Addressing the Third Epidemic of Retinopathy of Prematurity Through Telemedicine and Technology: A Systematic Review

Abstract

The rising prevalence of retinopathy of prematurity (ROP) in low- and middle-income countries has increased the need for screening at-risk infants. The purpose of this article was to review the impact of tele-medicine and technology on ROP screening programs. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed using PubMed, Pro-Quest, and Google Scholar bibliographic search engine. Terms searched included retinopathy of prematurity, telemedicine, and tele-ophthalmology. Data regarding internet access and gross domestic product per capita were obtained from the World Bank. Information was also obtained about internet access, speeds, and costs in low-income countries. There has been increasing integration of telemedicine and technology for ROP screening and management. Low-income countries are using available internet options and information and communications technology for ROP screening, which can aid in addressing the unique challenges faced by low-income countries. This provides a promising solution to the third epidemic of ROP by expanding and improving screening and management. Although telemedicine systems may serve as a cost-effective approach to facilitate delivery of health care, programs (especially in lowand middle-income countries) require national support to maintain its infrastructure. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):261–269.]

Current Management of Retinopathy of Prematurity

“…The framework for telemedicine programs for ROP offers solutions to many of the challenges of the third epidemic of ROP by means of nonphysician imagers and interpreters to grade ROP with accuracy to allow for timely management of cases requiring treatment [18,19]. Telemedicine programs typically operate by means of trained nonphysician imagers to obtain accurate images to send to specialists who then confirm diagnosis and can facilitate referral for treatment in a timely manner [6 Telemedicine screening programs have also allowed for the development of training programs for nonphysicians and AI systems for ROP diagnosis by harvesting the digital images taken during telemedicine sessions to be used for education [20]. This has the potential to create a sustainable, affordable, and robust network of data and images to continue to expand ROP education and management.…”

“…Notably, the i-ROP DL system has been found to diagnose plus disease as good and even better than experts (92% vs. 82% accuracy); it has potential to predict progression to treatment requiring ROP; and can also be used to survey regression post treatment [28,29,30]. Specifically, the i-ROP system generates a vascular severity score (VSS) [1,2,3,4,5,6,7,8,9] for ROP [31•]. In addition, the CNN was found to be accurate in the diagnosis of ROP stages 1, 2, and 3 in fundus images from datasets in North America and Nepal [32].…”

Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework

“…Telemedicine has become widely used to expand availability of ROP healthcare services, educational strategies, and screening programs. More recently, it has emerged as a significant mode for accurate, reliable, sustainable, and cost-effective ROP healthcare service delivery 39. Retinal images captured by trained personnel can be evaluated and interpreted by remote ROP experts for diagnosis and staging of ROP, eliminating one of the major limitations for accessible ROP care: shortage of expertise and workforce 46.…”

Research Partnerships and Guidance in Academic Global Ophthalmology

“…As a result of the lessons learned from this screening program, iTeleGEN, which is a web-based platform that integrates data management, tele-education modules, and telemedicine, was developed. Pilot projects in Kathmandu and Nepal in ROP screening were conducted, followed by expansion for its used at Aravind Eye Hospital (Coimbatore, India) for both telemedicine and tele-screening of ROP, and has promising utility in the adoption of artificial intelligence-assisted screening programs 19–22…”

“…Pilot projects in Kathmandu and Nepal in ROP screening were conducted, followed by expansion for its used at Aravind Eye Hospital (Coimbatore, India) for both telemedicine and tele-screening of ROP, and has promising utility in the adoption of artificial intelligence-assisted screening programs. 19 – 22 …”