the expert graders. These options for remote reading of images to detect vascular abnormalities deserve consideration in the quest to use telemedicine with remote reading for efficient delivery of high-quality care and to detect infants requiring bedside examination.
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Affiliation(s)
- Ashkan M Abbey
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Antonio Capone
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - Kimberly A Drenser
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan
| | - David K Wallace
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Susan Ostmo
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Michael Chiang
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Michael T Trese
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; Associated Retinal Consultants, Royal Oak, Michigan.
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Vinekar A, Jayadev C, Mangalesh S, Shetty B, Vidyasagar D. Role of tele-medicine in retinopathy of prematurity screening in rural outreach centers in India - a report of 20,214 imaging sessions in the KIDROP program. Semin Fetal Neonatal Med 2015; 20:335-45. [PMID: 26092301 DOI: 10.1016/j.siny.2015.05.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Middle-income countries such as India are suffering from the third epidemic of retinopathy of prematurity (ROP). Improved survival and lower infant mortality rates have resulted in an increased number of preterm survivors in rural areas that unfortunately lack ROP specialists. We report our experience of a public-private partnership in rural India of an ongoing telemedicine program Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity program KIDROP that provides ROP screening by non-physicians. The analysis of 20,214 imaging sessions of 7106 from 36 rural centers in 77 months of activity are presented. The overall incidence of any stage and treatment requiring ROP was 22.39% and 3.57% respectively. We found a higher incidence of severe ROP in private (7.1%) vs government centers (1.7%). Fifty of the 254 babies (19.69%) who underwent treatment were outside the American screening guidelines cut-off. The report compares other "real-world" tele-ROP programs, summarizes the impact, and provides future strategies for outreach ROP screening in middle-income countries.
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Affiliation(s)
- Anand Vinekar
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India.
| | - Chaitra Jayadev
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Shwetha Mangalesh
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India; Duke University, Durham, NC, USA
| | - Bhujang Shetty
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Dharmapuri Vidyasagar
- University of Illinois, Chicago, IL, USA; M.S. Ramaiah Medical College, Bangalore, India
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Bajwa A, Aman R, Reddy AK. A comprehensive review of diagnostic imaging technologies to evaluate the retina and the optic disk. Int Ophthalmol 2015; 35:733-55. [DOI: 10.1007/s10792-015-0087-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/19/2015] [Indexed: 12/19/2022]
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29
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Wang SK, Callaway NF, Wallenstein MB, Henderson MT, Leng T, Moshfeghi DM. SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Can J Ophthalmol 2015; 50:101-6. [DOI: 10.1016/j.jcjo.2014.11.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 11/07/2014] [Indexed: 01/06/2023]
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30
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Tejada-Palacios P, Zarratea L, Moral M, de la Cruz-Bértolo J. Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity. ACTA ACUST UNITED AC 2015; 90:373-8. [PMID: 25817958 DOI: 10.1016/j.oftal.2015.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 04/09/2014] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the performance of RetCam vs. binocular ophthalmoscopy (BIO) in a screening program for retinopathy of prematurity (ROP). METHODS Observational comparative study with prospective data collection. Examinations with RetCam (n=169) were performed on 83 infants included in a screening program for ROP and stored for analysis at a later stage. An experienced ophthalmologist examined the ocular fundus with binocular indirect ophthalmoscopy (BIO). The RetCam images were assessed for the presence of ROP, zone, grade, and presence of plus disease. RetCam and BIO data were compared by visually to estimate sensitivity, specificity, positive (VPP) and negative (VPN) predictive values. RESULTS ROP disease was detected in 108 eyes with BIO, and in 74 with RetCam. Out of 306 eyes examined with RetCam, false negative results were found in 34 eyes, with no false positives. Sensitivity of RetCam exam vs. BIO was 0.68, and specificity was 0.99. Positive predictive value was 0.93 and negative predictive value was 0.85. All 34 ROP cases not detected with RetCam were in zone III or outer zone II. They were all mild and regressed spontaneously. No threshold ROP was missed with RetCam. CONCLUSION Binocular indirect ophthalmoscopy is the reference method for the diagnosis of ROP. RetCam may be used as an alternative for ROP screening.
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Affiliation(s)
- P Tejada-Palacios
- Sección de Oftalmología Infantil, Hospital 12 de Octubre, Madrid, España.
| | - L Zarratea
- Sección de Oftalmología Infantil, Hospital 12 de Octubre, Madrid, España
| | - M Moral
- Servicio de neonatología, Hospital 132 de Octubre, Madrid, España
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Abstract
Retinopathy of prematurity (ROP) remains a significant threat to vision for extremely premature infants despite the availability of therapeutic modalities capable, in most cases, of managing this disorder. It has been shown in many controlled trials that application of therapies at the appropriate time is essential to successful outcomes in premature infants affected by ROP. Bedside binocular indirect ophthalmoscopy has been the standard technique for diagnosis and monitoring of ROP in these patients. However, implementation of routine use of this screening method for at-risk premature infants has presented challenges within our existing care systems, including relative local scarcity of qualified ophthalmologist examiners in some locations and the remote location of some NICUs. Modern technology, including the development of wide-angle ocular digital fundus photography, coupled with the ability to send digital images electronically to remote locations, has led to the development of telemedicine-based remote digital fundus imaging (RDFI-TM) evaluation techniques. These techniques have the potential to allow the diagnosis and monitoring of ROP to occur in lieu of the necessity for some repeated on-site examinations in NICUs. This report reviews the currently available literature on RDFI-TM evaluations for ROP and outlines pertinent practical and risk management considerations that should be used when including RDFI-TM in any new or existing ROP care structure.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Navarro-blanco C, Peralta-calvo J, Pastora-salvador N, Álvarez-rementería L, Chamorro E, Sánchez-ramos C. Reliability of retinal imaging screening in retinopathy of prematurity. Anales de Pediatría (English Edition) 2014; 81:149-54. [DOI: 10.1016/j.anpede.2013.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Navarro-Blanco C, Peralta-Calvo J, Pastora-Salvador N, Álvarez-Rementería L, Chamorro E, Sánchez-Ramos C. Fiabilidad en el cribado de la retinopatía del prematuro mediante el análisis de retinografías. An Pediatr (Barc) 2014; 81:149-54. [DOI: 10.1016/j.anpedi.2013.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022] Open
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Abstract
For decades, the standard method for screening and grading severity of diabetic retinal disease has relied upon a montage of photographs using normal angle fundus cameras. With the development of ultrawide field (UWF) fundus imaging, more of the retina can be imaged with fewer pictures, less dependence on photographer skill, and, often, greater ease on the patient. Recent studies have shown comparability between traditional and UWF imaging for standard grading of diabetic retinopathy. Moreover, UWF images can detect peripheral pathology not typically seen in standard photographs, which may enlighten our understanding of disease severity and suggest new indications for treatment.
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Affiliation(s)
- Szilárd Kiss
- Weill Cornell Medical College, 1305 York Avenue, 11th Floor, New York, NY, 10021, USA,
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Abstract
PURPOSE Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE. METHODS The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights <1251 g. At each visit, ophthalmologists perform DEs and non-physician imagers obtain iris and five retinal images with the disc positioned in the center, right, left, up and down. Images are uploaded to a secure server for grading by non-physician readers for the detection of plus disease, stage 3 ROP and/or zone I disease, any of which indicates "referral-warranted ROP" (RW-ROP). Images from all infants with RW-ROP and a random sample of infants without RW-ROP (based on DEs) are selected for grading. Gradings are compared to DEs to determine the validity and evaluate reliability, feasibility, safety, and cost-effectiveness of the telemedicine system. RESULTS e-ROP is conducted in 12 Clinical Centers in the US and Canada with Study Headquarters, the Data Coordinating Center and the Image Reading Center in Philadelphia and the ROP Data Center in Oklahoma City. A total of 27 study center coordinators, 34 ophthalmologists, 26 imagers, and 4 readers have been certified. All study data are submitted using a secure web-based system. CONCLUSION The design and findings of this study will be useful to conduct other ROP studies or evaluate telemedicine for other diseases.
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Fijalkowski N, Zheng LL, Henderson MT, Wang SK, Wallenstein MB, Leng T, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): five years of screening with telemedicine. Ophthalmic Surg Lasers Imaging Retina 2014; 45:106-13. [PMID: 24444469 DOI: 10.3928/23258160-20140122-01] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/23/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE To report the 5-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative. PATIENTS AND METHODS Infants requiring retinopathy of prematurity (ROP) screening at six neonatal intensive care units from December 1, 2005, to November 30, 2010, were evaluated with remote retinal photography by an ROP specialist. Every infant received outpatient binocular indirect ophthalmoscope examinations until termination criteria were achieved or until treatment. Outcomes were treatment-warranted ROP (TW-ROP, ETROP type 1) and adverse anatomical events. RESULTS Five hundred eleven infants (1,022 eyes) were screened. Fifteen infants had TW-ROP and underwent laser photocoagulation. The TW-ROP cohort had significantly lower birth weight and gestational age (both P < .001). No patient progressed to adverse anatomical outcomes and no case of TW-ROP was missed. Tele-medicine had 100% sensitivity, 99.8% specificity, 93.8% positive predictive value, and 100% negative predictive value for detection of TW-ROP. CONCLUSION Telemedicine demonstrates high diagnostic accuracy for detection of TW-ROP and can complement ROP screening.
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Vinekar A, Gilbert C, Dogra M, Kurian M, Shainesh G, Shetty B, Bauer N. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting. Indian J Ophthalmol 2014; 62:41-9. [PMID: 24492500 PMCID: PMC3955069 DOI: 10.4103/0301-4738.126178] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/15/2013] [Indexed: 12/16/2022] Open
Abstract
AIM To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. MATERIALS AND METHODS KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shuttle (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). RESULTS 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs. Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively. CONCLUSIONS This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.
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Affiliation(s)
- Anand Vinekar
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mangat Dogra
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mathew Kurian
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | | | - Bhujang Shetty
- Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Noel Bauer
- Maastricht University Medical Center, Maastricht, Netherlands
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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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Toniappa A, Barman SA, Corvee E, Moseley MJ, Cocker K, Fielder AR. Image quality assessment in retinal images of premature infants taken with RetCam 120 digital fundus camera. The Imaging Science Journal 2013. [DOI: 10.1179/136821904x24073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sekeroglu MA, Hekimoglu E, Sekeroglu HT, Arslan U. Alternative methods for the screening of retinopathy of prematurity: binocular indirect ophthalmoscopy vs wide-field digital retinal imaging. Eye (Lond) 2013; 27:1053-7. [PMID: 23764991 DOI: 10.1038/eye.2013.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/12/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the diagnostic efficacy of wide-field digital retinal imaging (WFDRI) with binocular indirect ophthalmoscopy (BIO) for retinopathy of prematurity (ROP) screening. METHODS Premature infants admitted for ROP screening were included in this prospective, randomized and double-blind comparative study. They were examined by using BIO and WFDRI. RESULTS A total of 58 infants were enrolled in the study. The sensitivities of WFDRI in detecting any stage of ROP, treatment-requiring ROP and plus disease were 58.6, 100, and 100% respectively, with a specificity of 100% for all. The proportional agreement between WFDRI and BIO was 0.903 for detection of any stage of ROP, 1.0 for treatment-requiring ROP, and 1.0 for plus disease. CONCLUSION The sensitivity and specificity of WFDRI was excellent for the diagnosis of severe and treatment-requiring ROP. However, BIO was superior in mild ROP particularly for the ones in retinal periphery.
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Affiliation(s)
- M A Sekeroglu
- ROP Screening, Treatment and Training Center, Department of Ophthalmology, Etlik Zubeyde Hanim Maternity and Women's Health Research Hospital, Ankara, Turkey
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Purcaro V, Velia P, Baldascino A, Antonio B, Papacci P, Patrizia P, Giannantonio C, Carmen G, Molisso A, Anna M, Molle F, Fernando M, Lepore D, Domenico L, Romagnoli C, Costantino R. Fluorescein angiography and retinal vascular development in premature infants. J Matern Fetal Neonatal Med 2013; 25 Suppl 3:53-6. [PMID: 23016619 DOI: 10.3109/14767058.2012.712313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the role of fluorescein angiography (FA) in the management of retinopathy of prematurity (ROP) in preterm newborns. METHODS An observational case series of 13 extremely low birth weight infants. From September 2009 to March 2010, 13 newborn infants with a gestational age <29 weeks end/or birth weight <1000 g underwent serial fluorescein angiography with RetCam (Clarity, Pleasanton, CA) every 2 weeks. The fluorescein angiograms were examined to optimize the timing of diagnosis of ROP and to investigate development of retinal and choroidal vascularization. RESULTS There were no side effects related to FA. Variable features of retinal and choroidal circulation in preterm infants with a high risk of developing ROP were noted. FA allows vessels branching at the junction between vascular and avascular retina (V-Av junction) to be viewed easily and shows the ROP findings that sometimes cannot be seen by indirect ophthalmoscopy. Dye leakage is the most significant sign of progression to severe ROP or the need for surgery in newborn babies with ROP. CONCLUSIONS RetCam-assisted intravenous FA is safe and allows a more objective assessment of the ROP stage and zone.
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Affiliation(s)
- Velia Purcaro
- Department of Paediatrics, Division of Neonatology, Catholic University of Rome, Rome, Italy.
| | - Purcaro Velia
- Department of Paediatrics, Division of Neonatology, Catholic University of Rome, Rome, Italy.
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Witmer MT, Parlitsis G, Patel S, Kiss S. Comparison of ultra-widefield fluorescein angiography with the Heidelberg Spectralis(®) noncontact ultra-widefield module versus the Optos(®) Optomap(®). Clin Ophthalmol 2013; 7:389-94. [PMID: 23458976 PMCID: PMC3583407 DOI: 10.2147/opth.s41731] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare ultra-widefield fluorescein angiography imaging using the Optos® Optomap® and the Heidelberg Spectralis® noncontact ultra-widefield module. Methods Five patients (ten eyes) underwent ultra-widefield fluorescein angiography using the Optos® panoramic P200Tx imaging system and the noncontact ultra-widefield module in the Heidelberg Spectralis® HRA+OCT system. The images were obtained as a single, nonsteered shot centered on the macula. The area of imaged retina was outlined and quantified using Adobe® Photoshop® C5 software. The total area and area within each of four visualized quadrants was calculated and compared between the two imaging modalities. Three masked reviewers also evaluated each quadrant per eye (40 total quadrants) to determine which modality imaged the retinal vasculature most peripherally. Results Optos® imaging captured a total retinal area averaging 151,362 pixels, ranging from 116,998 to 205,833 pixels, while the area captured using the Heidelberg Spectralis® was 101,786 pixels, ranging from 73,424 to 116,319 (P = 0.0002). The average area per individual quadrant imaged by Optos® versus the Heidelberg Spectralis® superiorly was 32,373 vs 32,789 pixels, respectively (P = 0.91), inferiorly was 24,665 vs 26,117 pixels, respectively (P = 0.71), temporally was 47,948 vs 20,645 pixels, respectively (P = 0.0001), and nasally was 46,374 vs 22,234 pixels, respectively (P = 0.0001). The Heidelberg Spectralis® was able to image the superior and inferior retinal vasculature to a more distal point than was the Optos®, in nine of ten eyes (18 of 20 quadrants). The Optos® was able to image the nasal and temporal retinal vasculature to a more distal point than was the Heidelberg Spectralis®, in ten of ten eyes (20 of 20 quadrants). Conclusion The ultra-widefield fluorescein angiography obtained with the Optos® and Heidelberg Spectralis® ultra-widefield imaging systems are both excellent modalities that provide views of the peripheral retina. On a single nonsteered image, the Optos® Optomap® covered a significantly larger total retinal surface area, with greater image variability, than did the Heidelberg Spectralis® ultra-widefield module. The Optos® captured an appreciably wider view of the retina temporally and nasally, albeit with peripheral distortion, while the ultra-widefield Heidelberg Spectralis® module was able to image the superior and inferior retinal vasculature more peripherally. The clinical significance of these findings as well as the area imaged on steered montaged images remains to be determined.
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Affiliation(s)
- Matthew T Witmer
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA
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Fijalkowski N, Zheng LL, Henderson MT, Wallenstein MB, Leng T, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): four-years of screening with telemedicine. Curr Eye Res 2013; 38:283-91. [PMID: 23330739 DOI: 10.3109/02713683.2012.754902] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP). MATERIALS AND METHODS A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes. RESULTS The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome. CONCLUSIONS The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.
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Affiliation(s)
- Natalia Fijalkowski
- Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Palo Alto, CA 94303, USA
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Abstract
The frequency of premature births is increasing world-wide. This factor, combined with improved survival and revised screening criteria, is resulting in an increased workload in screening for retinopathy of prematurity. Digital retinal imaging is emerging as an important alternative tool for diagnosing retinopathy of prematurity, and its use has even been extended to developing countries. Neonatal nurses and technicians can be trained to use digital imaging devices effectively. This is important in areas that do not have ready access to paediatric ophthalmologists. The ability to transfer images electronically makes it a valuable tool in telemedicine, while the ability to store and retrieve images is also advantageous from a medico-legal perspective. Image analysis software can further improve the accuracy of diagnosis. The main limitation of this technology is its high capital cost.
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Chiang MF. Telescreening for Retinopathy of Prematurity. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Moral-Pumarega MT, Caserío-Carbonero S, De-La-Cruz-Bértolo J, Tejada-Palacios P, Lora-Pablos D, Pallás-Alonso CR. Pain and stress assessment after retinopathy of prematurity screening examination: indirect ophthalmoscopy versus digital retinal imaging. BMC Pediatr 2012; 12:132. [PMID: 22928523 PMCID: PMC3469398 DOI: 10.1186/1471-2431-12-132] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress. METHODS The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination. RESULTS Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3-5). At 30 seconds the score was 8 (6-9) for BIO and 6 (5-7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments. CONCLUSIONS A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.
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Affiliation(s)
- M Teresa Moral-Pumarega
- Department of Neonatology (IMAS12-SAMID), 12 de Octubre, University Hospital (SERMAS), Madrid, Spain
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Weaver DT, Murdock TJ. Telemedicine detection of type 1 ROP in a distant neonatal intensive care unit. J AAPOS 2012; 16:229-33. [PMID: 22681938 DOI: 10.1016/j.jaapos.2012.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/26/2012] [Accepted: 01/31/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To demonstrate the feasibility of telemedicine screening for retinopathy of prematurity (ROP) by summarizing the results of our experience screening premature infants at a distant hospital in a rural location. METHODS Records of all premature infants remotely screened for ROP at a neonatal intensive care unit in Great Falls, Montana, from January 1, 2007 to June 30, 2011, were retrospectively reviewed. The RetCam II imaging system was used to capture retinal images, which were posted on a secure server for evaluation by one of two pediatric ophthalmologists. Infants suspected of having ROP approaching the criteria for laser treatment were transferred to a hospital, where a diagnostic examination was performed and treatment administered when indicated. All other infants received an outpatient diagnostic examination within 2 weeks of discharge. RESULTS A total of 582 telemedicine examinations were performed on 137 infants during the study period. Of 13 infants transferred for referral-warranted ROP, 9 ultimately required laser treatment. Good outcomes were noted in all cases, with none progressing to stage 4 or 5 ROP. CONCLUSIONS Telemedicine ROP screening detected patients at a remote site in need of laser treatment, allowing prompt transfer with no poor outcomes over a 4.5-year period. Our experience demonstrates the utility of remote screening for ROP.
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